Achieving Quality in Occupational Health

NASA Technical Reports Server (NTRS)

O'Donnell, Michele (Editor); Hoffler, G. Wyckliffe (Editor)

1997-01-01

The conference convened approximately 100 registered participants of invited guest speakers, NASA presenters, and a broad spectrum of the Occupational Health disciplines representing NASA Headquarters and all NASA Field Centers. Centered on the theme, "Achieving Quality in Occupational Health," conferees heard presentations from award winning occupational health program professionals within the Agency and from private industry; updates on ISO 9000 status, quality assurance, and information technologies; workshops on ergonomics and respiratory protection; an overview from the newly commissioned NASA Occupational Health Assessment Team; and a keynote speech on improving women's health. In addition, NASA occupational health specialists presented 24 poster sessions and oral deliveries on various aspects of current practice at their field centers.

Student Health and Academic Achievement

MedlinePlus

... Innovative Programs Additional Evaluation Resources Health & Academics Anti-Bullying Policies and Enumeration: An Infobrief for Local Education ... and Academic Achievement Resources for Reporting on Suicide, Bullying, and Sexual Violence Bullying and Absenteeism: Information for ...

Optimal non-linear health insurance.

PubMed

Blomqvist, A

1997-06-01

Most theoretical and empirical work on efficient health insurance has been based on models with linear insurance schedules (a constant co-insurance parameter). In this paper, dynamic optimization techniques are used to analyse the properties of optimal non-linear insurance schedules in a model similar to one originally considered by Spence and Zeckhauser (American Economic Review, 1971, 61, 380-387) and reminiscent of those that have been used in the literature on optimal income taxation. The results of a preliminary numerical example suggest that the welfare losses from the implicit subsidy to employer-financed health insurance under US tax law may be a good deal smaller than previously estimated using linear models.

Optimism and Physical Health: A Meta-analytic Review

PubMed Central

Rasmussen, Heather N.; Greenhouse, Joel B.

2010-01-01

Background Prior research links optimism to physical health, but the strength of the association has not been systematically evaluated. Purpose The purpose of this study is to conduct a meta-analytic review to determine the strength of the association between optimism and physical health. Methods The findings from 83 studies, with 108 effect sizes (ESs), were included in the analyses, using random-effects models. Results Overall, the mean ES characterizing the relationship between optimism and physical health outcomes was 0.17, p<.001. ESs were larger for studies using subjective (versus objective) measures of physical health. Subsidiary analyses were also conducted grouping studies into those that focused solely on mortality, survival, cardiovascular outcomes, physiological markers (including immune function), immune function only, cancer outcomes, outcomes related to pregnancy, physical symptoms, or pain. In each case, optimism was a significant predictor of health outcomes or markers, all p<.001. Conclusions Optimism is a significant predictor of positive physical health outcomes. PMID:19711142

Optimization of human, animal, and environmental health by using the One Health approach.

PubMed

Sleeman, Jonathan M; DeLiberto, Thomas; Nguyen, Natalie

2017-08-31

Emerging diseases are increasing burdens on public health, negatively affecting the world economy, causing extinction of species, and disrupting ecological integrity. One Health recognizes that human, domestic animal, and wildlife health are interconnected within ecosystem health and provides a framework for the development of multidisciplinary solutions to global health challenges. To date, most health-promoting interventions have focused largely on single-sector outcomes. For example, risk for transmission of zoonotic pathogens from bush-meat hunting is primarily focused on human hygiene and personal protection. However, bush-meat hunting is a complex issue promoting the need for holistic strategies to reduce transmission of zoonotic disease while addressing food security and wildlife conservation issues. Temporal and spatial separation of humans and wildlife, risk communication, and other preventative strategies should allow wildlife and humans to co-exist. Upstream surveillance, vaccination, and other tools to prevent pathogen spillover are also needed. Clear multi-sector outcomes should be defined, and a systems-based approach is needed to develop interventions that reduce risks and balance the needs of humans, wildlife, and the environment. The ultimate goal is long-term action to reduce forces driving emerging diseases and provide interdisciplinary scientific approaches to management of risks, thereby achieving optimal outcomes for human, animal, and environmental health.

Optimization of human, animal, and environmental health by using the One Health approach

USGS Publications Warehouse

Sleeman, Jonathan M.; DeLiberto, Thomas; Nguyen, Natalie T.

2017-01-01

Emerging diseases are increasing burdens on public health, negatively affecting the world economy, causing extinction of species, and disrupting ecological integrity. One Health recognizes that human, domestic animal, and wildlife health are interconnected within ecosystem health and provides a framework for the development of multidisciplinary solutions to global health challenges. To date, most health-promoting interventions have focused largely on single-sector outcomes. For example, risk for transmission of zoonotic pathogens from bush-meat hunting is primarily focused on human hygiene and personal protection. However, bush-meat hunting is a complex issue promoting the need for holistic strategies to reduce transmission of zoonotic disease while addressing food security and wildlife conservation issues. Temporal and spatial separation of humans and wildlife, risk communication, and other preventative strategies should allow wildlife and humans to co-exist. Upstream surveillance, vaccination, and other tools to prevent pathogen spillover are also needed. Clear multi-sector outcomes should be defined, and a systems-based approach is needed to develop interventions that reduce risks and balance the needs of humans, wildlife, and the environment. The ultimate goal is long-term action to reduce forces driving emerging diseases and provide interdisciplinary scientific approaches to management of risks, thereby achieving optimal outcomes for human, animal, and environmental health.

Optimal dietary patterns designed from local foods to achieve maternal nutritional goals.

PubMed

Raymond, Jofrey; Kassim, Neema; Rose, Jerman W; Agaba, Morris

2018-04-04

Achieving nutritional requirements for pregnant and lactating mothers in rural households while maintaining the intake of local and culture-specific foods can be a difficult task. Deploying a linear goal programming approach can effectively generate optimal dietary patterns that incorporate local and culturally acceptable diets. The primary objective of this study was to determine whether a realistic and affordable diet that achieves nutritional goals for rural pregnant and lactating women can be formulated from locally available foods in Tanzania. A cross sectional study was conducted to assess dietary intakes of 150 pregnant and lactating women using a weighed dietary record (WDR), 24 h dietary recalls and a 7-days food record. A market survey was also carried out to estimate the cost per 100 g of edible portion of foods that are frequently consumed in the study population. Dietary survey and market data were then used to define linear programming (LP) model parameters for diet optimisation. All LP analyses were done using linear program solver to generate optimal dietary patterns. Our findings showed that optimal dietary patterns designed from locally available foods would improve dietary adequacy for 15 and 19 selected nutrients in pregnant and lactating women, respectively, but inadequacies remained for iron, zinc, folate, pantothenic acid, and vitamin E, indicating that these are problem nutrients (nutrients that did not achieve 100% of their RNIs in optimised diets) in the study population. These findings suggest that optimal use of local foods can improve dietary adequacy for rural pregnant and lactating women aged 19-50 years. However, additional cost-effective interventions are needed to ensure adequate intakes for the identified problem nutrients.

Adolescent Mental Health, Behavior Problems, and Academic Achievement

PubMed Central

McLeod, Jane D.; Uemura, Ryotaro; Rohrman, Shawna

2013-01-01

Prior research on the association of mental health and behavior problems with academic achievement is limited because it does not consider multiple problems simultaneously, take co-occurring problems into account, and control for academic aptitude. We addressed these limitations using data from the National Longitudinal Study of Adolescent Health (N = 6,315). We estimated the associations of depression, attention problems, delinquency, and substance use with two indicators of academic achievement (high school GPA and highest degree received) with controls for academic aptitude. Attention problems, delinquency, and substance use were significantly associated with diminished achievement, but depression was not. Combinations of problems involving substance use were especially consequential. Our results demonstrate that the social consequences of mental health problems are not the inevitable result of diminished functional ability but, rather, reflect negative social responses. These results also encourage a broader perspective on mental health by demonstrating that behavior problems heighten the negative consequences of more traditional forms of distress. PMID:23197485

Academic Optimism, Organizational Citizenship Behaviors, and Student Achievement at Charter Schools

ERIC Educational Resources Information Center

Guvercin, Mustafa

2013-01-01

The purpose of this study was to examine the relationship among academic optimism, Organizational Citizenship Behaviors (OCBs), and student achievement in college preparatory charter schools. A purposeful sample of elementary school teachers from college preparatory charter schools (N = 226) in southeast Texas was solicited to complete the…

Designing optimal food intake patterns to achieve nutritional goals for Japanese adults through the use of linear programming optimization models.

PubMed

Okubo, Hitomi; Sasaki, Satoshi; Murakami, Kentaro; Yokoyama, Tetsuji; Hirota, Naoko; Notsu, Akiko; Fukui, Mitsuru; Date, Chigusa

2015-06-06

Simultaneous dietary achievement of a full set of nutritional recommendations is difficult. Diet optimization model using linear programming is a useful mathematical means of translating nutrient-based recommendations into realistic nutritionally-optimal food combinations incorporating local and culture-specific foods. We used this approach to explore optimal food intake patterns that meet the nutrient recommendations of the Dietary Reference Intakes (DRIs) while incorporating typical Japanese food selections. As observed intake values, we used the food and nutrient intake data of 92 women aged 31-69 years and 82 men aged 32-69 years living in three regions of Japan. Dietary data were collected with semi-weighed dietary record on four non-consecutive days in each season of the year (16 days total). The linear programming models were constructed to minimize the differences between observed and optimized food intake patterns while also meeting the DRIs for a set of 28 nutrients, setting energy equal to estimated requirements, and not exceeding typical quantities of each food consumed by each age (30-49 or 50-69 years) and gender group. We successfully developed mathematically optimized food intake patterns that met the DRIs for all 28 nutrients studied in each sex and age group. Achieving nutritional goals required minor modifications of existing diets in older groups, particularly women, while major modifications were required to increase intake of fruit and vegetables in younger groups of both sexes. Across all sex and age groups, optimized food intake patterns demanded greatly increased intake of whole grains and reduced-fat dairy products in place of intake of refined grains and full-fat dairy products. Salt intake goals were the most difficult to achieve, requiring marked reduction of salt-containing seasoning (65-80%) in all sex and age groups. Using a linear programming model, we identified optimal food intake patterns providing practical food choices and

WFH: closing the global gap--achieving optimal care.

PubMed

Skinner, Mark W

2012-07-01

For 50 years, the World Federation of Hemophilia (WFH) has been working globally to close the gap in care and to achieve Treatment for All patients, men and women, with haemophilia and other inherited bleeding disorders, regardless of where they might live. The WFH estimates that more than one in 1000 men and women has a bleeding disorder equating to 6,900,000 worldwide. To close the gap in care between developed and developing nations a continued focus on the successful strategies deployed heretofore will be required. However, in response to the rapid advances in treatment and emerging therapeutic advances on the horizon it will also require fresh approaches and renewed strategic thinking. It is difficult to predict what each therapeutic advance on the horizon will mean for the future, but there is no doubt that we are in a golden age of research and development, which has the prospect of revolutionizing treatment once again. An improved understanding of "optimal" treatment is fundamental to the continued evolution of global care. The challenges of answering government and payer demands for evidence-based medicine, and cost justification for the introduction and enhancement of treatment, are ever-present and growing. To sustain and improve care it is critical to build the body of outcome data for individual patients, within haemophilia treatment centers (HTCs), nationally, regionally and globally. Emerging therapeutic advances (longer half-life therapies and gene transfer) should not be justified or brought to market based only on the notion that they will be economically more affordable, although that may be the case, but rather more importantly that they will be therapeutically more advantageous. Improvements in treatment adherence, reductions in bleeding frequency (including microhemorrhages), better management of trough levels, and improved health outcomes (including quality of life) should be the foremost considerations. As part of a new WFH strategic plan

Financing and funding health care: Optimal policy and political implementability.

PubMed

Nuscheler, Robert; Roeder, Kerstin

2015-07-01

Health care financing and funding are usually analyzed in isolation. This paper combines the corresponding strands of the literature and thereby advances our understanding of the important interaction between them. We investigate the impact of three modes of health care financing, namely, optimal income taxation, proportional income taxation, and insurance premiums, on optimal provider payment and on the political implementability of optimal policies under majority voting. Considering a standard multi-task agency framework we show that optimal health care policies will generally differ across financing regimes when the health authority has redistributive concerns. We show that health care financing also has a bearing on the political implementability of optimal health care policies. Our results demonstrate that an isolated analysis of (optimal) provider payment rests on very strong assumptions regarding both the financing of health care and the redistributive preferences of the health authority. Copyright © 2015 Elsevier B.V. All rights reserved.

Optimal treatment adherence counseling outcomes for people living with HIV and limited health literacy

PubMed Central

Pellowski, Jennifer A.; Kalichman, Seth C.; Grebler, Tamar

2014-01-01

Limited health literacy has been shown to contribute to poor health, including poor adherence to antiretroviral therapy (ART) in people living with HIV/AIDS, over and above other indicators of social disadvantage and poverty. Given the mixed results of previous interventions for people with HIV and low health literacy, investigating possible targets for improved adherence is warranted. The present study aims to identify the correlates of optimal and suboptimal outcomes among participants of a recent skills-based medication adherence intervention (Kalichman et al., 2013). Participants included in this secondary analysis were 188 men and women living with HIV who had low health literacy as determined by scoring ≤90% on a test of health literacy and had complete viral load data for baseline and follow-up. Participants completed physical, psychosocial and literacy measures using computerized interviews. Adherence was assessed by unannounced pill count and follow-up viral loads were assessed by blood draw. Results showed that higher levels of health literacy and lower levels of alcohol use were the strongest predictors of achieving HIV viral load optimal outcomes. The interplay between lower health literacy and alcohol use on adherence should be the focus of future research. PMID:25211524

Physiological geroscience: targeting function to increase healthspan and achieve optimal longevity

PubMed Central

Justice, Jamie N.; LaRocca, Thomas J.

2015-01-01

Abstract Most nations of the world are undergoing rapid and dramatic population ageing, which presents great socio‐economic challenges, as well as opportunities, for individuals, families, governments and societies. The prevailing biomedical strategy for reducing the healthcare impact of population ageing has been ‘compression of morbidity’ and, more recently, to increase healthspan, both of which seek to extend the healthy period of life and delay the development of chronic diseases and disability until a brief period at the end of life. Indeed, a recently established field within biological ageing research, ‘geroscience’, is focused on healthspan extension. Superimposed on this background are new attitudes and demand for ‘optimal longevity’ – living long, but with good health and quality of life. A key obstacle to achieving optimal longevity is the progressive decline in physiological function that occurs with ageing, which causes functional limitations (e.g. reduced mobility) and increases the risk of chronic diseases, disability and mortality. Current efforts to increase healthspan centre on slowing the fundamental biological processes of ageing such as inflammation/oxidative stress, increased senescence, mitochondrial dysfunction, impaired proteostasis and reduced stress resistance. We propose that optimization of physiological function throughout the lifespan should be a major emphasis of any contemporary biomedical policy addressing global ageing. Effective strategies should delay, reduce in magnitude or abolish reductions in function with ageing (primary prevention) and/or improve function or slow further declines in older adults with already impaired function (secondary prevention). Healthy lifestyle practices featuring regular physical activity and ideal energy intake/diet composition represent first‐line function‐preserving strategies, with pharmacological agents, including existing and new pharmaceuticals and novel �

Physiological geroscience: targeting function to increase healthspan and achieve optimal longevity.

PubMed

Seals, Douglas R; Justice, Jamie N; LaRocca, Thomas J

2016-04-15

Most nations of the world are undergoing rapid and dramatic population ageing, which presents great socio-economic challenges, as well as opportunities, for individuals, families, governments and societies. The prevailing biomedical strategy for reducing the healthcare impact of population ageing has been 'compression of morbidity' and, more recently, to increase healthspan, both of which seek to extend the healthy period of life and delay the development of chronic diseases and disability until a brief period at the end of life. Indeed, a recently established field within biological ageing research, 'geroscience', is focused on healthspan extension. Superimposed on this background are new attitudes and demand for 'optimal longevity' - living long, but with good health and quality of life. A key obstacle to achieving optimal longevity is the progressive decline in physiological function that occurs with ageing, which causes functional limitations (e.g. reduced mobility) and increases the risk of chronic diseases, disability and mortality. Current efforts to increase healthspan centre on slowing the fundamental biological processes of ageing such as inflammation/oxidative stress, increased senescence, mitochondrial dysfunction, impaired proteostasis and reduced stress resistance. We propose that optimization of physiological function throughout the lifespan should be a major emphasis of any contemporary biomedical policy addressing global ageing. Effective strategies should delay, reduce in magnitude or abolish reductions in function with ageing (primary prevention) and/or improve function or slow further declines in older adults with already impaired function (secondary prevention). Healthy lifestyle practices featuring regular physical activity and ideal energy intake/diet composition represent first-line function-preserving strategies, with pharmacological agents, including existing and new pharmaceuticals and novel 'nutraceutical' compounds, serving as potential

Translational Geroscience: Emphasizing function to achieve optimal longevity

PubMed Central

Seals, Douglas R.; Melov, Simon

2014-01-01

Among individuals, biological aging leads to cellular and organismal dysfunction and an increased risk of chronic degenerative diseases and disability. This sequence of events in combination with the projected increases in the number of older adults will result in a worldwide healthcare burden with dire consequences. Superimposed on this setting are the adults now reaching traditional retirement ages--the baby boomers--a group that wishes to remain active, productive and physically and cognitively fit as they grow older. Together, these conditions are producing an unprecedented demand for increased healthspan or what might be termed “optimal longevity”—to live long, but well. To meet this demand, investigators with interests in the biological aspects of aging from model organisms to human epidemiology (population aging) must work together within an interactive process that we describe as translational geroscience. An essential goal of this new investigational platform should be the optimization and preservation of physiological function throughout the lifespan, including integrative physical and cognitive function, which would serve to increase healthspan, compress morbidity and disability into a shorter period of late-life, and help achieve optimal longevity. To most effectively utilize this new approach, we must rethink how investigators and administrators working at different levels of the translational research continuum communicate and collaborate with each other, how best to train the next generation of scientists in this new field, and how contemporary biological-biomedical aging research should be organized and funded. PMID:25324468

Optimized Delivery System Achieves Enhanced Endomyocardial Stem Cell Retention

PubMed Central

Behfar, Atta; Latere, Jean-Pierre; Bartunek, Jozef; Homsy, Christian; Daro, Dorothee; Crespo-Diaz, Ruben J.; Stalboerger, Paul G.; Steenwinckel, Valerie; Seron, Aymeric; Redfield, Margaret M.; Terzic, Andre

2014-01-01

Background Regenerative cell-based therapies are associated with limited myocardial retention of delivered stem cells. The objective of this study is to develop an endocardial delivery system for enhanced cell retention. Methods and Results Stem cell retention was simulated in silico using one and three-dimensional models of tissue distortion and compliance associated with delivery. Needle designs, predicted to be optimal, were accordingly engineered using nitinol – a nickel and titanium alloy displaying shape memory and super-elasticity. Biocompatibility was tested with human mesenchymal stem cells. Experimental validation was performed with species-matched cells directly delivered into Langendorff-perfused porcine hearts or administered percutaneously into the endocardium of infarcted pigs. Cell retention was quantified by flow cytometry and real time quantitative polymerase chain reaction methodology. Models, computing optimal distribution of distortion calibrated to favor tissue compliance, predicted that a 75°-curved needle featuring small-to-large graded side holes would ensure the highest cell retention profile. In isolated hearts, the nitinol curved needle catheter (C-Cath) design ensured 3-fold superior stem cell retention compared to a standard needle. In the setting of chronic infarction, percutaneous delivery of stem cells with C-Cath yielded a 37.7±7.1% versus 10.0±2.8% retention achieved with a traditional needle, without impact on biocompatibility or safety. Conclusions Modeling guided development of a nitinol-based curved needle delivery system with incremental side holes achieved enhanced myocardial stem cell retention. PMID:24326777

Do health and education agencies in the United States share responsibility for academic achievement and health? A review of 25 years of evidence about the relationship of adolescents' academic achievement and health behaviors.

PubMed

Bradley, Beverly J; Greene, Amy C

2013-05-01

The United States Centers for Disease Control and Prevention monitors health-risk behaviors of adolescents in United States, which include (1) violence; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors contributing to unintended pregnancy and sexually transmitted diseases; (5) inadequate physical activity; and (6) unhealthy dietary behaviors. We reviewed original research published in peer-reviewed journals between 1985 and 2010 to synthesize evidence about the association of adolescent health-risk behaviors and academic achievement. Using predetermined selection criteria, 122 articles were included that used at least one variable for health-risk behaviors and also for academic achievement. For all six health-risk behaviors, 96.6% of the studies reported statistically significant inverse relationships between health-risk behaviors and academic achievement. With this persuasive evidence about the interrelationship of health-risk behaviors and academic achievement, it is imperative that leaders in education and health act together to make wise investments in our nation's school-age youth that will benefit the entire population. A unified system that addresses both health behavior and academic achievement would have reciprocal and synergistic effects on the health and academic achievement not only of children and adolescents, but also of adults in the United States. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Achieving Optimal Best: Instructional Efficiency and the Use of Cognitive Load Theory in Mathematical Problem Solving

ERIC Educational Resources Information Center

Phan, Huy P.; Ngu, Bing H.; Yeung, Alexander S.

2017-01-01

We recently developed the "Framework of Achievement Bests" to explain the importance of effective functioning, personal growth, and enrichment of well-being experiences. This framework postulates a concept known as "optimal achievement best," which stipulates the idea that individuals may, in general, strive to achieve personal…

Optimizing Health Care Environmental Hygiene.

PubMed

Carling, Philip C

2016-09-01

This article presents a review and perspectives on aspects of optimizing health care environmental hygiene. The topics covered include the epidemiology of environmental surface contamination, a discussion of cleaning health care patient area surfaces, an overview of disinfecting health care surfaces, an overview of challenges in monitoring cleaning versus cleanliness, a description of an integrated approach to environmental hygiene and hand hygiene as interrelated disciplines, and an overview of the research opportunities and challenges related to health care environmental hygiene. Copyright © 2016 Elsevier Inc. All rights reserved.

Faculty Sense of Academic Optimism and Its Relationship to Students' Achievement in Well Performing High Schools

ERIC Educational Resources Information Center

Cromartie, Michael Tyrone

2013-01-01

The aim of this study was to determine the organizational characteristics and behaviors that contribute to sustaining a culture of academic optimism as a mechanism of student achievement. While there is a developing research base identifying both the individual elements of academic optimism as well as the academic optimism construct itself as…

Optimism predicts positive health in repatriated prisoners of war.

PubMed

Segovia, Francine; Moore, Jeffrey L; Linnville, Steven E; Hoyt, Robert E

2015-05-01

"Positive health," defined as a state beyond the mere absence of disease, was used as a model to examine factors for enhancing health despite extreme trauma. The study examined the United States' longest detained American prisoners of war, those held in Vietnam in the 1960s through early 1970s. Positive health was measured using a physical and a psychological composite score for each individual, based on 9 physical and 9 psychological variables. Physical and psychological health was correlated with optimism obtained postrepatriation (circa 1973). Linear regressions were employed to determine which variables contributed most to health ratings. Optimism was the strongest predictor of physical health (β = -.33, t = -2.73, p = .008), followed by fewer sleep complaints (β = -.29, t = -2.52, p = .01). This model accounted for 25% of the variance. Optimism was also the strongest predictor of psychological health (β = -.41, t = -2.87, p = .006), followed by Minnesota Multiphasic Personality Inventory-Psychopathic Deviate (MMPI-PD; McKinley & Hathaway, 1944) scores (β = -.23, t = -1.88, p = .07). This model strongly suggests that optimism is a significant predictor of positive physical and psychological health, and optimism also provides long-term protective benefits. These findings and the utility of this model suggest a promising area for future research and intervention. (c) 2015 APA, all rights reserved).

Creating the Business Case for Achieving Health Equity.

PubMed

Chin, Marshall H

2016-07-01

Health care organizations have increasingly acknowledged the presence of health care disparities across race/ethnicity and socioeconomic status, but significantly fewer have made health equity for diverse patients a true priority. Lack of financial incentives is a major barrier to achieving health equity. To create a business case for equity, governmental and private payors can: 1) Require health care organizations to report clinical performance data stratified by race, ethnicity, and socioeconomic status. 2) Incentivize preventive care and primary care. Implement more aggressive shared savings plans, update physician relative value unit fee schedules, and encourage partnerships across clinical and non-clinical sectors. 3) Incentivize the reduction of health disparities with equity accountability measures in payment programs. 4) Align equity accountability measures across public and private payors. 5) Assist safety-net organizations. Provide adequate Medicaid reimbursement, risk-adjust clinical performance scores for sociodemographic characteristics of patients, provide support for quality improvement efforts, and calibrate cuts to Disproportionate Share Hospital (DSH) payments to the pace of health insurance expansion. 6) Conduct demonstration projects to test payment and delivery system reform interventions to reduce disparities. Commitment to social justice is essential to achieve health equity, but insufficient without a strong business case that makes interventions financially feasible.

A Blueprint for Innovation to Achieve Health System Transformation.

PubMed

Snowdon, Anne W

2017-01-01

Global health systems are challenged by escalating costs and growing demands for care created by the demands of aging populations and rising rates of chronic illness which place unsustainable pressure on health systems to meet population health needs. To overcome these challenges, transformational change is needed to strengthen health system performance and sustainability. Innovation is widely viewed as the strategy to drive transformational change in health systems; yet to date, innovation has lacked a clearly defined focus or agenda to achieve transformation. An actionable innovation agenda is needed to achieve transformational change for health systems. The key conditions for success as an innovation strategy are examined, including clearly defined innovation objectives, key milestones, and actionable steps every system stakeholder must pursue in order to guide the innovation agenda and ultimately accelerate the transformational changes needed for a sustainable healthcare system that delivers value to populations.

Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage.

PubMed

Ooms, G; Marten, R; Waris, A; Hammonds, R; Mulumba, M; Friedman, E A

2014-02-01

Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,(1) why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

An exercise in nostalgia: Nostalgia promotes health optimism and physical activity.

PubMed

Kersten, Mike; Cox, Cathy R; Van Enkevort, Erin A

2016-10-01

Previous research has shown that nostalgia, a sentimental longing for the past, leads to greater feelings of optimism, with other work demonstrating that optimistic thinking (general & health-orientated) is associated with better physical and psychological health. Integrating these two lines of research, the current studies examined whether nostalgia-induced health optimism promotes attitudes and behaviours associated with better physical well-being. Participants, in three experiments, were randomly assigned to write about either a nostalgic or ordinary event. Following this, everyone completed a measure of health optimism (Studies 1-3), measures of health attitudes (Study 2) and had their physical activity monitored over the course of 2 weeks (Study 3). The results revealed that, in comparison to control conditions, nostalgic reverie led to greater health optimism (Studies 1-3). Further, heightened health optimism following nostalgic reflection led to more positive health attitudes (Study 2), and increased physical activity over a two-week period (i.e. Fitbit activity trackers; Study 3). These findings highlight the importance of nostalgia on health attitudes and behaviours. Specifically, this work suggests that nostalgia can be used as a mechanism to increase the importance, perceived efficacy and behaviour associated with better physical health.

Achieving meaningful use: a health system perspective.

PubMed

Bero, Cynthia L; Lee, Thomas H

2010-12-01

In 2002, Partners HealthCare (Partners) launched a strategy to accelerate the use of ambulatory electronic medical records across its network of 6000 physicians. Through focus on quality software products, creation of a system of financial incentives, and active engagement of health system leadership, Partners reached high levels of physician adoption by late 2006. Partners eventually introduced a mandate that made ambulatory electronic medical record use a requirement for all of its physicians. During this multi-year initiative, Partners also focused on the effective use of electronic medical records and introduced a series of tactics designed to optimize the use of these systems. With introduction of the meaningful-use concepts in the Health Information Technology for Economic and Clinical Health (HITECH) Act, Partners will transition its efforts toward this important national priority. Partners' experience offers some unique insights into the process of electronic medical record adoption across a large, diverse health system.

Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision.

PubMed

Fusheini, Adam; Eyles, John

2016-10-07

Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously

The Role of a Provider-Sponsored Health Plan in Achieving Scale and Integration.

PubMed

Johnson, Steven P

2016-01-01

In pursuit of two primary strategies-to become an integrated delivery network (IDN) on the local level and to achieve additional overall organizational scale to sustain operations-Health First, based in Rockledge, Florida, relies on the success of its provider-sponsored health plan (PSHP) as a critical asset. For Health First, the PSHP serves as an agent for holding and administering financial risk for the health of populations. In addition, we are learning that our PSHP is a critical asset in support of integrating the components of our care delivery system to manage that financial risk effectively, efficiently, and in a manner that creates a unified experience for the customer.Health First is challenged by continuing pressure on reimbursement, as well as by a substantial regulatory burden, as we work to optimize the environments and tools of care and population health management. Even with strong margins and a healthy balance sheet, we simply do not have the resources needed to bring an IDN robustly to life. However, we have discovered that our PSHP can be the vehicle that carries us to additional scale. Many health systems do not own or otherwise have access to a PSHP to hold and manage financial risk. Health First sought and found a not-for-profit health system with complementary goals and a strong brand to partner with, and we now provide private-label health plan products for that system using its strong name while operating the insurance functions under our license and with our capabilities.

Adolescent Health Behavior, Contentment in School, and Academic Achievement

ERIC Educational Resources Information Center

Kristjansson, Alfgeir Logi; Sigfusdottir, Inga Dora; Allegrante, John P.; Helgason, Asgeir R.

2009-01-01

Objectives: To examine the association between health behavior indicators, school contentment, and academic achievement. Methods: Structural equation modeling with 5810 adolescents. Results: Our model explained 36% of the variance in academic achievement and 24% in school contentment. BMI and sedentary lifestyle were negatively related to school…

Effects of health-related physical education on academic achievement: project SPARK.

PubMed

Sallis, J F; McKenzie, T L; Kolody, B; Lewis, M; Marshall, S; Rosengard, P

1999-06-01

The effects of a 2-year health-related school physical education program on standardized academic achievement scores was assessed in 759 children who completed Metropolitan Achievement Tests before and after the program. Schools were randomly assigned to condition: (a) Specialists taught the Sports, Play, and Active Recreation for Kids curriculum; (b) classroom teachers were trained to implement the curriculum; and (c) controls continued their usual programs. The Trained Teacher condition was superior to Control on Language, Reading, and Basic Battery. The Specialist condition was superior to Control on Reading, but inferior on Language. Despite devoting twice as many minutes per week to physical education as Controls, the health-related physical education program did not interfere with academic achievement. Health-related physical education may have favorable effects on students' academic achievement.

Optimizing the efficacy of multimedia consumer health information.

PubMed

Monkman, Helen; Kushniruk, Andre W

2015-01-01

Using two or more communication methods (e.g., text, narration, pictures, animation, video) is known as multimedia. Multimedia has been used in a broad range of domains. Not surprisingly, multimedia is gaining popularity in the field of consumer health information as its benefits are being recognized. However, there is a large body of evidence in the cognitive literature that could be used to inform and optimize multimedia presentation of consumer health information. This paper outlines the Cognitive Theory of Multimedia Learning (CTML) and presents the application of this model for consumer health informatics. The CTML is a valuable resource for the development and revision of consumer health information to optimize its efficacy. Current research on multimedia and consumer health information is described. Finally, the outstanding opportunities to leverage the CTML for consumer health information are discussed.

Regulating thrombus growth and stability to achieve an optimal response to injury

PubMed Central

Brass, Lawrence F.; Wannemacher, Kenneth M.; Ma, Peisong; Stalker, Timothy J.

2012-01-01

An optimal platelet response to injury can be defined as one in which blood loss is restrained and haemostasis is achieved without the penalty of further tissue damage caused by unwarranted vascular occlusion. This brief review considers some of the ways in which thrombus growth and stability can be regulated so that an optimal platelet response can be achieved in vivo. Three related topics are considered. The first focuses on intracellular mechanisms that regulate the early events of platelet activation downstream of G protein coupled receptors for agonists such as thrombin, thromboxane A2 and ADP. The second considers the ways in which signalling events that are dependent on stable contacts between platelets can influence the state of platelet activation and thus affect thrombus growth and stability. The third focuses on the changes that are experienced by platelets as they move from their normal environment in freely-flowing plasma to a very different environment within the growing haemostatic plug, an environment in which the narrowing gaps and junctions between platelets not only facilitate communication, but also increasingly limit both the penetration of plasma and the exodus of platelet-derived bioactive molecules. PMID:21781243

Equalizing access to pandemic influenza vaccines through optimal allocation to public health distribution points.

PubMed

Huang, Hsin-Chan; Singh, Bismark; Morton, David P; Johnson, Gregory P; Clements, Bruce; Meyers, Lauren Ancel

2017-01-01

Vaccines are arguably the most important means of pandemic influenza mitigation. However, as during the 2009 H1N1 pandemic, mass immunization with an effective vaccine may not begin until a pandemic is well underway. In the U.S., state-level public health agencies are responsible for quickly and fairly allocating vaccines as they become available to populations prioritized to receive vaccines. Allocation decisions can be ethically and logistically complex, given several vaccine types in limited and uncertain supply and given competing priority groups with distinct risk profiles and vaccine acceptabilities. We introduce a model for optimizing statewide allocation of multiple vaccine types to multiple priority groups, maximizing equal access. We assume a large fraction of available vaccines are distributed to healthcare providers based on their requests, and then optimize county-level allocation of the remaining doses to achieve equity. We have applied the model to the state of Texas, and incorporated it in a Web-based decision-support tool for the Texas Department of State Health Services (DSHS). Based on vaccine quantities delivered to registered healthcare providers in response to their requests during the 2009 H1N1 pandemic, we find that a relatively small cache of discretionary doses (DSHS reserved 6.8% in 2009) suffices to achieve equity across all counties in Texas.

A Review of Literature to Understand the Complexity of Equity, Ethics and Management for Achieving Public Health Goals in India

PubMed Central

Garg, Pankaj; Nagpal, Jitender

2014-01-01

In the context of inadequate public spending on health care in India (0.9% of the GDP); government liberalized its policies in the form of subsidized lands and tax incentives, resulting in the mushrooming of private hospitals and clinics in India. Paradoxically, a robust framework was not developed for the regulation of these health care providers, resulting in disorganized health sector, inadequate financing models, and lack of prioritization of services, as well as a sub-optimal achievement of the Millennium Development Goals (MDG). We systematically reviewed the evidence base regarding regulation of private hospitals, applicability of private-public mix, state of health insurance and effective policy development for India, while seeking lessons on regulation of private health systems, from South African (a developing country) and Australian (a developed country) health care systems. PMID:24701465

Self-reported physical health of inmates: Impact of incarceration and relation to optimism

PubMed Central

Heigel, Caron P.; Stuewig, Jeffrey; Tangney, June P.

2011-01-01

This study investigated the relationship between inmates’ physical health concerns and optimism. Optimism has been consistently associated with physical health in community samples, but little research has examined this potentially malleable variable in an inmate population. This study of 502 male and female jail inmates attempts to bridge this gap. Results showed optimism was negatively associated with physical health concerns upon entry to jail and prior to release or transfer. Additionally, optimism assessed upon entry to jail predicted modest decreases in physical health concerns over incarceration. Results suggest that optimism is a health-related variable that may be beneficial when optimism-increasing components are integrated into treatment. PMID:20339128

Comparative optimism in older adults' future health expectations.

PubMed

Vanderzanden, Karen; Ruthig, Joelle C

2018-05-13

Despite a common belief that health declines with age, many older adults remain optimistic about their future health. However, the longitudinal impact of personal and comparatively optimistic future health estimates (FHEs) is unclear. Among 408 older adults (M age  = 70.32 years), this study identified the prevalence, source, and two-year stability of comparatively optimistic FHEs; examined demographic, psychosocial, and health correlates of comparative FHEs; and assessed the role of comparative FHEs in predicting eight-year survival odds. Nearly half of participants were comparatively optimistic due to interpersonal pessimism more so than personal optimism. Regarding stability, comparative optimism declined over the two-year period. Being younger and having more perceived control, dispositional optimism, and recent positive emotions were associated with better FHEs for oneself and a similar other. Beyond effects of age, gender, relationship status, and dispositional optimism, optimistic personal FHEs predicted eight-year survival odds. Findings have implications for predicting survival and advancing the conceptual understanding of comparative FHEs. Statement of contribution What is already known on the subject? Previous research has demonstrated that older adults tend to believe diminished health accompanies increasing age. Despite this notion, older adults remain comparatively optimistic about their health. What does this study add? The longitudinal results of the current study indicated that nearly half of participants were categorized as comparative optimists, primarily due to interpersonal pessimism. The current study demonstrated that there is little distinction between personal FHEs and those for a similar other in terms of demographic, psychosocial, and health correlates. The current study identified factors that predicted eight-year survival among older adults, such as being female, younger, in a committed relationship, and better personal FHEs. © 2018

Optimal Sensor Selection for Health Monitoring Systems

NASA Technical Reports Server (NTRS)

Santi, L. Michael; Sowers, T. Shane; Aguilar, Robert B.

2005-01-01

Sensor data are the basis for performance and health assessment of most complex systems. Careful selection and implementation of sensors is critical to enable high fidelity system health assessment. A model-based procedure that systematically selects an optimal sensor suite for overall health assessment of a designated host system is described. This procedure, termed the Systematic Sensor Selection Strategy (S4), was developed at NASA John H. Glenn Research Center in order to enhance design phase planning and preparations for in-space propulsion health management systems (HMS). Information and capabilities required to utilize the S4 approach in support of design phase development of robust health diagnostics are outlined. A merit metric that quantifies diagnostic performance and overall risk reduction potential of individual sensor suites is introduced. The conceptual foundation for this merit metric is presented and the algorithmic organization of the S4 optimization process is described. Representative results from S4 analyses of a boost stage rocket engine previously under development as part of NASA's Next Generation Launch Technology (NGLT) program are presented.

Using tailored methodical approaches to achieve optimal science outcomes

NASA Astrophysics Data System (ADS)

Wingate, Lory M.

2016-08-01

The science community is actively engaged in research, development, and construction of instrumentation projects that they anticipate will lead to new science discoveries. There appears to be very strong link between the quality of the activities used to complete these projects, and having a fully functioning science instrument that will facilitate these investigations.[2] The combination of using internationally recognized standards within the disciplines of project management (PM) and systems engineering (SE) has been demonstrated to lead to achievement of positive net effects and optimal project outcomes. Conversely, unstructured, poorly managed projects will lead to unpredictable, suboptimal project outcomes ultimately affecting the quality of the science that can be done with the new instruments. The proposed application of these two specific methodical approaches, implemented as a tailorable suite of processes, are presented in this paper. Project management (PM) is accepted worldwide as an effective methodology used to control project cost, schedule, and scope. Systems engineering (SE) is an accepted method that is used to ensure that the outcomes of a project match the intent of the stakeholders, or if they diverge, that the changes are understood, captured, and controlled. An appropriate application, or tailoring, of these disciplines can be the foundation upon which success in projects that support science can be optimized.

Optimal allocation of HIV prevention funds for state health departments.

PubMed

Yaylali, Emine; Farnham, Paul G; Cohen, Stacy; Purcell, David W; Hauck, Heather; Sansom, Stephanie L

2018-01-01

To estimate the optimal allocation of Centers for Disease Control and Prevention (CDC) HIV prevention funds for health departments in 52 jurisdictions, incorporating Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program funds, to improve outcomes along the HIV care continuum and prevent infections. Using surveillance data from 2010 to 2012 and budgetary data from 2012, we divided the 52 health departments into 5 groups varying by number of persons living with diagnosed HIV (PLWDH), median annual CDC HIV prevention budget, and median annual HRSA expenditures supporting linkage to care, retention in care, and adherence to antiretroviral therapy. Using an optimization and a Bernoulli process model, we solved for the optimal CDC prevention budget allocation for each health department group. The optimal allocation distributed the funds across prevention interventions and populations at risk for HIV to prevent the greatest number of new HIV cases annually. Both the HIV prevention interventions funded by the optimal allocation of CDC HIV prevention funds and the proportions of the budget allocated were similar across health department groups, particularly those representing the large majority of PLWDH. Consistently funded interventions included testing, partner services and linkage to care and interventions for men who have sex with men (MSM). Sensitivity analyses showed that the optimal allocation shifted when there were differences in transmission category proportions and progress along the HIV care continuum. The robustness of the results suggests that most health departments can use these analyses to guide the investment of CDC HIV prevention funds into strategies to prevent the most new cases of HIV.

Canada's universal health-care system: achieving its potential.

PubMed

Martin, Danielle; Miller, Ashley P; Quesnel-Vallée, Amélie; Caron, Nadine R; Vissandjée, Bilkis; Marchildon, Gregory P

2018-04-28

Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Translating school health research to policy. School outcomes related to the health environment and changes in mathematics achievement.

PubMed

Snelling, Anastasia M; Belson, Sarah Irvine; Watts, Erin; George, Stephanie; Van Dyke, Hugo; Malloy, Elizabeth; Kalicki, Michelle

2015-10-01

This paper describes an exploration of the relationship between mathematic achievement and the school health environment relative to policy-driven changes in the school setting, specifically with regard to physical education/physical activity. Using school-level data, the authors seek to understand the relationship between mathematics achievement and the school health environment and physical education minutes. This work provides a description of the aspects of the school health environment, an exploration of the interrelationships between school health and student achievement, and an assessment of the effects of the school health policy and practice on student performance and health status. Based on these findings, we identify additional research necessary to describe the relationship between obesity and learning in children. Copyright © 2015 Elsevier Ltd. All rights reserved.

Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores Among Urban Youth in the United States*

PubMed Central

Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

2014-01-01

Background The Institute of Medicine (2012) concluded that we must “strengthen schools as the heart of health.” To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement, and (2) examine cumulative effects of these assets on academic achievement. Methods Participants include 940 students (grades 5 and 6) from 12 schools randomly selected from an urban district. Data include physical assessments, fitness testing, surveys, and district records. Fourteen health indicators were gathered including physical health (eg, body mass index [BMI]), health behaviors (eg, meeting recommendations for fruit/vegetable consumption), family environment (eg, family meals), and psychological well-being (eg, sleep quality). Data were collected 3-6 months prior to standardized testing. Results On average, students reported 7.1 health assets out of 14. Those with more health assets were more likely to be at goal for standardized tests (reading/writing/mathematics), and students with the most health assets were 2.2 times more likely to achieve goal compared with students with the fewest health assets (both p < .001). Conclusions Schools that utilize nontraditional instructional strategies to improve student health may also improve academic achievement, closing equity gaps in both health and academic achievement. PMID:24320151

The Bangladesh paradox: exceptional health achievement despite economic poverty.

PubMed

Chowdhury, A Mushtaque R; Bhuiya, Abbas; Chowdhury, Mahbub Elahi; Rasheed, Sabrina; Hussain, Zakir; Chen, Lincoln C

2013-11-23

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints. Copyright © 2013 Elsevier Ltd. All rights reserved.

Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing.

PubMed

Williams, Shanita D; Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis

2014-01-01

It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators-health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work-both within and outside the nursing field-that is necessary to answer these important but largely unanswered questions.

Using Social Determinants of Health to Link Health Workforce Diversity, Care Quality and Access, and Health Disparities to Achieve Health Equity in Nursing

PubMed Central

Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis

2014-01-01

It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators—health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work—both within and outside the nursing field—that is necessary to answer these important but largely unanswered questions. PMID:24385662

Effects of optimism on recovery and mental health after a tornado outbreak.

PubMed

Carbone, Eric G; Echols, Erin Thomas

2017-05-01

Dispositional optimism, a stable expectation that good things will happen, has been shown to improve health outcomes in a wide range of contexts, but very little research has explored the impact of optimism on post-disaster health and well-being. Data for this study come from the Centers for Disease Control and Prevention's Public health systems and mental health community recovery (PHSMHCR) Survey. Participants included 3216 individuals living in counties affected by the April 2011 tornado outbreak in Mississippi and Alabama. This study assesses the effect of dispositional optimism on post-disaster recovery and mental health. Dispositional optimism was found to have a positive effect on personal recovery and mental health after the disaster. Furthermore, it moderated the relationship between level of home damage and personal recovery as well as the relationship between home damage and post-traumatic stress disorder (PTSD), with stronger effects for those with increased levels of home damage. The utility of screening for optimism is discussed, along with the potential for interventions to increase optimism as a means of mitigating adverse mental health effects and improving the recovery of individuals affected by disasters and other traumatic events.

Eminence, IQ, physical and mental health, and achievement domain : Cox's 282 Geniuses revisited.

PubMed

Simonton, Dean Keith; Song, Anna V

2009-04-01

Catharine Cox published two studies of highly eminent creators and leaders, the first in 1926 as the second volume of Terman's landmark Genetic Studies of Genius and the second in 1936 as a coauthored article. The former publication concentrated on the relation between IQ and achieved eminence, and the latter focused on early physical and mental health. Taking advantage of unpublished data from the second study, we examined, for the first time, the relationships among achieved eminence, IQ, early physical and mental health, and achievement domain. The correlation and regression analyses showed, for these 282 individuals, that eminence is a positive function of IQ and that IQ is a positive function of mental health and a negative function of physical health, implying an indirect effect of physical and mental health on eminence. Furthermore, levels of early physical and mental health vary across 10 specific domains of achievement.

Optimal achieved blood pressure in acute intracerebral hemorrhage: INTERACT2.

PubMed

Arima, Hisatomi; Heeley, Emma; Delcourt, Candice; Hirakawa, Yoichiro; Wang, Xia; Woodward, Mark; Robinson, Thompson; Stapf, Christian; Parsons, Mark; Lavados, Pablo M; Huang, Yining; Wang, Jiguang; Chalmers, John; Anderson, Craig S

2015-02-03

To investigate the effects of intensive blood pressure (BP) lowering according to baseline BP levels and optimal achieved BP levels in patients with acute intracerebral hemorrhage (ICH). INTERACT2 was an open, blinded endpoint, randomized controlled trial in 2,839 patients with ICH within 6 hours of onset and elevated systolic BP (SBP) (150-220 mm Hg) who were allocated to receive intensive (target SBP <140 mm Hg within 1 hour, with lower limit of 130 mm Hg for treatment cessation) or guideline-recommended (target SBP <180 mm Hg) BP-lowering treatment. Outcome was physical function across all 7 levels of the modified Rankin Scale at 90 days. Analysis of the randomized comparisons showed that intensive BP lowering produced comparable benefits on physical function at 90 days in 5 subgroups defined by baseline SBP of <160, 160-169, 170-179, 180-189, and ≥190 mm Hg (p homogeneity = 0.790). Analyses of achieved BP showed linear increases in the risk of physical dysfunction for achieved SBP above 130 mm Hg for both hyperacute (1-24 hours) and acute (2-7 days) phases while modest increases were also observed for achieved SBP below 130 mm Hg. Intensive BP lowering appears beneficial across a wide range of baseline SBP levels, and target SBP level of 130-139 mm Hg is likely to provide maximum benefit in acute ICH. This study provides Class I evidence that the effect of intensive BP lowering on physical function is not influenced by baseline BP. © 2014 American Academy of Neurology.

Healthful School Living: Environmental Health in the School.

ERIC Educational Resources Information Center

Rowe, Daryl E.

1987-01-01

Environmental health, as it relates to schools, is defined. Site, chemical, biological, and physical health hazards are identified. Recommendations and precautions to help achieve optimal health, safety, and comfort are presented. Resources are noted. (Author/MT)

Achieving universal health coverage in small island states: could importing health services provide a solution?

PubMed Central

Walls, Helen; Smith, Richard

2018-01-01

Background Universal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option. Methods Analysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003–2013, together with in-depth review of medical travel schemes for the two highest importing SIDS—the Maldives and Tuvalu. Findings Medical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS. Interpretation Our findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control. PMID:29527349

Optimal allocation of HIV prevention funds for state health departments

PubMed Central

Farnham, Paul G.; Cohen, Stacy; Purcell, David W.; Hauck, Heather; Sansom, Stephanie L.

2018-01-01

Objective To estimate the optimal allocation of Centers for Disease Control and Prevention (CDC) HIV prevention funds for health departments in 52 jurisdictions, incorporating Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program funds, to improve outcomes along the HIV care continuum and prevent infections. Methods Using surveillance data from 2010 to 2012 and budgetary data from 2012, we divided the 52 health departments into 5 groups varying by number of persons living with diagnosed HIV (PLWDH), median annual CDC HIV prevention budget, and median annual HRSA expenditures supporting linkage to care, retention in care, and adherence to antiretroviral therapy. Using an optimization and a Bernoulli process model, we solved for the optimal CDC prevention budget allocation for each health department group. The optimal allocation distributed the funds across prevention interventions and populations at risk for HIV to prevent the greatest number of new HIV cases annually. Results Both the HIV prevention interventions funded by the optimal allocation of CDC HIV prevention funds and the proportions of the budget allocated were similar across health department groups, particularly those representing the large majority of PLWDH. Consistently funded interventions included testing, partner services and linkage to care and interventions for men who have sex with men (MSM). Sensitivity analyses showed that the optimal allocation shifted when there were differences in transmission category proportions and progress along the HIV care continuum. Conclusion The robustness of the results suggests that most health departments can use these analyses to guide the investment of CDC HIV prevention funds into strategies to prevent the most new cases of HIV. PMID:29768489

Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research.

PubMed

Purnell, Tanjala S; Calhoun, Elizabeth A; Golden, Sherita H; Halladay, Jacqueline R; Krok-Schoen, Jessica L; Appelhans, Bradley M; Cooper, Lisa A

2016-08-01

In the United States, racial/ethnic minority, rural, and low-income populations continue to experience suboptimal access to and quality of health care despite decades of recognition of health disparities and policy mandates to eliminate them. Many health care interventions that were designed to achieve health equity fall short because of gaps in knowledge and translation. We discuss these gaps and highlight innovative interventions that help address them, focusing on cardiovascular disease and cancer. We also provide recommendations for advancing the field of health equity and informing the implementation and evaluation of policies that target health disparities through improved access to care and quality of care. Project HOPE—The People-to-People Health Foundation, Inc.

Achieving and Sustaining Universal Health Coverage: Fiscal Reform of the National Health Insurance in Taiwan.

PubMed

Lan, Jesse Yu-Chen

2017-12-01

The paper discusses the expansion of the universal health coverage (UHC) in Taiwan through the establishment of National Health Insurance (NHI), and the fiscal crisis it caused. Two key questions are addressed: How did the NHI gradually achieve universal coverage, and yet cause Taiwanese health spending to escalate to fiscal crisis? What measures have been taken to reform the NHI finance and achieve moderate success to date? The main argument of this paper is that the Taiwanese Government did try to implement various reforms to save costs and had moderate success, but the path-dependent process of reform does not allow increasing contribution rates significantly and thereby makes sustainability challenging.

Effects of optimism on recovery and mental health after a tornado outbreak

PubMed Central

Carbone, Eric G.; Echols, Erin Thomas

2017-01-01

Objective Dispositional optimism, a stable expectation that good things will happen, has been shown to improve health outcomes in a wide range of contexts, but very little research has explored the impact of optimism on post-disaster health and well-being. Design Data for this study come from the Centers for Disease Control and Prevention’s Public health systems and mental health community recovery (PHSMHCR) Survey. Participants included 3216 individuals living in counties affected by the April 2011 tornado outbreak in Mississippi and Alabama. Main outcome measures This study assesses the effect of dispositional optimism on post-disaster recovery and mental health. Results Dispositional optimism was found to have a positive effect on personal recovery and mental health after the disaster. Furthermore, it moderated the relationship between level of home damage and personal recovery as well as the relationship between home damage and post-traumatic stress disorder (PTSD), with stronger effects for those with increased levels of home damage. Conclusions The utility of screening for optimism is discussed, along with the potential for interventions to increase optimism as a means of mitigating adverse mental health effects and improving the recovery of individuals affected by disasters and other traumatic events. PMID:28156138

Results of a workplace health campaign: what can be achieved?

PubMed

Leyk, Dieter; Rohde, Ulrich; Hartmann, Nadine D; Preuß, Philipp A; Sievert, Alexander; Witzki, Alexander

2014-05-02

Effective health promotion in the workplace is now essential because of the rising health-related costs for businesses, the increasing pressure arising from international competition, prolonged working lives, and the aging of the work force. The basic problem of prevention campaigns is that the target groups are too rarely reached and sustainable benefits too rarely achieved. In 2011, we carried out a broad-based health and fitness campaign to assess how many personnel could be motivated to participate in a model study under nearly ideal conditions. 1010 personnel were given the opportunity to participate in various kinds of sports, undergo sports-medicine examinations, attend monthly expert lectures, and benefit from nutritional offerings and Intranet information during work hours. Pseudonymized questionnaires were used to classify the participants according to their exercise behavior as non-active, not very active, and very active. The participants' subjective responses (regarding, e.g., health, exercise, nutrition, and the factors that motivated them to participate in sports or discouraged them from doing so) were recorded, as were their objective data (measures of body size and strength). The duration of the study was one year. 490 of the 1010 personnel (48.5%, among whom 27.2% were nonactive, 44.1% not very active, and 28.7% very active) participated in the initial questionnaire and testing. By the end of the study, this figure had dropped to 17.8%; diminished participation affected all three groups to a comparable extent. A comparison of dropouts and non-dropouts revealed that older age was a stable predictor for drop-out (bivariate odds ratio [OR] 1.028, p = 0.006; multivariate OR 1.049, p = 0.009). The study participants reported beneficial effects on their health and health awareness, performance ability, psychological balance, stress perception, exercise and dietary behavior. Even under optimal conditions and with high use of staff resources, this model

Stochastic multi-objective auto-optimization for resource allocation decision-making in fixed-input health systems.

PubMed

Bastian, Nathaniel D; Ekin, Tahir; Kang, Hyojung; Griffin, Paul M; Fulton, Lawrence V; Grannan, Benjamin C

2017-06-01

The management of hospitals within fixed-input health systems such as the U.S. Military Health System (MHS) can be challenging due to the large number of hospitals, as well as the uncertainty in input resources and achievable outputs. This paper introduces a stochastic multi-objective auto-optimization model (SMAOM) for resource allocation decision-making in fixed-input health systems. The model can automatically identify where to re-allocate system input resources at the hospital level in order to optimize overall system performance, while considering uncertainty in the model parameters. The model is applied to 128 hospitals in the three services (Air Force, Army, and Navy) in the MHS using hospital-level data from 2009 - 2013. The results are compared to the traditional input-oriented variable returns-to-scale Data Envelopment Analysis (DEA) model. The application of SMAOM to the MHS increases the expected system-wide technical efficiency by 18 % over the DEA model while also accounting for uncertainty of health system inputs and outputs. The developed method is useful for decision-makers in the Defense Health Agency (DHA), who have a strategic level objective of integrating clinical and business processes through better sharing of resources across the MHS and through system-wide standardization across the services. It is also less sensitive to data outliers or sampling errors than traditional DEA methods.

The quantum mitochondrion and optimal health

PubMed Central

Nunn, Alistair V.W.; Guy, Geoffrey W.; Bell, Jimmy D.

2016-01-01

A sufficiently complex set of molecules, if subject to perturbation, will self-organize and show emergent behaviour. If such a system can take on information it will become subject to natural selection. This could explain how self-replicating molecules evolved into life and how intelligence arose. A pivotal step in this evolutionary process was of course the emergence of the eukaryote and the advent of the mitochondrion, which both enhanced energy production per cell and increased the ability to process, store and utilize information. Recent research suggest that from its inception life embraced quantum effects such as ‘tunnelling’ and ‘coherence’ while competition and stressful conditions provided a constant driver for natural selection. We believe that the biphasic adaptive response to stress described by hormesis–a process that captures information to enable adaptability, is central to this whole process. Critically, hormesis could improve mitochondrial quantum efficiency, improving the ATP/ROS ratio, whereas inflammation, which is tightly associated with the aging process, might do the opposite. This all suggests that to achieve optimal health and healthy aging, one has to sufficiently stress the system to ensure peak mitochondrial function, which itself could reflect selection of optimum efficiency at the quantum level. PMID:27528758

The quantum mitochondrion and optimal health.

PubMed

Nunn, Alistair V W; Guy, Geoffrey W; Bell, Jimmy D

2016-08-15

A sufficiently complex set of molecules, if subject to perturbation, will self-organize and show emergent behaviour. If such a system can take on information it will become subject to natural selection. This could explain how self-replicating molecules evolved into life and how intelligence arose. A pivotal step in this evolutionary process was of course the emergence of the eukaryote and the advent of the mitochondrion, which both enhanced energy production per cell and increased the ability to process, store and utilize information. Recent research suggest that from its inception life embraced quantum effects such as 'tunnelling' and 'coherence' while competition and stressful conditions provided a constant driver for natural selection. We believe that the biphasic adaptive response to stress described by hormesis-a process that captures information to enable adaptability, is central to this whole process. Critically, hormesis could improve mitochondrial quantum efficiency, improving the ATP/ROS ratio, whereas inflammation, which is tightly associated with the aging process, might do the opposite. This all suggests that to achieve optimal health and healthy aging, one has to sufficiently stress the system to ensure peak mitochondrial function, which itself could reflect selection of optimum efficiency at the quantum level. © 2016 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society.

Can biosimilars help achieve the goals of US health care reform?

PubMed

Boccia, Ralph; Jacobs, Ira; Popovian, Robert; de Lima Lopes, Gilberto

2017-01-01

The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.

Anger and health in dementia caregivers: exploring the mediation effect of optimism.

PubMed

López, J; Romero-Moreno, R; Márquez-González, M; Losada, A

2015-04-01

Although previous studies indicate a negative association between caregivers' anger and health, the potential mechanisms linking this relationship are not yet fully understood. The aim of this study was to explore the potential mediating role of optimism in the relationship between anger and caregivers' physical health. Dementia caregivers (n = 108) were interviewed and filled out instruments assessing their anger (reaction), optimism and health (vitality). A mediational model was tested to determine whether optimism partially mediated the relationship between anger and vitality. Angry reaction was negatively associated with optimism and vitality; optimism was positively associated with vitality. Finally, the relationship between angry reaction and vitality decreased when optimism was entered simultaneously. A non-parametric bootstrap approach confirmed that optimism significantly mediated some of the relationship between angry reaction and vitality. These findings suggest that low optimism may help explain the association between caregivers' anger and reduced sense of vitality. The results provide a specific target for intervention with caregivers. Copyright © 2013 John Wiley & Sons, Ltd.

Soy foods: are they useful for optimal bone health?

PubMed Central

2011-01-01

Numerous studies have investigated the relationship between soy foods, soy protein, or isoflavone extracts and markers of bone health and osteoporosis prevention, and have come to conflicting conclusions. Research on dietary patterns, rather than on specific food ingredients or individual foods, may offer an opportunity for better understanding the role of soy foods in bone health. Evidence is reviewed regarding the question of whether soy foods contribute to a dietary pattern in humans that supports and promotes bone health. Soy foods are associated with improved markers of bone health and improved outcomes, especially among Asian women. Although the optimal amounts and types of soy foods needed to support bone health are not yet clear, dietary pattern evidence suggests that regular consumption of soy foods is likely to be useful for optimal bone health as an integral part of a dietary pattern that is built largely from whole plant foods. PMID:22870487

Soy foods: are they useful for optimal bone health?

PubMed

Lanou, Amy J

2011-12-01

Numerous studies have investigated the relationship between soy foods, soy protein, or isoflavone extracts and markers of bone health and osteoporosis prevention, and have come to conflicting conclusions. Research on dietary patterns, rather than on specific food ingredients or individual foods, may offer an opportunity for better understanding the role of soy foods in bone health. Evidence is reviewed regarding the question of whether soy foods contribute to a dietary pattern in humans that supports and promotes bone health. Soy foods are associated with improved markers of bone health and improved outcomes, especially among Asian women. Although the optimal amounts and types of soy foods needed to support bone health are not yet clear, dietary pattern evidence suggests that regular consumption of soy foods is likely to be useful for optimal bone health as an integral part of a dietary pattern that is built largely from whole plant foods.

Universal health coverage and the health Sustainable Development Goal: achievements and challenges for Sri Lanka.

PubMed

de Silva, Amala; Ranasinghe, Thushara; Abeykoon, Palitha

2016-09-01

With state-funded health care that is free at the point of delivery, a sound primary health-care policy and widespread health-care services, Sri Lanka seems a good example of universal health coverage. Yet, health transition and disparities in provision and financing threaten this situation. Sri Lanka did well on the Millennium Development Goal health indicators, but the Sustainable Development Goal (SDG) for health has a wider purview, which is to "ensure healthy lives and promote well-being for all at all ages". The gender gap in life expectancy and the gap between life expectancy and healthy life expectancy make achievement of the health SDG more challenging. Although women and children do well overall, the comparative health disadvantage for men in Sri Lanka is a cause for concern. From a financing perspective, high out-of-pocket expenditure and high utilization of the private sector, even by those in the lowest income quintile, are concerns, as is the emerging "third tier", where some individuals accessing state health care that is free at the point of delivery actually bear some of the costs of drugs, investigations and surgery. This cost sharing is resulting in catastrophic health expenditure for individuals, and delays in and non-compliance with treatment. These concerns about provision and financing must be addressed, as health transition will intensify the morbidity burden and loss of well-being, and could derail plans to achieve the health SDG.

Constrained Optimization Methods in Health Services Research-An Introduction: Report 1 of the ISPOR Optimization Methods Emerging Good Practices Task Force.

PubMed

Crown, William; Buyukkaramikli, Nasuh; Thokala, Praveen; Morton, Alec; Sir, Mustafa Y; Marshall, Deborah A; Tosh, Jon; Padula, William V; Ijzerman, Maarten J; Wong, Peter K; Pasupathy, Kalyan S

2017-03-01

Providing health services with the greatest possible value to patients and society given the constraints imposed by patient characteristics, health care system characteristics, budgets, and so forth relies heavily on the design of structures and processes. Such problems are complex and require a rigorous and systematic approach to identify the best solution. Constrained optimization is a set of methods designed to identify efficiently and systematically the best solution (the optimal solution) to a problem characterized by a number of potential solutions in the presence of identified constraints. This report identifies 1) key concepts and the main steps in building an optimization model; 2) the types of problems for which optimal solutions can be determined in real-world health applications; and 3) the appropriate optimization methods for these problems. We first present a simple graphical model based on the treatment of "regular" and "severe" patients, which maximizes the overall health benefit subject to time and budget constraints. We then relate it back to how optimization is relevant in health services research for addressing present day challenges. We also explain how these mathematical optimization methods relate to simulation methods, to standard health economic analysis techniques, and to the emergent fields of analytics and machine learning. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Knowledge Visualizations: A Tool to Achieve Optimized Operational Decision Making and Data Integration

DTIC Science & Technology

2015-06-01

Hadoop Distributed File System (HDFS) without any integration with Accumulo-based Knowledge Stores based on OWL/RDF. 4. Cloud Based The Apache Software...BTW, 7(12), pp. 227–241. Godin, A. & Akins, D. (2014). Extending DCGS-N naval tactical clouds from in-storage to in-memory for the integrated fires...VISUALIZATIONS: A TOOL TO ACHIEVE OPTIMIZED OPERATIONAL DECISION MAKING AND DATA INTEGRATION by Paul C. Hudson Jeffrey A. Rzasa June 2015 Thesis

Quantitative Guidance for Stove Usage and Performance to Achieve Health and Environmental Targets

PubMed Central

Chiang, Ranyee A.

2015-01-01

Background Displacing the use of polluting and inefficient cookstoves in developing countries is necessary to achieve the potential health and environmental benefits sought through clean cooking solutions. Yet little quantitative context has been provided on how much displacement of traditional technologies is needed to achieve targets for household air pollutant concentrations or fuel savings. Objectives This paper provides instructive guidance on the usage of cooking technologies required to achieve health and environmental improvements. Methods We evaluated different scenarios of displacement of traditional stoves with use of higher performing technologies. The air quality and fuel consumption impacts were estimated for these scenarios using a single-zone box model of indoor air quality and ratios of thermal efficiency. Results Stove performance and usage should be considered together, as lower performing stoves can result in similar or greater benefits than a higher performing stove if the lower performing stove has considerably higher displacement of the baseline stove. Based on the indoor air quality model, there are multiple performance–usage scenarios for achieving modest indoor air quality improvements. To meet World Health Organization guidance levels, however, three-stone fire and basic charcoal stove usage must be nearly eliminated to achieve the particulate matter target (< 1–3 hr/week), and substantially limited to meet the carbon monoxide guideline (< 7–9 hr/week). Conclusions Moderate health gains may be achieved with various performance–usage scenarios. The greatest benefits are estimated to be achieved by near-complete displacement of traditional stoves with clean technologies, emphasizing the need to shift in the long term to near exclusive use of clean fuels and stoves. The performance–usage scenarios are also provided as a tool to guide technology selection and prioritize behavior change opportunities to maximize impact. Citation

Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores among Urban Youth in the United States

ERIC Educational Resources Information Center

Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

2014-01-01

Background: The Institute of Medicine (2012) concluded that we must "strengthen schools as the heart of health." To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement,…

The Impossibility of Achieving Consistently Good Mental Health.

ERIC Educational Resources Information Center

Ellis, Albert

1987-01-01

People disturb themselves with irrational beliefs, some of which are obvious and blatant while others are subtle and tricky. The latter type make people more disturbed than do the former kind. Even when helped by the most efficient forms of psychotherapy, humans have difficulty achieving and maintaining good mental health. (Author/VM)

Linking Organizational Health in Jeddah Secondary Schools to Students' Academic Achievement

ERIC Educational Resources Information Center

Alqarni, Saleh Ali Y.

2016-01-01

This study aimed to assess organizational health (OH) in secondary schools in Jeddah district in Saudi Arabia. A second aim of the study was to compare the organizational health of these schools according to their rankings on student achievement tests, school type and the nature of the respondents' work. The Organizational Health Inventory (OHI),…

Health of the Force

DTIC Science & Technology

2015-11-01

health readiness by ensuring the Total Force has the required physical , emotional, and cog- nitive health and fitness to win in environments that are...overall installation score for optimal physical activity as assessed by Body Mass Index (BMI), moderate or vigorous activity levels, resistance...activity and nutrition (SAN) are critical for achieving optimal physical , mental, and emotion-al health and wellbeing. They are integral to max

Health benefit modelling and optimization of vehicular pollution control strategies

NASA Astrophysics Data System (ADS)

Sonawane, Nayan V.; Patil, Rashmi S.; Sethi, Virendra

2012-12-01

This study asserts that the evaluation of pollution reduction strategies should be approached on the basis of health benefits. The framework presented could be used for decision making on the basis of cost effectiveness when the strategies are applied concurrently. Several vehicular pollution control strategies have been proposed in literature for effective management of urban air pollution. The effectiveness of these strategies has been mostly studied as a one at a time approach on the basis of change in pollution concentration. The adequacy and practicality of such an approach is studied in the present work. Also, the assessment of respective benefits of these strategies has been carried out when they are implemented simultaneously. An integrated model has been developed which can be used as a tool for optimal prioritization of various pollution management strategies. The model estimates health benefits associated with specific control strategies. ISC-AERMOD View has been used to provide the cause-effect relation between control options and change in ambient air quality. BenMAP, developed by U.S. EPA, has been applied for estimation of health and economic benefits associated with various management strategies. Valuation of health benefits has been done for impact indicators of premature mortality, hospital admissions and respiratory syndrome. An optimization model has been developed to maximize overall social benefits with determination of optimized percentage implementations for multiple strategies. The model has been applied for sub-urban region of Mumbai city for vehicular sector. Several control scenarios have been considered like revised emission standards, electric, CNG, LPG and hybrid vehicles. Reduction in concentration and resultant health benefits for the pollutants CO, NOx and particulate matter are estimated for different control scenarios. Finally, an optimization model has been applied to determine optimized percentage implementation of specific

Addressing the Human Resources for Health crisis in countries: How far have we gone? What can we expect to achieve by 2015?

PubMed

Dayrit, Manuel M; Dolea, Carmen; Dreesch, Norbert

2011-06-01

The World Health Report 2006 identified 57 countries world-wide whose health worker to population density fell below a critical threshold of 2.3 per 1,000 population. This meant that below this critical threshold, a country could not provide the basic health services to its population, defined here as 80% immunization coverage and 80% skilled birth attendance at delivery. Of the 57 countries, 36 are located in Africa. This article reviews the progress countries have made in addressing their health workforce crisis. It cites 3 of the most recent global studies and the indicators used to measure progress. It also features the experiences of 8 countries, namely Malawi, Peru, Ethiopia, Brazil, Thailand, Philippines, Zambia, Mali. Their situations provide a diverse picture of country efforts, challenges, and successes. The article asks the question of whether the target of 25% reduction in the number of crisis countries can be achieved by 2015. This was a goal set by the World Health Assembly in 2008. While the authors wish to remain optimistic about the striving towards this target, their optimism must be matched by an adequate level of investment in countries on HRH development. The next four years will show how much will really be achieved.

[Psychological benefits of physical activity for optimal mental health].

PubMed

Poirel, Emmanuel

Mental health is a worldwide public health concern, as can be seen from the WHO's comprehensive mental health action plan 2013-2020 which was adopted by the 66th World Health Assembly. According to the Mental health commission of Canada (2012), one in five Canadians will personally experience a mental illness in their lifetime, and the WHO shows that mental illness represents the second most prevalent risk of morbidity after heart disease. Physical activity certainly provides an answer to this problem. Physical activity has been shown to improve physical health but it is also one of the most natural and accessible means to improve mental health. The aim of the present article is to propose a biopsychosocial model on the basis of a literature review on the psychological benefits of physical activity. In view of the findings we assume that physical activity increases mental well-being and optimal mental health as opposed to poor mental health. Hence, physical activity provides a state of well-being that enables individuals to realize their own potential, and that helps to cope with the normal stresses of life or adversity. The model certainly opens the way for research and new hypothesis, but it also aims at the promotion of the benefits of physical activity on psychological well-being for optimal mental health.

How to achieve a collaborative approach in health promotion: preferences and ideas of users of mental health services.

PubMed

Pals, Regitze Anne Saurbrey; Hempler, Nana Folmann

2018-02-12

Collaborative approaches to consensus building or decision-making are beneficial in health-promoting activities targeting users of mental health services (users). However, little is known about how to achieve a collaborative approach in practice. The purpose of this study was to explore: (1) users' preferences and ideas related to achieving a collaborative approach in health-related communication and (2) perspectives of healthcare and social work professionals and family members on users' ideas and preferences. Data were collected through interactive workshops with users (n = 15), professionals (n = 21) and users' family members (n = 12). Data were analysed using systematic text condensation. Users provided three recommendations for establishing a collaborative approach in communication about health: (1) involving users in deciding the agenda and setting for health-promoting activities; (2) exchanging knowledge between users and professionals about health and values; and (3) exploring users' motivation for change. Users and professionals had diverging perceptions of the value of establishing a collaborative approach. Professionals regarded relationship building and health promotion as separate phenomena, whereas users perceived relationship building as inherently health promoting. Family members of users requested specific guidance and support with regard to clarifying and fulfilling the best possible support role as a family member. The findings suggest that a collaborative approach in health promotion may be difficult to achieve without a focus on professional development for healthcare and social work professionals. © 2018 Nordic College of Caring Science.

Promoting equity to achieve maternal and child health.

PubMed

Thomsen, Sarah; Hoa, Dinh Thi Phuong; Målqvist, Mats; Sanneving, Linda; Saxena, Deepak; Tana, Susilowati; Yuan, Beibei; Byass, Peter

2011-11-01

Maternal and child mortality rates, the targets for two of the eight Millennium Development Goals, remain unacceptably high in many countries. Some countries have made significant advances in reducing deaths in pregnancy, childbirth, and childhood at the national level. However, on a sub-national basis most countries show wide disparities in health indices which are not necessarily reflected in national figures. This is a sign of inequitable access to and provision of health services. Yet there has been little attention to health equity in relation to the Millennium Development Goals. Instead, countries have focused on achieving national targets. This has led to an emphasis on utilitarian, as opposed to universalist, approaches to public health, which we discuss here. We recommend a policy of "proportionate universalism". In this approach, universal health care and a universal social policy are the ultimate goal, but in the interim actions are carried out with intensities proportionate to disadvantage. We also briefly describe an initiative that aims to promote evidence-based policy and interventions that will reduce inequity in access to maternal and child health care in China, India, Indonesia and Viet Nam. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Health Coaching to Optimize Well-Being among Returning Veterans with Suicide Risk

DTIC Science & Technology

2017-10-01

AWARD NUMBER: W81XWH-16-1-0630 TITLE: Health Coaching to Optimize Well-Being among Returning Veterans with Suicide Risk PRINCIPAL INVESTIGATOR...Lauren M. Denneson, PhD CONTRACTING ORGANIZATION: Oregon Health & Science University Portland, OR 97239 REPORT DATE: October 2017 TYPE OF...COVERED (From - To) 15 Sept 2016 - 14 Sept 2017 4. TITLE AND SUBTITLE Health Coaching to Optimize Well-Being among Returning Veterans with Suicide Risk

Integrating epidemiology, psychology, and economics to achieve HPV vaccination targets.

PubMed

Basu, Sanjay; Chapman, Gretchen B; Galvani, Alison P

2008-12-02

Human papillomavirus (HPV) vaccines provide an opportunity to reduce the incidence of cervical cancer. Optimization of cervical cancer prevention programs requires anticipation of the degree to which the public will adhere to vaccination recommendations. To compare vaccination levels driven by public perceptions with levels that are optimal for maximizing the community's overall utility, we develop an epidemiological game-theoretic model of HPV vaccination. The model is parameterized with survey data on actual perceptions regarding cervical cancer, genital warts, and HPV vaccination collected from parents of vaccine-eligible children in the United States. The results suggest that perceptions of survey respondents generate vaccination levels far lower than those that maximize overall health-related utility for the population. Vaccination goals may be achieved by addressing concerns about vaccine risk, particularly those related to sexual activity among adolescent vaccine recipients. In addition, cost subsidizations and shifts in federal coverage plans may compensate for perceived and real costs of HPV vaccination to achieve public health vaccination targets.

Linking the Organizational Health of Middle Grades Schools to Student Achievement

ERIC Educational Resources Information Center

Roney, Kathleen; Coleman, Howard; Schlichting, Kathleen A.

2007-01-01

The purpose of this study was to examine the relationship between student reading achievement and the organizational health of five middle grades schools in North Carolina. The theoretical framework was based upon Hoy and Feldman's definition of organizational health, which links healthy school climates to improved learning environments and…

What have health care reforms achieved in Turkey? An appraisal of the "Health Transformation Programme".

PubMed

Ökem, Zeynep Güldem; Çakar, Mehmet

2015-09-01

Poor health status indicators, low quality care, inequity in the access to health services and inefficiency due to fragmented health financing and provision have long been problems in Turkey's health system. To address these problems a radical reform process known as the Health Transformation Programme (HTP) was initiated in 2003. The health sector reforms in Turkey are considered to have been among the most successful of middle-income countries undergoing reform. Numerous articles have been published that review these reforms in terms of, variously, financial sustainability, efficiency, equity and quality. Evidence suggests that Turkey has indeed made significant progress, yet these achievements are uneven among its regions, and their long-term financial sustainability is unresolved due to structural problems in employment. As yet, there is no comprehensive evidence-based analysis of how far the stated reform objectives have been achieved. This article reviews the empirical evidence regarding the outcomes of the HTP during 10 years of its implementation. Strengthening the strategic purchasing function of the Social Security Institution (SSI) should be a priority. Overall performance can be improved by linking resource allocation to provider performance. More emphasis on prevention rather than treatment, with an effective referral chain, can also bring better outcomes, greater efficiency gains and contribute to sustainability. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Risk alignment in health care quality and financing: optimizing value.

PubMed

Granata, A V

1998-01-01

How should health care best consolidate rational cost control while preserving and enhancing quality? That is, how can a system best optimize value? A limitation of many current health management modalities may be that the power to control health spending has been expropriated from physician providers, while they are still fully responsible for quality. Assigning responsibility without authority is a significant predicament. There are growing indications that well-organized, well-managed groups of high quality physicians may be able to directly manage both types of risk-quality and financial. The best way to optimize responsibility and authority, and to control financial and quality risks, is to place such responsibility and authority within the same entity.

Organizational attributes that assure optimal utilization of public health nurses.

PubMed

Meagher-Stewart, Donna; Underwood, Jane; MacDonald, Mary; Schoenfeld, Bonnie; Blythe, Jennifer; Knibbs, Kristin; Munroe, Val; Lavoie-Tremblay, Mélanie; Ehrlich, Anne; Ganann, Rebecca; Crea, Mary

2010-01-01

Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.

Health Behaviour and Academic Achievement in Icelandic School Children

ERIC Educational Resources Information Center

Sigfusdottir, Inga Dora; Kristjansson, Alfgeir Logi; Allegrante, John P.

2007-01-01

Interest in the relationship between health behaviours and academic achievement has recently intensified in the face of an epidemic of childhood and adolescent obesity and converging school reforms in the United States and other nations with advanced economies. Epidemiologic research has demonstrated that poor diet and lack of adequate physical…

Understanding Adolescents' Mental Health and Academic Achievement: Does Physical Fitness Matter?

ERIC Educational Resources Information Center

Xiang, Man; Gu, Xiangli; Jackson, Allen; Zhang, Tao; Wang, Xiaozan; Guo, Qiang

2017-01-01

Despite consensus that physical fitness (PF) plays an important role in promoting mental health and academic achievement, little is known regarding the mechanisms by which this effect works. Blair, Cheng, and Holder (2001) proposed a conceptual model to identify the behavioral mechanism of health outcomes, in which both health-related PF and…

Quantitative Guidance for Stove Usage and Performance to Achieve Health and Environmental Targets.

PubMed

Johnson, Michael A; Chiang, Ranyee A

2015-08-01

Displacing the use of polluting and inefficient cookstoves in developing countries is necessary to achieve the potential health and environmental benefits sought through clean cooking solutions. Yet little quantitative context has been provided on how much displacement of traditional technologies is needed to achieve targets for household air pollutant concentrations or fuel savings. This paper provides instructive guidance on the usage of cooking technologies required to achieve health and environmental improvements. We evaluated different scenarios of displacement of traditional stoves with use of higher performing technologies. The air quality and fuel consumption impacts were estimated for these scenarios using a single-zone box model of indoor air quality and ratios of thermal efficiency. Stove performance and usage should be considered together, as lower performing stoves can result in similar or greater benefits than a higher performing stove if the lower performing stove has considerably higher displacement of the baseline stove. Based on the indoor air quality model, there are multiple performance-usage scenarios for achieving modest indoor air quality improvements. To meet World Health Organization guidance levels, however, three-stone fire and basic charcoal stove usage must be nearly eliminated to achieve the particulate matter target (< 1-3 hr/week), and substantially limited to meet the carbon monoxide guideline (< 7-9 hr/week). Moderate health gains may be achieved with various performance-usage scenarios. The greatest benefits are estimated to be achieved by near-complete displacement of traditional stoves with clean technologies, emphasizing the need to shift in the long term to near exclusive use of clean fuels and stoves. The performance-usage scenarios are also provided as a tool to guide technology selection and prioritize behavior change opportunities to maximize impact.

Bridging miles to achieve milestones: Corporate social responsibility for primary health care.

PubMed

Gulati, Ruchie

2017-01-01

Sustainable Developmental Goals aim to provide "Good health for all". The task though immense ,requires equitable and efficient distribution of health resources to the community, reached predominantly by the Primary Health Centres. Strengthening these centres is essential to attain the goal. Adequate health financing is one of the important determinants for utilizing the optimal potential of these centres . Pooling funds from alternate financing strategies as Corporate Social Responsibility (CSR) funds may give impetus and facilitate healthcare affordability to the underserved population. This convergence of vision of corporate funding for "basic health services" may bridge the gap arising out of inadequate funding and facilitate "Good Health for all" in India.

Design of Mobile Health Tools to Promote Goal Achievement in Self-Management Tasks

PubMed Central

Henderson, Geoffrey; Parmanto, Bambang

2017-01-01

Background Goal-setting within rehabilitation is a common practice ultimately geared toward helping patients make functional progress. Objective The purposes of this study were to (1) qualitatively analyze data from a wellness program for patients with spina bifida (SB) and spinal cord injury (SCI) in order to generate software requirements for a goal-setting module to support their complex goal-setting routines, (2) design a prototype of a goal-setting module within an existing mobile health (mHealth) system, and (3) identify what educational content might be necessary to integrate into the system. Methods A total of 750 goals were analyzed from patients with SB and SCI enrolled in a wellness program. These goals were qualitatively analyzed in order to operationalize a set of software requirements for an mHealth goal-setting module and identify important educational content. Results Those of male sex (P=.02) and with SCI diagnosis (P<.001) were more likely to achieve goals than females or those with SB. Temporality (P<.001) and type (P<.001) of goal were associated with likelihood that the goal would be achieved. Nearly all (210/213; 98.6%) of the fact-finding goals were achieved. There was no significant difference in achievement based on goal theme. Checklists, data tracking, and fact-finding tools were identified as three functionalities that could support goal-setting and achievement in an mHealth system. Based on the qualitative analysis, a list of software requirements for a goal-setting module was generated, and a prototype was developed. Targets for educational content were also generated. Conclusions Innovative mHealth tools can be developed to support commonly set goals by individuals with disabilities. PMID:28739558

How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency.

PubMed

Wesson, Donald E; Kitzman, Heather E

2018-01-16

Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.

Understanding and benchmarking health service achievement of policy goals for chronic disease

PubMed Central

2012-01-01

Background Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges. Methods A ‘multi-value QCA’ (MVQCA) analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1) whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2) the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements. Results Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement). The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening. Conclusions The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The weaknesses of QCA can be

Health-Related Behaviors and Academic Achievement Among High School Students - United States, 2015.

PubMed

Rasberry, Catherine N; Tiu, Georgianne F; Kann, Laura; McManus, Tim; Michael, Shannon L; Merlo, Caitlin L; Lee, Sarah M; Bohm, Michele K; Annor, Francis; Ethier, Kathleen A

2017-09-08

Studies have shown links between educational outcomes such as letter grades, test scores, or other measures of academic achievement, and health-related behaviors (1-4). However, as reported in a 2013 systematic review, many of these studies have used samples that are not nationally representative, and quite a few studies are now at least 2 decades old (1). To update the relevant data, CDC analyzed results from the 2015 national Youth Risk Behavior Survey (YRBS), a biennial, cross-sectional, school-based survey measuring health-related behaviors among U.S. students in grades 9-12. Analyses assessed relationships between academic achievement (i.e., self-reported letter grades in school) and 30 health-related behaviors (categorized as dietary behaviors, physical activity, sedentary behaviors, substance use, sexual risk behaviors, violence-related behaviors, and suicide-related behaviors) that contribute to leading causes of morbidity and mortality among adolescents in the United States (5). Logistic regression models controlling for sex, race/ethnicity, and grade in school found that students who earned mostly A's, mostly B's, or mostly C's had statistically significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors than did students with mostly D's/F's. These findings highlight the link between health-related behaviors and education outcomes, suggesting that education and public health professionals can find their respective education and health improvement goals to be mutually beneficial. Education and public health professionals might benefit from collaborating to achieve both improved education and health outcomes for youths.

Optimism, well-being, depressive symptoms, and perceived physical health: a study among Stroke survivors.

PubMed

Shifren, Kim; Anzaldi, Kristen

2018-01-01

The investigation of the relation of positive personality characteristics to mental and physical health among Stroke survivors has been a neglected area of research. The purpose of this study was to examine the relationship between optimism, well-being, depressive symptoms, and perceived physical health among Stroke survivors. It was hypothesized that Stroke survivors' optimism would explain variance in their physical health above and beyond the variance explained by demographic variables, diagnostic variables, and mental health. One hundred seventy-six Stroke survivors (97 females, 79 males) completed the Revised Life Orientation Test, the Center for Epidemiological Studies Depression Scale, two items on perceived physical health from the 36-item Short Form of the Medical Outcomes study, and the Identity scale of the Illness Perception Questionnaire. Pearson correlations, hierarchical regression analyses, and the PROCESS approach to determining mediators were used to assess hypothesized relations between variables. Stroke survivors' level of optimism explained additional variance in overall health in regression models controlling for demographic and diagnostic variables, and mental health. Analyses revealed that optimism played a partial mediator role between mental health (well-being, depressive symptoms and total score on CES-D) variables and overall health.

Optimal formulations of local foods to achieve nutritional adequacy for 6–23-month-old rural Tanzanian children

PubMed Central

Raymond, Jofrey; Kassim, Neema; Rose, Jerman W.; Agaba, Morris

2017-01-01

ABSTRACT Background: Achieving nutritional goals of infants and young children while maintaining the intake of local and culture-specific foods can be a daunting task. Diet optimisation using linear goal programming (LP) can effectively generate optimal formulations incorporating local and culturally acceptable foods. Objective: The primary objective of this study was to determine whether a realistic and affordable diet that achieves dietary recommended intakes (DRIs) for 22 selected nutrients can be formulated for rural 6–23-month-old children in Tanzania. Design: Dietary intakes of 400 children aged 6–23 months were assessed using a weighed dietary record (WDR), 24-hour dietary recalls and a 7-days food record. A market survey was also carried out to estimate the cost per 100 g of edible portion of foods that are commonly consumed in the study area. Dietary and market survey data were then used to define LP model parameters for diet optimisation. All LP analyses were done using linear program solver (LiPS) version 1.9.4 to generate optimal food formulations. Results: Optimal formulations that achieved DRIs for 20 nutrients for children aged 6–11 months and all selected nutrients for children aged 12–23 months were successfully developed at a twofold cost of the observed food purchase across age groups. Optimal formulations contained a mixture of ingredients such as wholegrain cereals, Irish potatoes, pulses and seeds, fish and poultry meat as well as fruits and vegetables that can be sourced locally. Conclusions: Our findings revealed that given the available food choices, it is possible to develop optimal formulations that can improve dietary adequacy for rural 6–23-month-old children if food budget for the child’s diets is doubled. These findings suggest the need for setting alternative interventions which can help households increase access to nutrient-dense foods that can fill the identified nutrient gaps. PMID:28814951

Promoting Student Achievement through Improved Health Policy. Policy Update. Vol. 22, No. 11

ERIC Educational Resources Information Center

Fobbs, Erima

2015-01-01

"Promoting Student Achievement through Improved Health Policy" is a quick primer of the [Centers for Disease Control and Prevention] CDC's "Whole School, Whole Community, Whole Child" model, which highlights 10 important areas for connecting health and learning: health education; physical education and physical activity;…

Optimal information networks: Application for data-driven integrated health in populations

PubMed Central

Servadio, Joseph L.; Convertino, Matteo

2018-01-01

Development of composite indicators for integrated health in populations typically relies on a priori assumptions rather than model-free, data-driven evidence. Traditional variable selection processes tend not to consider relatedness and redundancy among variables, instead considering only individual correlations. In addition, a unified method for assessing integrated health statuses of populations is lacking, making systematic comparison among populations impossible. We propose the use of maximum entropy networks (MENets) that use transfer entropy to assess interrelatedness among selected variables considered for inclusion in a composite indicator. We also define optimal information networks (OINs) that are scale-invariant MENets, which use the information in constructed networks for optimal decision-making. Health outcome data from multiple cities in the United States are applied to this method to create a systemic health indicator, representing integrated health in a city. PMID:29423440

Health-financing reforms in southeast Asia: challenges in achieving universal coverage.

PubMed

Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Ir, Por; Aljunid, Syed Mohamed; Mukti, Ali Ghufron; Akkhavong, Kongsap; Banzon, Eduardo; Huong, Dang Boi; Thabrany, Hasbullah; Mills, Anne

2011-03-05

In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened. Copyright © 2011 Elsevier Ltd. All rights reserved.

Mental Health and Academic Achievement among M.Ed. Students in Kerala

ERIC Educational Resources Information Center

Moradi Sheykhjan, Tohid; K., Rajeswari; Jabari, Kamran

2017-01-01

The present research endeavor was aimed to assess relationship between Mental Health and Academic Achievement among M.Ed. students in Kerala. The sample of the study consisted of 314 M.Ed. students in Kerala. The method used for the present study was survey method. Mental Health Status Scale (M.H.S. Scale) was used and the study used the total…

Psychological distress, optimism and general health in breast cancer survivors: a data linkage study using the Scottish Health Survey.

PubMed

Leung, Janni; Atherton, Iain; Kyle, Richard G; Hubbard, Gill; McLaughlin, Deirdre

2016-04-01

The aim of this study is to examine the association between optimism and psychological distress in women with breast cancer after taking into account their self-rated general health. Data were aggregated from the Scottish Health Survey (2008 to 2011) to derive a nationally representative sample of 12,255 women (11,960 cancer-free controls, and 295 breast cancer cases identified from linked cancer registry data). The explanatory variables were optimism and general health, and the outcome variable was symptoms of psychological distress. Logistic regression analyses were conducted, with optimism entered in step 1 and general health entered in step 2. In an unadjusted model, higher levels of optimism were associated with lower odds of psychological distress in both the control group (OR = 0. 57, 95 % CI = 0.51-0.60) and breast cancer group (OR = 0. 64, 95 % CI = 0.47-0.88). However, in a model adjusting for general health, optimism was associated with lower odds of psychological distress only in the control group (OR = 0.50, 95 % CI = 0.44-0.57), but not significantly in the breast cancer group (OR = 1.15, 95 % CI = 0.32-4.11). In the breast cancer group, poor general health was a stronger associate of psychological distress (OR = 4. 98, 95 % CI = 1.32-18.75). Results were consistent after adjusting for age, years since breast cancer diagnosis, survey year, socioeconomic status, education, marital status, body mass index, smoking status, and alcohol consumption. This research confirms the value of multicomponent supportive care interventions for women with breast cancer. Specifically, it suggests that following breast cancer diagnosis, health care professionals need to provide advice and signpost to services that assist women to maintain or improve both their psychological and general health.

The World Health Organization European Health in Prisons Project After 10 Years: Persistent Barriers and Achievements

PubMed Central

Gatherer, Alex; Moller, Lars; Hayton, Paul

2005-01-01

The recognition that good prison health is important to general public health has led 28 countries in the European Region of the World Health Organization (WHO) to join a WHO network dedicated to improving health within prisons. Within the 10 years since that time, vital actions have been taken and important policy documents have been produced. A key factor in making progress is breaking down the isolation of prison health services and bringing them into closer collaboration with the country’s public health services. However, barriers to progress remain. A continuing challenge is how best to move from policy recommendations to implementation, so that the network’s fundamental aim of noticeable improvements in the health and care of prisoners is further achieved. PMID:16186449

Project TEAMS (Techniques and Education for Achieving Management Skills): Health Care Administrators.

ERIC Educational Resources Information Center

Platte Technical Community Coll., Columbus, NE.

These Project TEAMS (Techniques and Education for Achieving Management Skills) instructional materials consist of five units for use in training health care administrators. Unit 1 contains materials designed to help the health care administrators increase their management skills in regard to self-awareness, time management, problem solving,…

Green Infrastructure Simulation and Optimization to Achieve Combined Sewer Overflow Reductions in Philadelphia's Mill Creek Sewershed

NASA Astrophysics Data System (ADS)

Cohen, J. S.; McGarity, A. E.

2017-12-01

The ability for mass deployment of green stormwater infrastructure (GSI) to intercept significant amounts of urban runoff has the potential to reduce the frequency of a city's combined sewer overflows (CSOs). This study was performed to aid in the Overbrook Environmental Education Center's vision of applying this concept to create a Green Commercial Corridor in Philadelphia's Overbrook Neighborhood, which lies in the Mill Creek Sewershed. In an attempt to further implement physical and social reality into previous work using simulation-optimization techniques to produce GSI deployment strategies (McGarity, et al., 2016), this study's models incorporated land use types and a specific neighborhood in the sewershed. The low impact development (LID) feature in EPA's Storm Water Management Model (SWMM) was used to simulate various geographic configurations of GSI in Overbrook. The results from these simulations were used to obtain formulas describing the annual CSO reduction in the sewershed based on the deployed GSI practices. These non-linear hydrologic response formulas were then implemented into the Storm Water Investment Strategy Evaluation (StormWISE) model (McGarity, 2012), a constrained optimization model used to develop optimal stormwater management practices on the watershed scale. By saturating the avenue with GSI, not only will CSOs from the sewershed into the Schuylkill River be reduced, but ancillary social and economic benefits of GSI will also be achieved. The effectiveness of these ancillary benefits changes based on the type of GSI practice and the type of land use in which the GSI is implemented. Thus, the simulation and optimization processes were repeated while delimiting GSI deployment by land use (residential, commercial, industrial, and transportation). The results give a GSI deployment strategy that achieves desired annual CSO reductions at a minimum cost based on the locations of tree trenches, rain gardens, and rain barrels in specified land

Achieving health equity in Aotearoa: strengthening responsiveness to Māori in health research.

PubMed

Reid, Papaarangi; Paine, Sarah-Jane; Curtis, Elana; Jones, Rhys; Anderson, Anneka; Willing, Esther; Harwood, Matire

2017-11-10

Excellent health research is essential for good health outcomes, services and systems. Health research should also build towards equity and in doing so ensure that no one is left behind. As recipients of government funding, researchers are increasingly required to demonstrate an understanding of their delegated responsibilities to undertake research that has the potential to address Māori health needs and priorities. These requirements form the basis of responsiveness to Māori in health research, and several research institutions have implemented systems to support their organisational approach to this endeavour. However, many health researchers have a narrow view of responsiveness to Māori and how it might be relevant to their work. In this viewpoint paper we provide an overview of existing frameworks that can be used to develop thinking and positioning in relation to the Treaty of Waitangi and responsiveness to Māori. We also describe an equity-based approach to responsiveness to Māori and highlight four key areas that require careful consideration, namely: (1) relevance to Māori; (2) Māori as participants; (3) promoting the Māori voice, and; (4) human tissue. Finally, we argue for greater engagement with responsiveness to Māori activities as part of our commitment to achieving equitable health outcomes.

Optimizing Distribution of Pandemic Influenza Antiviral Drugs

PubMed Central

Huang, Hsin-Chan; Morton, David P.; Johnson, Gregory P.; Gutfraind, Alexander; Galvani, Alison P.; Clements, Bruce; Meyers, Lauren A.

2015-01-01

We provide a data-driven method for optimizing pharmacy-based distribution of antiviral drugs during an influenza pandemic in terms of overall access for a target population and apply it to the state of Texas, USA. We found that during the 2009 influenza pandemic, the Texas Department of State Health Services achieved an estimated statewide access of 88% (proportion of population willing to travel to the nearest dispensing point). However, access reached only 34.5% of US postal code (ZIP code) areas containing <1,000 underinsured persons. Optimized distribution networks increased expected access to 91% overall and 60% in hard-to-reach regions, and 2 or 3 major pharmacy chains achieved near maximal coverage in well-populated areas. Independent pharmacies were essential for reaching ZIP code areas containing <1,000 underinsured persons. This model was developed during a collaboration between academic researchers and public health officials and is available as a decision support tool for Texas Department of State Health Services at a Web-based interface. PMID:25625858

Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care.

PubMed

Deutsch, Stephanie Anne; Fortin, Kristine

2015-10-01

Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed. Copyright © 2015 Mosby, Inc. All rights reserved.

The role of optimism in health-promoting behaviors in new primiparous mothers.

PubMed

Gill, Robyn M; Loh, Jennifer M I

2010-01-01

Perceived stress has been associated with fewer health-promoting behaviors in new primiparous mothers, but less is known about the mechanisms responsible for such effects. The objective of this study was to examine the hypothesis that the relationship between perceived stress and health-promoting behaviors is mediated partially by a primiparous mother's sense of optimism. The transactional model of stress and coping and the model of behavioral self-regulation were used as the theoretical framework for the study. An ex post facto cross-sectional design was used for this study. Participants consisted of 174 primiparous mothers who had given birth within the previous 12 months. Participants completed a self-reported online questionnaire consisting of the Perceived Stress Scale, the Health-Promoting Lifestyle Profile II, and the revised Life Orientation Test. Results indicated that perceived stress predicted less health-promoting behaviors in new primiparous mothers (p < .001). Importantly, this relationship was mediated partially by the optimism displayed by the mother (p < .001). The findings indicated that optimism partially mediated the relationship between perceived stress and health-promoting behaviors in new primiparous mothers. The implications for psychological practice are discussed.

Reconstruction after complex facial trauma: achieving optimal outcome through multiple contemporary surgeries.

PubMed

Jaiswal, Rohit; Pu, Lee L Q

2013-04-01

Major facial trauma injuries often require complex repair. Traditionally, the reconstruction of such injuries has primarily utilized only free tissue transfer. However, the advent of newer, contemporary procedures may lead to potential reconstructive improvement through the use of complementary procedures after free flap reconstruction. An 18-year-old male patient suffered a major left facial degloving injury resulting in soft-tissue defect with exposed zygoma, and parietal bone. Multiple operations were undertaken in a staged manner for reconstruction. A state-of-the-art free anterolateral thigh (ALT) perforator flap and Medpor implant reconstruction of the midface were initially performed, followed by flap debulking, lateral canthopexy, midface lift with redo canthopexy, scalp tissue expansion for hairline reconstruction, and epidermal skin grafting for optimal skin color matching. Over a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures following an excellent free ALT flap reconstruction. Multiple staged reconstructions are essential in producing an optimal outcome in this complex facial injury that would likely not have been produced through a 1-stage traditional free flap reconstruction. Utilizing multiple, sequential contemporary surgeries may substantially improve outcome through the enhancement and refinement of results based on possibly the best initial soft-tissue reconstruction.

Use of allopurinol with low-dose 6-mercaptopurine in inflammatory bowel disease to achieve optimal active metabolite levels: A review of four cases and the literature

PubMed Central

Witte, Todd N; Ginsberg, Allen L

2008-01-01

BACKGROUND: At least one-third of patients with inflammatory bowel disease do not respond or are intolerant to therapy with 6-mercaptopurine (6-MP). A subgroup fails to attain optimal levels of 6-thioguanine nucleotide (6-TGN) and instead shunts to 6-methylmercaptopurine nucleotide (6-MMPN). PATIENTS AND METHODS: A retrospective chart review was conducted, and four patients are described who had been previously unable to achieve optimal 6-TGN metabolite levels until allopurinol was added to their treatment. RESULTS: All four patients achieved optimal 6-TGN levels and undetectable 6-MMPN with a mean 6-MP dose of 0.49 mg/kg. Three achieved steroid-free clinical remission. Two of those three patients had normalization of liver enzymes; one patient had baseline normal liver enzymes despite an initial 6-MMPN level of 27,369 pmol/8×108 red blood cells. Two patients experienced reversible leukopenia. CONCLUSIONS: Combination allopurinol and low-dose 6-MP is an effective means to achieve optimal metabolite levels and steroid-free clinical remission in previously refractory patients. Caution is advised. PMID:18299738

Millennium Development Goals: how public health professionals perceive the achievement of MDGs.

PubMed

Lomazzi, Marta; Laaser, Ulrich; Theisling, Mareike; Tapia, Leticia; Borisch, Bettina

2014-01-01

There have been various consultations on the Millennium Development Goals (MDGs) by different groups. However, even if it is clear that the health sector has led the development success of the MDGs, only a few MDG reports consider public health experts' points of view and these are mainly government driven. The World Federation of Public Health Associations (WFPHA) has executed a global survey to consult public health professionals worldwide concerning the implementation and achievements of the MDGs. The survey was conceived by WFPHA health professionals and promulgated online. Public health professionals and organisations dealing with MDGs responded to the survey. Content analysis was conducted to analyse the data. Survey participants attributed the highest importance worldwide to MDGs dealing with women, poverty and hunger reduction, and disease prevention and management. Moreover, they underlined the role of education, referring both to school children and professionals. In high and upper-middle income countries, environmental challenges also received considerable attention. Notably, respondents underlined that weak governance and unstable political situations, as well as the gap between professionals and politicians, were among the main causes that detracted from MDG achievements. The public health workforce felt it would be imperative to be included from the outset in the design and implementation of further goals. This implies that those professionals have to take an active part in the political process leading to a new and accountable framework.

Mental-health and educational achievement: the link between poor mental-health and upper secondary school completion and grades.

PubMed

Brännlund, Annica; Strandh, Mattias; Nilsson, Karina

2017-08-01

Education profoundly affects adult socioeconomic status, so it is important to ensure that all children have the capability and opportunity to achieve educational goals. The study aimed to examine the relationship between mental-health during adolescence and upper secondary school completion and grades, which has received comparatively little research attention to date. Longitudinal administrative and registered data were used to analyse the relationship between school achievement and prescriptions of psycholeptic and psycho-analeptic drugs. The sample consisted of all children born in Sweden in 1990 (n = 109 223), who were followed from birth to age 20. Logistic and OLS regressions were performed separately for boys and girls, controlling for birth health and family characteristics. A negative relationship between mental-health problems and educational outcomes was found; this result was almost independent of the controls. Only minor differences between the sexes were detected. Poor mental-health during childhood correlated negatively with educational attainment. Given the strong link between educational success and adult life, more resources are needed to support children with mental-health problems.

Thirty years of national health insurance in South Korea: lessons for achieving universal health care coverage.

PubMed

Kwon, Soonman

2009-01-01

South Korea introduced mandatory social health insurance for industrial workers in large corporations in 1977, and extended it incrementally to the self-employed until it covered the entire population in 1989. Thirty years of national health insurance in Korea can provide valuable lessons on key issues in health care financing policy which now face many low- and middle-income countries aiming to achieve universal health care coverage, such as: tax versus social health insurance; population and benefit coverage; single scheme versus multiple schemes; purchasing and provider payment method; and the role of politics and political commitment. National health insurance in Korea has been successful in mobilizing resources for health care, rapidly extending population coverage, effectively pooling public and private resources to purchase health care for the entire population, and containing health care expenditure. However, there are also challenges posed by the dominance of private providers paid by fee-for-service, the rapid aging of the population, and the public-private mix related to private health insurance.

Strategic Planning as a Tool for Achieving Alignment in Academic Health Centers

PubMed Central

Higginbotham, Eve J.; Church, Kathryn C.

2012-01-01

After the passage of the Patient Protection and Affordable Care Act in March 2010, there is an urgent need for medical schools, teaching hospitals, and practice plans to work together seamlessly across a common mission. Although there is agreement that there should be greater coordination of initiatives and resources, there is little guidance in the literature to address the method to achieve the necessary transformation. Traditional approaches to strategic planning often engage a few leaders and produce a set of immeasurable initiatives. A nontraditional approach, consisting of a Whole-Scale (Dannemiller Tyson Associates, Ann Arbor, MI) engagement, appreciative inquiry, and a balanced scorecard can, more rapidly transform an academic health center. Using this nontraditional approach to strategic planning, increased organizational awareness was achieved in a single academic health center. Strategic planning can be an effective tool to achieve alignment, enhance accountability, and a first step in meeting the demands of the new landscape of healthcare. PMID:23303997

Strategic planning as a tool for achieving alignment in academic health centers.

PubMed

Higginbotham, Eve J; Church, Kathryn C

2012-01-01

After the passage of the Patient Protection and Affordable Care Act in March 2010, there is an urgent need for medical schools, teaching hospitals, and practice plans to work together seamlessly across a common mission. Although there is agreement that there should be greater coordination of initiatives and resources, there is little guidance in the literature to address the method to achieve the necessary transformation. Traditional approaches to strategic planning often engage a few leaders and produce a set of immeasurable initiatives. A nontraditional approach, consisting of a Whole-Scale (Dannemiller Tyson Associates, Ann Arbor, MI) engagement, appreciative inquiry, and a balanced scorecard can, more rapidly transform an academic health center. Using this nontraditional approach to strategic planning, increased organizational awareness was achieved in a single academic health center. Strategic planning can be an effective tool to achieve alignment, enhance accountability, and a first step in meeting the demands of the new landscape of healthcare.

Barriers to optimal diabetes care in Trinidad and Tobago: a health care Professionals' perspective.

PubMed

Roopnarinesingh, Nira; Brennan, Nancyellen; Khan, Claude; Ladenson, Paul W; Hill-Briggs, Felicia; Kalyani, Rita Rastogi

2015-09-19

The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high prevalence of diabetes mellitus (DM) compared to others in the Caribbean. To date, there have been no studies on health care professionals' (HCP) perspectives regarding the barriers to achieving optimal care of patients with DM in this country and few previous studies in the Caribbean, yet such perspectives are imperative to develop strategies that reduce the global burden of this disease. An electronic invitation was sent to prospective HCP in T&T inviting them to attend a symposium on DM and cardiovascular disease. A total of 198 HCP participants attended of whom approximately 100 participants completed an Audience Response Survey at the completion of the conference. The Audience Response Survey included questions regarding access to resources, need for prevention and education, and coordination of care for to diabetes care in T&T. Responses were analyzed in aggregate. The 198 HCP participants attending the symposium included mostly nurses (40 %) and physicians (43 %). The most common specialty indicated by the 198 HCP participants was Internal and Family Medicine (28 %), followed by Anesthesiology (7 %), Emergency Medicine (6 %), Endocrinology and Diabetes (5 %) and Cardiology (3 %). Among the ~100 HCP who completed the Audience Response Survey, multiple barriers to achieving optimal care of patients with diabetes were reported such as: limited access to blood testing (75 %), ophthalmological evaluations (96 %), ECGs (69 %), and cardiac stress tests (92 %); inadequate time to screen and evaluate DM complications (95 %); poor access to consultants for referral of difficult cases (77 %); and lack of provider education regarding cardiovascular complications of DM (57 %). HCP agreed that nurses could potentially be considered to have a more active role in the care and prevention of cardiovascular disease and diabetes through leading patient education efforts (98

Moving Toward Universal Health Coverage (UHC) to Achieve Inclusive and Sustainable Health Development: Three Essential Strategies Drawn From Asian Experience

PubMed Central

Xu, Ye; Huang, Cheng; Colón-Ramos, Uriyoán

2015-01-01

Binagwaho and colleagues’ perspective piece provided a timely reflection on the experience of Rwanda in achieving the Millennium Development Goals (MDGs) and a proposal of 5 principles to carry forward in post-2015 health development. This commentary echoes their viewpoints and offers three lessons for health policy reforms consistent with these principles beyond 2015. Specifically, we argue that universal health coverage (UHC) is an integrated solution to advance the global health development agenda, and the three essential strategies drawn from Asian countries’ health reforms toward UHC are: (1) Public financing support and sequencing health insurance expansion by first extending health insurance to the extremely poor, vulnerable, and marginalized population are critical for achieving UHC; (2) Improved quality of delivered care ensures supply-side readiness and effective coverage; (3) Strategic purchasing and results-based financing creates incentives and accountability for positive changes. These strategies were discussed and illustrated with experience from China and other Asian economies. PMID:26673477

The application of defaults to optimize parents' health-based choices for children.

PubMed

Loeb, Katharine L; Radnitz, Cynthia; Keller, Kathleen; Schwartz, Marlene B; Marcus, Sue; Pierson, Richard N; Shannon, Michael; DeLaurentis, Danielle

2017-06-01

Optimal defaults is a compelling model from behavioral economics and the psychology of human decision-making, designed to shape or "nudge" choices in a positive direction without fundamentally restricting options. The current study aimed to test the effectiveness of optimal (less obesogenic) defaults and parent empowerment priming on health-based decisions with parent-child (ages 3-8) dyads in a community-based setting. Two proof-of-concept experiments (one on breakfast food selections and one on activity choice) were conducted comparing the main and interactive effects of optimal versus suboptimal defaults, and parent empowerment priming versus neutral priming, on parents' health-related choices for their children. We hypothesized that in each experiment, making the default option more optimal will lead to more frequent health-oriented choices, and that priming parents to be the ultimate decision-makers on behalf of their child's health will potentiate this effect. Results show that in both studies, default condition, but not priming condition or the interaction between default and priming, significantly predicted choice (healthier vs. less healthy option). There was also a significant main effect for default condition (and no effect for priming condition or the interaction term) on the quantity of healthier food children consumed in the breakfast experiment. These pilot studies demonstrate that optimal defaults can be practicably implemented to improve parents' food and activity choices for young children. Results can inform policies and practices pertaining to obesogenic environmental factors in school, restaurant, and home environments. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Study of the Relationships between Distributed Leadership, Teacher Academic Optimism and Student Achievement in Taiwanese Elementary Schools

ERIC Educational Resources Information Center

Chang, I-Hua

2011-01-01

The purpose of this study was to explore the relationships between distributed leadership, teachers' academic optimism and student achievement in learning. The study targeted public elementary schools in Taiwan and adopted stratified random sampling to investigate 1500 teachers. Teachers' perceptions were collected by a self-report scale. In…

Direct and Mediated Relationships Between Participation in a Telephonic Health Coaching Program and Health Behavior, Life Satisfaction, and Optimism.

PubMed

Sears, Lindsay E; Coberley, Carter R; Pope, James E

2016-07-01

The aim of this study was to examine the direct and mediated effects of a telephonic health coaching program on changes to healthy behaviors, life satisfaction, and optimism. This longitudinal correlational study of 4881 individuals investigated simple and mediated relationships between participation in a telephonic health risk coaching program and outcomes from three annual Well-being Assessments. Program participation was directly related to improvements in healthy behaviors, life satisfaction and optimism, and indirect effects of coaching on these variables concurrently and over a one-year time lag were also supported. Given previous research that improvements to life satisfaction, optimism, and health behaviors are valuable for individuals, employers, and communities, a clearer understanding of intervention approaches that may impact these outcomes simultaneously can drive greater program effectiveness and value on investment.

Improving mental health outcomes: achieving equity through quality improvement.

PubMed

Poots, Alan J; Green, Stuart A; Honeybourne, Emmi; Green, John; Woodcock, Thomas; Barnes, Ruth; Bell, Derek

2014-04-01

To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. A psychological therapy service in Westminster, London, UK. People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = -6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories. QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome.

Changes in Optimism Are Associated with Changes in Health Over Time Among Older Adults.

PubMed

Chopik, William J; Kim, Eric S; Smith, Jacqui

2015-09-01

Little is known about how optimism differs by age and changes over time, particularly among older adults. Even less is known about how changes in optimism are related to changes in physical health. We examined age differences and longitudinal changes in optimism in 9,790 older adults over a four-year period. We found an inverted U-shaped pattern between optimism and age both cross-sectionally and longitudinally, such that optimism generally increased in older adults before decreasing. Increases in optimism over a four-year period were associated with improvements in self-rated health and fewer chronic illnesses over the same time frame. The findings from the current study are consistent with changes in emotion regulation strategies employed by older adults and age-related changes in well-being.

Changes in Optimism Are Associated with Changes in Health Over Time Among Older Adults

PubMed Central

Chopik, William J.; Kim, Eric S.; Smith, Jacqui

2016-01-01

Little is known about how optimism differs by age and changes over time, particularly among older adults. Even less is known about how changes in optimism are related to changes in physical health. We examined age differences and longitudinal changes in optimism in 9,790 older adults over a four-year period. We found an inverted U-shaped pattern between optimism and age both cross-sectionally and longitudinally, such that optimism generally increased in older adults before decreasing. Increases in optimism over a four-year period were associated with improvements in self-rated health and fewer chronic illnesses over the same time frame. The findings from the current study are consistent with changes in emotion regulation strategies employed by older adults and age-related changes in well-being. PMID:27114753

Relationships among Stress, Coping, and Mental Health in High-Achieving High School Students

ERIC Educational Resources Information Center

Suldo, Shannon M.; Shaunessy, Elizabeth; Hardesty, Robin

2008-01-01

This study investigates the relationships among stress, coping, and mental health in 139 students participating in an International Baccalaureate (IB) high school diploma program. Mental health was assessed using both positive indicators (life satisfaction, academic achievement, academic self-efficacy) and negative indicators (psychopathology) of…

The Longitudinal Link between Student Health and Math Achievement Scores

ERIC Educational Resources Information Center

Garcy, Anthony M.

2009-01-01

This study investigated the relationship between health conditions suffered over time and student scores on the Stanford Achievement Test 9 in Yuma County, Arizona, public grade schools. The majority of children in Yuma County were of Hispanic origin. The poverty and low income status of most of these children placed them at greater risk for…

Inverse-optimized 3D conformal planning: Minimizing complexity while achieving equivalence with beamlet IMRT in multiple clinical sites

PubMed Central

Fraass, Benedick A.; Steers, Jennifer M.; Matuszak, Martha M.; McShan, Daniel L.

2012-01-01

user-controllable search strategies which optimize plans without beamlet or pencil beam approximations. IO-3D allows comparisons of beamlet, multisegment, and conformal plans optimized using the same cost functions, dose points, and plan evaluation metrics, so quantitative comparisons are straightforward. Here, comparisons of IO-3D and beamlet IMRT techniques are presented for breast, brain, liver, and lung plans. Results: IO-3D achieves high quality results comparable to beamlet IMRT, for many situations. Though the IO-3D plans have many fewer degrees of freedom for the optimization, this work finds that IO-3D plans with only one to two segments per beam are dosimetrically equivalent (or nearly so) to the beamlet IMRT plans, for several sites. IO-3D also reduces plan complexity significantly. Here, monitor units per fraction (MU/Fx) for IO-3D plans were 22%–68% less than that for the 1 cm × 1 cm beamlet IMRT plans and 72%–84% than the 0.5 cm × 0.5 cm beamlet IMRT plans. Conclusions: The unique IO-3D algorithm illustrates that inverse planning can achieve high quality 3D conformal plans equivalent (or nearly so) to unconstrained beamlet IMRT plans, for many sites. IO-3D thus provides the potential to optimize flat or few-segment 3DCRT plans, creating less complex optimized plans which are efficient and simple to deliver. The less complex IO-3D plans have operational advantages for scenarios including adaptive replanning, cases with interfraction and intrafraction motion, and pediatric patients. PMID:22755717

Platform-dependent optimization considerations for mHealth applications

NASA Astrophysics Data System (ADS)

Kaghyan, Sahak; Akopian, David; Sarukhanyan, Hakob

2015-03-01

Modern mobile devices contain integrated sensors that enable multitude of applications in such fields as mobile health (mHealth), entertainment, sports, etc. Human physical activity monitoring is one of such the emerging applications. There exists a range of challenges that relate to activity monitoring tasks, and, particularly, exploiting optimal solutions and architectures for respective mobile software application development. This work addresses mobile computations related to integrated inertial sensors for activity monitoring, such as accelerometers, gyroscopes, integrated global positioning system (GPS) and WLAN-based positioning, that can be used for activity monitoring. Some of the aspects will be discussed in this paper. Each of the sensing data sources has its own characteristics such as specific data formats, data rates, signal acquisition durations etc., and these specifications affect energy consumption. Energy consumption significantly varies as sensor data acquisition is followed by data analysis including various transformations and signal processing algorithms. This paper will address several aspects of more optimal activity monitoring implementations exploiting state-of-the-art capabilities of modern platforms.

A system dynamics optimization framework to achieve population desired of average weight target

NASA Astrophysics Data System (ADS)

Abidin, Norhaslinda Zainal; Zulkepli, Jafri Haji; Zaibidi, Nerda Zura

2017-11-01

Obesity is becoming a serious problem in Malaysia as it has been rated as the highest among Asian countries. The aim of the paper is to propose a system dynamics (SD) optimization framework to achieve population desired weight target based on the changes in physical activity behavior and its association to weight and obesity. The system dynamics approach of stocks and flows diagram was used to quantitatively model the impact of both behavior on the population's weight and obesity trends. This work seems to bring this idea together and highlighting the interdependence of the various aspects of eating and physical activity behavior on the complex of human weight regulation system. The model was used as an experimentation vehicle to investigate the impacts of changes in physical activity on weight and prevalence of obesity implications. This framework paper provides evidence on the usefulness of SD optimization as a strategic decision making approach to assist in decision making related to obesity prevention. SD applied in this research is relatively new in Malaysia and has a high potential to apply to any feedback models that address the behavior cause to obesity.

The Relationship of Mental Pressure with Optimism and Academic Achievement Motivation among Second Grade Male High School Students

ERIC Educational Resources Information Center

Sarouni, Ali Sedigh; Jenaabadi, Hossein; Pourghaz, Abdulwahab

2016-01-01

The present study aimed to examine the relationship of mental pressure with optimism and academic achievement motivation among second grade second period male high school students. This study followed a descriptive-correlational method. The sample included 200 second grade second period male high school students in Sooran. Data collection tools in…

Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China

PubMed Central

Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan

2017-01-01

Objective China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. Methods A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. Results There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Conclusion Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that

Toward achieving precision health

PubMed Central

Gambhir, Sanjiv Sam; Ge, T. Jessie; Vermesh, Ophir; Spitler, Ryan

2018-01-01

Health care systems primarily focus on patients after they present with disease, not before. The emerging field of precision health encourages disease prevention and earlier detection by monitoring health and disease based on an individual’s risk. Active participation in health care can be encouraged with continuous health-monitoring devices, providing a higher-resolution picture of human health and disease. However, the development of monitoring technologies must prioritize the collection of actionable data and long-term user engagement. PMID:29491186

Millennium Development Goals: how public health professionals perceive the achievement of MDGs

PubMed Central

Lomazzi, Marta; Laaser, Ulrich; Theisling, Mareike; Tapia, Leticia; Borisch, Bettina

2014-01-01

Background There have been various consultations on the Millennium Development Goals (MDGs) by different groups. However, even if it is clear that the health sector has led the development success of the MDGs, only a few MDG reports consider public health experts’ points of view and these are mainly government driven. Designs The World Federation of Public Health Associations (WFPHA) has executed a global survey to consult public health professionals worldwide concerning the implementation and achievements of the MDGs. The survey was conceived by WFPHA health professionals and promulgated online. Public health professionals and organisations dealing with MDGs responded to the survey. Content analysis was conducted to analyse the data. Results Survey participants attributed the highest importance worldwide to MDGs dealing with women, poverty and hunger reduction, and disease prevention and management. Moreover, they underlined the role of education, referring both to school children and professionals. In high and upper-middle income countries, environmental challenges also received considerable attention. Notably, respondents underlined that weak governance and unstable political situations, as well as the gap between professionals and politicians, were among the main causes that detracted from MDG achievements. Conclusion The public health workforce felt it would be imperative to be included from the outset in the design and implementation of further goals. This implies that those professionals have to take an active part in the political process leading to a new and accountable framework. PMID:25249060

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals

PubMed Central

Matt, Dominik T.

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system. PMID:29065578

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals.

PubMed

Arcidiacono, Gabriele; Matt, Dominik T; Rauch, Erwin

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system.

Towards achievement of universal health care in India by 2020: a call to action.

PubMed

Reddy, K Srinath; Patel, Vikram; Jha, Prabhat; Paul, Vinod K; Kumar, A K Shiva; Dandona, Lalit

2011-02-26

To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the out-of-pocket expenditure on health care through a well regulated integration of the private sector within the national health-care system. Dialogue and consensus building among the stakeholders in the government, civil society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In our call to action, we propose that India must achieve health care for all by 2020. Copyright © 2011 Elsevier Ltd. All rights reserved.

Towards achievement of universal health care in India by 2020: a call to action

PubMed Central

Reddy, K Srinath; Patel, Vikram; Jha, Prabhat; Paul, Vinod K; Shiva Kumar, A K; Dandona, Lalit

2016-01-01

To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the out-of-pocket expenditure on health care through a well regulated integration of the private sector within the national health-care system. Dialogue and consensus building among the stakeholders in the government, civil society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In our call to action, we propose that India must achieve health care for all by 2020. PMID:21227489

Periodic Application of Stochastic Cost Optimization Methodology to Achieve Remediation Objectives with Minimized Life Cycle Cost

NASA Astrophysics Data System (ADS)

Kim, U.; Parker, J.

2016-12-01

Many dense non-aqueous phase liquid (DNAPL) contaminated sites in the U.S. are reported as "remediation in progress" (RIP). However, the cost to complete (CTC) remediation at these sites is highly uncertain and in many cases, the current remediation plan may need to be modified or replaced to achieve remediation objectives. This study evaluates the effectiveness of iterative stochastic cost optimization that incorporates new field data for periodic parameter recalibration to incrementally reduce prediction uncertainty and implement remediation design modifications as needed to minimize the life cycle cost (i.e., CTC). This systematic approach, using the Stochastic Cost Optimization Toolkit (SCOToolkit), enables early identification and correction of problems to stay on track for completion while minimizing the expected (i.e., probability-weighted average) CTC. This study considers a hypothetical site involving multiple DNAPL sources in an unconfined aquifer using thermal treatment for source reduction and electron donor injection for dissolved plume control. The initial design is based on stochastic optimization using model parameters and their joint uncertainty based on calibration to site characterization data. The model is periodically recalibrated using new monitoring data and performance data for the operating remediation systems. Projected future performance using the current remediation plan is assessed and reoptimization of operational variables for the current system or consideration of alternative designs are considered depending on the assessment results. We compare remediation duration and cost for the stepwise re-optimization approach with single stage optimization as well as with a non-optimized design based on typical engineering practice.

Practical Approaches for Achieving Integrated Behavioral Health Care in Primary Care Settings

PubMed Central

Ratzliff, Anna; Phillips, Kathryn E.; Sugarman, Jonathan R.; Unützer, Jürgen; Wagner, Edward H.

2016-01-01

Behavioral health problems are common, yet most patients do not receive effective treatment in primary care settings. Despite availability of effective models for integrating behavioral health care in primary care settings, uptake has been slow. The Behavioral Health Integration Implementation Guide provides practical guidance for adapting and implementing effective integrated behavioral health care into patient-centered medical homes. The authors gathered input from stakeholders involved in behavioral health integration efforts: safety net providers, subject matter experts in primary care and behavioral health, a behavioral health patient and peer specialist, and state and national policy makers. Stakeholder input informed development of the Behavioral Health Integration Implementation Guide and the GROW Pathway Planning Worksheet. The Behavioral Health Integration Implementation Guide is model neutral and allows organizations to take meaningful steps toward providing integrated care that achieves access and accountability. PMID:26698163

Practical Approaches for Achieving Integrated Behavioral Health Care in Primary Care Settings.

PubMed

Ratzliff, Anna; Phillips, Kathryn E; Sugarman, Jonathan R; Unützer, Jürgen; Wagner, Edward H

Behavioral health problems are common, yet most patients do not receive effective treatment in primary care settings. Despite availability of effective models for integrating behavioral health care in primary care settings, uptake has been slow. The Behavioral Health Integration Implementation Guide provides practical guidance for adapting and implementing effective integrated behavioral health care into patient-centered medical homes. The authors gathered input from stakeholders involved in behavioral health integration efforts: safety net providers, subject matter experts in primary care and behavioral health, a behavioral health patient and peer specialist, and state and national policy makers. Stakeholder input informed development of the Behavioral Health Integration Implementation Guide and the GROW Pathway Planning Worksheet. The Behavioral Health Integration Implementation Guide is model neutral and allows organizations to take meaningful steps toward providing integrated care that achieves access and accountability.

Making it local: Beacon Communities use health information technology to optimize care management.

PubMed

Allen, Amy; Des Jardins, Terrisca R; Heider, Arvela; Kanger, Chatrian R; Lobach, David F; McWilliams, Lee; Polello, Jennifer M; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C; Turske, Scott A

2014-06-01

Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks--including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation--the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability.

Making It Local: Beacon Communities Use Health Information Technology to Optimize Care Management

PubMed Central

Allen, Amy; Des Jardins, Terrisca R.; Heider, Arvela; Kanger, Chatrian R.; Lobach, David F.; McWilliams, Lee; Polello, Jennifer M.; Schachter, Abigail A.; Singh, Ranjit; Sorondo, Barbara; Tulikangas, Megan C.; Turske, Scott A.

2014-01-01

Abstract Care management aims to provide cost-effective, coordinated, non-duplicative care to improve care quality, population health, and reduce costs. The 17 communities receiving funding from the Office of the National Coordinator for Health Information Technology through the Beacon Community Cooperative Agreement Program are leaders in building and strengthening their health information technology (health IT) infrastructure to provide more effective and efficient care management. This article profiles 6 Beacon Communities' health IT-enabled care management programs, highlighting the influence of local context on program strategy and design, and describing challenges, lessons learned, and policy implications for care delivery and payment reform. The unique needs (eg, disease burden, demographics), community partnerships, and existing resources and infrastructure all exerted significant influence on the overall priorities and design of each community's care management program. Though each Beacon Community needed to engage in a similar set of care management tasks—including patient identification, stratification, and prioritization; intervention; patient engagement; and evaluation—the contextual factors helped shape the specific strategies and tools used to carry out these tasks and achieve their objectives. Although providers across the country are striving to deliver standardized, high-quality care, the diverse contexts in which this care is delivered significantly influence the priorities, strategies, and design of community-based care management interventions. Gaps and challenges in implementing effective community-based care management programs include: optimizing allocation of care management services; lack of available technology tailored to care management needs; lack of standards and interoperability; integrating care management into care settings; evaluating impact; and funding and sustainability. (Population Health Management 2014;17:149–158) PMID

HealthMpowerment.org: Building Community through a Mobile-Optimized, Online Health Promotion Intervention

ERIC Educational Resources Information Center

Hightow-Weidman, Lisa B.; Muessig, Kathryn E.; Pike, Emily C.; LeGrand, Sara; Baltierra, Nina; Rucker, Alvin Justin; Wilson, Patrick

2015-01-01

Background: Both young Black men who have sex with men as well as young Black transgender women (YBMSM/TW) continue to experience a significant increase in HIV incidence. HealthMpowerment.org (HMP) is a mobile phone-optimized, online intervention for both YBMSM/TW to build community and facilitate supportive relationships. Methods: To assess the…

Achieving Millennium Development Goals for Health: Building Understanding, Trust and Capacity to Respond

PubMed Central

Larson, Heidi J.

2007-01-01

Biomedical interventions promise achievement of health-related Millennium Development Goals provided social-, capacity- and knowledge-based constraints to scaling up and reaching marginalized people at risk, are addressed, and balance between prevention and treatment is struck. We argue for a new approach: multi-stakeholder capacity building and learning for empowerment: MuSCLE. MuSCLE is used as a way to frame three systemic weaknesses in traditional health science and policy approaches: 1) a lack of engagement with people at risk to build a collective understanding of the contexts of health problems; 2) a lack of multi-criteria evaluation of alternative interventions; and 3) a lack of attention paid to integrated capacity building. The MuSCLE framework responds in three ways: 1) Participatory assessment of the ecological, socio-cultural, economic and political contexts of health, identifying priorities using risk and vulnerability science, and modeling drivers; 2) Selection among intervention alternatives that makes ecological, socio-cultural, economic and political tradeoffs transparent; and 3) Integrated capacity building for sustainable and adaptive interventions. Literature and field lessons support the argument, and guidelines are set down. A MuSCLE approach argues for a transformation in health science and policy in order to achieve Millennium Development Goals for health. PMID:17399849

Achieving Millennium Development Goals for health: building understanding, trust and capacity to respond.

PubMed

Downs, Timothy John; Larson, Heidi Jane

2007-10-01

Biomedical interventions promise achievement of health-related Millennium Development Goals provided social-, capacity- and knowledge-based constraints to scaling up and reaching marginalized people at risk, are addressed, and balance between prevention and treatment is struck. We argue for a new approach: multi-stakeholder capacity building and learning for empowerment: MuSCLE. MuSCLE is used as a way to frame three systemic weaknesses in traditional health science and policy approaches: (1) a lack of engagement with people at risk to build a collective understanding of the contexts of health problems, including social drivers; (2) a lack of multi-criteria evaluation of alternative interventions; (3) a lack of attention paid to integrated capacity building. The MuSCLE framework responds in three ways: (1) participatory assessment of the ecological, socio-cultural, economic and political contexts of health, identifying priorities using risk and vulnerability science, and modeling drivers; (2) selection among intervention alternatives that makes ecological, socio-cultural, economic and political tradeoffs transparent; (3) integrated capacity building for sustainable and adaptive interventions. Literature and field lessons support the argument, and guidelines are set down. A MuSCLE approach argues for a transformation in health science and policy in order to achieve Millennium Development Goals for health.

Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China.

PubMed

Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan

2017-06-02

China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members

End-Stage Renal Disease Models in the Americas: Optimizing Resources to Achieve Better Health Outcomes.

PubMed

Gilardino, Ramiro E; González-Pier, Eduardo; Brabata, Claudia

2018-05-21

End-stage renal disease, the last and most severe stage of chronic kidney disease, represents a major and rising concern for countries in Latin America, driven in large part by aging populations and the near-epidemic rises in diabetes, obesity, and hypertension. This places a great clinical, economic, and social burden on the region's health systems. During the ISPOR 6th Latin America Conference held in Sao Paulo, Brazil, in September 2017, an educational forum debated on value-based decision making in the treatment of end-stage renal disease in Latin America. We summarize the current state and how to build strategies and implement actions to move to a more patient-centered, outcomes-based approach for renal care in the region, taken from the discussions in the conference and also from a literature review. Models of renal care used in Ontario (Canada), Colombia, and a Chilean hospital stress the importance of empowering and supporting patients and their families, allowing for a better coordination between primary care providers and specialists, providing financial incentives to health units, and establishing an entity that holds insurers and providers accountable for health outcomes and costs of treatment. The study uses the framework of value-based health care for the evaluation of different dialysis options-peritoneal dialysis, hemodialysis, home dialysis, and so forth-and calls for the countries to adopt an integrated care model. We emphasize that countries in Latin America need to recognize the chronic kidney disease challenge and develop health systems and efficient renal care models to be able to reduce the burden of the disease. Copyright © 2018. Published by Elsevier Inc.

Optimal allocation of land and water resources to achieve Water, Energy and Food Security in the upper Blue Nile basin

NASA Astrophysics Data System (ADS)

Allam, M.; Eltahir, E. A. B.

2017-12-01

Rapid population growth, hunger problems, increasing energy demands, persistent conflicts between the Nile basin riparian countries and the potential impacts of climate change highlight the urgent need for the conscious stewardship of the upper Blue Nile (UBN) basin resources. This study develops a framework for the optimal allocation of land and water resources to agriculture and hydropower production in the UBN basin. The framework consists of three optimization models that aim to: (a) provide accurate estimates of the basin water budget, (b) allocate land and water resources optimally to agriculture, and (c) allocate water to agriculture and hydropower production, and investigate trade-offs between them. First, a data assimilation procedure for data-scarce basins is proposed to deal with data limitations and produce estimates of the hydrologic components that are consistent with the principles of mass and energy conservation. Second, the most representative topography and soil properties datasets are objectively identified and used to delineate the agricultural potential in the basin. The agricultural potential is incorporated into a land-water allocation model that maximizes the net economic benefits from rain-fed agriculture while allowing for enhancing the soils from one suitability class to another to increase agricultural productivity in return for an investment in soil inputs. The optimal agricultural expansion is expected to reduce the basin flow by 7.6 cubic kilometres, impacting downstream countries. The optimization framework is expanded to include hydropower production. This study finds that allocating water to grow rain-fed teff in the basin is more profitable than allocating water for hydropower production. Optimal operation rules for the Grand Ethiopian Renaissance dam (GERD) are identified to maximize annual hydropower generation while achieving a relatively uniform monthly production rate. Trade-offs between agricultural expansion and hydropower

Leadership profile: HealthAchieve 2013 Nursing Leadership Award Winner, Tiziana Rivera.

PubMed

Rivera, Tiziana

2014-03-01

Tiziana Rivera, the winner of the 2013 Nursing Leadership Award at the November HealthAchieve conference, is chief nursing executive and chief practice officer at Mackenzie Health. As such, she provides strategic leadership for the development and implementation of a shared vision for professional practice, nursing and all disciplines to promote innovative care and the development of care delivery models that will improve quality of care and population health.Prior to assuming her position at Mackenzie Health, Rivera provided strategic leadership for the Seniors' Health Program at Trillium Health Centre, where her role focused on the development of seniors' health services across the continuum of care. She has published numerous articles in refereed journals, conducted several research studies and presented her papers provincially, nationally and internationally. Rivera has a clinical appointment at the University of Toronto Faculty of Nursing, a faculty adviser position at Ryerson and an adjunct faculty position at the School of Health Sciences, York University and at the School of Health Sciences, Humber Institute of Technology and Advanced Learning.In the following Q and A, Rivera shares her thoughts on leadership in nursing and perspectives on several critical issues.

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals

PubMed

Arcidiacono, Gabriele; Matt, Dominik T.; Rauch, Erwin

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system. © 2017 Gabriele Arcidiacono et al.

The association between achieving low-density lipoprotein cholesterol (LDL-C) goal and statin treatment in an employee population.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Schultz, Alyssa B; Edington, Dee W

2010-02-01

Statin medications are recommended for patients who have not achieved low-density lipoprotein cholesterol (LDL-C) goals through lifestyle modifications. The objective of this retrospective observational study was to examine statin medication usage patterns and the relationship with LDL-C goal levels (according to Adult Treatment Panel III guidelines) among a cohort of employees of a major financial services corporation. From 1995 to 2004, a total of 1607 executives participated in a periodic health examination program. An index date was assigned for each study participant (date of their exam) and statin medication usage was determined from the pharmacy claims database for 365 days before the index date. Patients were identified as adherent to statins if the medication possession ratio was > or =80%. In all, 150 (9.3%) executives filled at least 1 statin prescription in the 365 days prior to their exam. A total of 102 statin users (68%) were adherent to statin medication. Among all executives who received statin treatment, 70% (odds ratio [OR] = 2.30, 95% confidence interval [CI] = 1.82, 2.90) achieved near-optimal (<130 mg/dL) and 30% (OR = 1.78, 95% CI = 1.15, 2.76) achieved optimal (<100 mg/dL) LDL-C goals, which is significantly higher than the rates among statin nonusers (55% and 21%). Adherent statin users were more likely to achieve recommended near-optimal LDL-C goals compared to statin nonusers (overall P = 0.002; adherent: OR = 2.75, 95% CI = 1.662, 4.550), while nonadherent statin users were more likely to achieve the optimal goal compared to statin nonusers (OR = 2.223; CI = 1.145, 4.313). Statin usage was associated with improvements in LDL-C goal attainment among executives who participated in a periodic health examination. Appropriate statin medication adherence should be encouraged in working populations in order to achieve LDL-C goals.

Health as a Predictor of Students' Academic Achievement: A 3-Level Longitudinal Study of Finnish Adolescents

ERIC Educational Resources Information Center

Minkkinen, Jaana; Lindfors, Pirjo; Kinnunen, Jaana; Finell, Eerika; Vainikainen, Mari-Pauliina; Karvonen, Sakari; Rimpelä, Arja

2017-01-01

Background: Studies have shown a relationship between students' health and their academic achievements, but whether health of classmates and schoolmates impacts individual students' school achievement is less known. We studied these effects on students in lower secondary school in Finland. Methods: Students (seventh grade, age 12-13 years, N =…

Achieving the American dream: facilitators and barriers to health and mental health for Latino immigrants.

PubMed

Shobe, Marcia A; Coffman, Maren J; Dmochowski, Jacek

2009-01-01

Latinos are the largest minority group in the U.S. For Latino immigrants, a shift in migration from larger to smaller cities has recently occurred; the Latino immigrant population in Charlotte, North Carolina, has increased by 634% since 1990. The extent to which immigrants can achieve health and well-being is often related to employment, healthcare access, and social support. This study explored the human, social, and financial capital circumstances of Latino immigrants new to Charlotte and examined the effects of different aspects of capital on health outcomes. Findings indicate that capital is significantly associated with functional status and depression. Implications for social work are discussed.

Performance evaluation of a health insurance in Nigeria using optimal resource use: health care providers perspectives

PubMed Central

2014-01-01

Background Performance measures are often neglected during the transition period of national health insurance scheme implementation in many low and middle income countries. These measurements evaluate the extent to which various aspects of the schemes meet their key objectives. This study assesses the implementation of a health insurance scheme using optimal resource use domains and examines possible factors that influence each domain, according to providers’ perspectives. Methods A retrospective, cross-sectional survey was done between August and December 2010 in Kaduna state, and 466 health care provider personnel were interviewed. Optimal-resource-use was defined in four domains: provider payment mechanism (capitation and fee-for-service payment methods), benefit package, administrative efficiency, and active monitoring mechanism. Logistic regression analysis was used to identify provider factors that may influence each domain. Results In the provider payment mechanism domain, capitation payment method (95%) performed better than fee-for-service payment method (62%). Benefit package domain performed strongly (97%), while active monitoring mechanism performed weakly (37%). In the administrative efficiency domain, both promptness of referral system (80%) and prompt arrival of funds (93%) performed well. At the individual level, providers with fewer enrolees encountered difficulties with reimbursement. Other factors significantly influenced each of the optimal-resource-use domains. Conclusions Fee-for-service payment method and claims review, in the provider payment and active monitoring mechanisms, respectively, performed weakly according to the providers’ (at individual-level) perspectives. A short-fall on the supply-side of health insurance could lead to a direct or indirect adverse effect on the demand-side of the scheme. Capitation payment per enrolees should be revised to conform to economic circumstances. Performance indicators and providers�

Toward a Fourth Generation of Disparities Research to Achieve Health Equity

PubMed Central

Thomas, Stephen B.; Quinn, Sandra Crouse; Butler, James; Fryer, Craig S.; Garza, Mary A.

2011-01-01

Achieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap. We propose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher’s own biases as part of the research process. PMID:21219164

Primary Health Care and Public Health: Foundations of Universal Health Systems

PubMed Central

White, Franklin

2015-01-01

The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. PMID:25591411

Primary health care and public health: foundations of universal health systems.

PubMed

White, Franklin

2015-01-01

The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

Achieving and sustaining automated health data linkages for learning systems: barriers and solutions.

PubMed

Van Eaton, Erik G; Devlin, Allison B; Devine, Emily Beth; Flum, David R; Tarczy-Hornoch, Peter

2014-01-01

implementations required each hospital to devote more IT resources than were predicted. Cost savings did not meet projections because of the increased IT resource requirements and a different source of lowered chart review costs. CERTAIN succeeded in recruiting unaffiliated hospitals into the Automation Project to create an enhanced registry to achieve AHRQ goals. This case report describes several distinct barriers to central data aggregation for QI and CER across unaffiliated hospitals: (1) competition for limited on-site IT expertise, (2) concerns about data use for QI versus research, (3) restrictions on data automation to a defined subset of patients, and (4) unpredictable resource needs because of idiosyncrasies among unaffiliated hospitals in how EHR data are coded, stored, and made available for transmission-even between hospitals using the same vendor's EHR. Therefore, even a fully optimized automation infrastructure would still not achieve complete automation. The Automation Project was unable to align sufficiently with internal hospital objectives, so it could not show a compelling case for sustainability.

Achieving and Sustaining Automated Health Data Linkages for Learning Systems: Barriers and Solutions

PubMed Central

Van Eaton, Erik G.; Devlin, Allison B.; Devine, Emily Beth; Flum, David R.; Tarczy-Hornoch, Peter

2014-01-01

challenges of idiosyncratic EHR implementations required each hospital to devote more IT resources than were predicted. Cost savings did not meet projections because of the increased IT resource requirements and a different source of lowered chart review costs. Discussion: CERTAIN succeeded in recruiting unaffiliated hospitals into the Automation Project to create an enhanced registry to achieve AHRQ goals. This case report describes several distinct barriers to central data aggregation for QI and CER across unaffiliated hospitals: (1) competition for limited on-site IT expertise, (2) concerns about data use for QI versus research, (3) restrictions on data automation to a defined subset of patients, and (4) unpredictable resource needs because of idiosyncrasies among unaffiliated hospitals in how EHR data are coded, stored, and made available for transmission—even between hospitals using the same vendor’s EHR. Therefore, even a fully optimized automation infrastructure would still not achieve complete automation. The Automation Project was unable to align sufficiently with internal hospital objectives, so it could not show a compelling case for sustainability. PMID:25848606

The association of optimism and perceived discrimination with health care utilization in adults with sickle cell disease.

PubMed

Stanton, Michael V; Jonassaint, Charles R; Bartholomew, Frederick B; Edwards, Christopher; Richman, Laura; DeCastro, Laura; Williams, Redford

2010-11-01

We evaluated the effect of perceived discrimination, optimism, and their interaction on health care utilization among African American adults with sickle cell disease (SCD). Measures of optimism and perceived discrimination were obtained in 49 African American SCD patients. Multiple regression analyses controlling for sex and age tested effects of optimism and perceived discrimination on the number of emergency department visits (ED) and number and duration of hospitalizations over the past year. A perceived discrimination-optimism interaction was associated with number of emergency departments visits (b = .29, p = .052), number of hospitalizations (b = .36, p = .019), and duration of hospitalizations (b = .30, p = .045) such that those with high perceived discrimination/high optimism had the greatest health care utilization. African American SCD patients with high perceived discrimination/high optimism had greater health care utilization than patients who reported either low perceived discrimination or low optimism. This study suggests that patient personality and coping styles should be considered when evaluating the effects of stress on SCD-related outcomes.

Health, Dietary Habits, and Achievement Motivation in College Students With Self-Reported ADHD Diagnosis.

PubMed

Merkt, Julia; Gawrilow, Caterina

2016-09-01

The present study aimed to investigate aspects of health and motivation in a subpopulation of college students with ADHD. Seventy-seven college students with self-reported ADHD (49 women; M age = 25.82, SD = 4.62) and 120 college students without ADHD (65 women; M age = 25.17, SD = 5.41) participated in an online survey assessing their health, dietary habits, and achievement motivation. College students with ADHD showed impairment in psychological functioning, impairment in their mental health, and reported more ambition and less self-control. Furthermore, we found gender differences: Women with ADHD reported worse psychological functioning, and the gender differences in obsessive-compulsive behavior and compensatory effort were mediated by the timing of diagnosis. College students, especially women, with ADHD struggle with health-related issues. Some of these gender differences might be due to under diagnosis of girls in childhood. Differences in achievement motivation might indicate compensatory mechanisms. © The Author(s) 2014.

A Consensus Action Agenda for Achieving the National Health Information Infrastructure

PubMed Central

Yasnoff, William A.; Humphreys, Betsy L.; Overhage, J. Marc; Detmer, Don E.; Brennan, Patricia Flatley; Morris, Richard W.; Middleton, Blackford; Bates, David W.; Fanning, John P.

2004-01-01

Background: Improving the safety, quality, and efficiency of health care will require immediate and ubiquitous access to complete patient information and decision support provided through a National Health Information Infrastructure (NHII). Methods: To help define the action steps needed to achieve an NHII, the U.S. Department of Health and Human Services sponsored a national consensus conference in July 2003. Results: Attendees favored a public–private coordination group to guide NHII activities, provide education, share resources, and monitor relevant metrics to mark progress. They identified financial incentives, health information standards, and overcoming a few important legal obstacles as key NHII enablers. Community and regional implementation projects, including consumer access to a personal health record, were seen as necessary to demonstrate comprehensive functional systems that can serve as models for the entire nation. Finally, the participants identified the need for increased funding for research on the impact of health information technology on patient safety and quality of care. Individuals, organizations, and federal agencies are using these consensus recommendations to guide NHII efforts. PMID:15187075

A consensus action agenda for achieving the national health information infrastructure.

PubMed

Yasnoff, William A; Humphreys, Betsy L; Overhage, J Marc; Detmer, Don E; Brennan, Patricia Flatley; Morris, Richard W; Middleton, Blackford; Bates, David W; Fanning, John P

2004-01-01

Improving the safety, quality, and efficiency of health care will require immediate and ubiquitous access to complete patient information and decision support provided through a National Health Information Infrastructure (NHII). To help define the action steps needed to achieve an NHII, the U.S. Department of Health and Human Services sponsored a national consensus conference in July 2003. Attendees favored a public-private coordination group to guide NHII activities, provide education, share resources, and monitor relevant metrics to mark progress. They identified financial incentives, health information standards, and overcoming a few important legal obstacles as key NHII enablers. Community and regional implementation projects, including consumer access to a personal health record, were seen as necessary to demonstrate comprehensive functional systems that can serve as models for the entire nation. Finally, the participants identified the need for increased funding for research on the impact of health information technology on patient safety and quality of care. Individuals, organizations, and federal agencies are using these consensus recommendations to guide NHII efforts.

What is Health and What is Important for its Achievement? A Qualitative Study on Adolescent Boys’ Perceptions and Experiences of Health

PubMed Central

Randell, Eva; Jerdén, Lars; Öhman, Ann; Flacking, Renée

2016-01-01

Few qualitative studies have explored adolescent boys’ perceptions of health. Aim: The aim of this study was therefore to explore how adolescent boys understand the concept of health and what they find important for its achievement Methods: Grounded theory was used as a method to analyse interviews with 33 adolescent boys aged 16 to 17 years attending three upper secondary schools in a relatively small town in Sweden. Results: There was a complexity in how health was perceived, experienced, dealt with, and valued. Although health on a conceptual level was described as ‘holistic’, health was experienced and dealt with in a more dualistic manner, one in which the boys were prone to differentiate between mind and body. Health was experienced as mainly emotional and relational, whereas the body had a subordinate value. The presence of positive emotions, experiencing self-esteem, balance in life, trustful relationships, and having a sense of belonging were important factors for health while the body was experienced as a tool to achieve health, as energy, and as a condition. Conclusion: Our findings indicate that young, masculine health is largely experienced through emotions and relationships and thus support theories on health as a social construction of interconnected processes. PMID:27347252

Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage

PubMed Central

Maaitah, Rowaida Al; AbuAlRub, Raeda Fawzi

2017-01-01

ABSTRACT Objective: to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs) towards the achievement of Universal Health Converge (UHC) as perceived by health key informants in Jordan. Methods: an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. Results: the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. Conclusion: study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation. PMID:28146176

Optimizing Bone Health in Duchenne Muscular Dystrophy.

PubMed

Buckner, Jason L; Bowden, Sasigarn A; Mahan, John D

2015-01-01

Duchenne muscular dystrophy (DMD) is an X-linked recessive disorder characterized by progressive muscle weakness, with eventual loss of ambulation and premature death. The approved therapy with corticosteroids improves muscle strength, prolongs ambulation, and maintains pulmonary function. However, the osteoporotic impact of chronic corticosteroid use further impairs the underlying reduced bone mass seen in DMD, leading to increased fragility fractures of long bones and vertebrae. These serious sequelae adversely affect quality of life and can impact survival. The current clinical issues relating to bone health and bone health screening methods in DMD are presented in this review. Diagnostic studies, including biochemical markers of bone turnover and bone mineral density by dual energy X-ray absorptiometry (DXA), as well as spinal imaging using densitometric lateral spinal imaging, and treatment to optimize bone health in patients with DMD are discussed. Treatment with bisphosphonates offers a method to increase bone mass in these children; oral and intravenous bisphosphonates have been used successfully although treatment is typically reserved for children with fractures and/or bone pain with low bone mass by DXA.

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing.

PubMed

Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

2015-11-01

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing

PubMed Central

Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

2015-01-01

Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser–provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite

Strategies to optimize lithium-ion supercapacitors achieving high-performance: Cathode configurations, lithium loadings on anode, and types of separator

NASA Astrophysics Data System (ADS)

Cao, Wanjun; Li, Yangxing; Fitch, Brian; Shih, Jonathan; Doung, Tien; Zheng, Jim

2014-12-01

The Li-ion capacitor (LIC) is composed of a lithium-doped carbon anode and an activated carbon cathode, which is a half Li-ion battery (LIB) and a half electrochemical double-layer capacitor (EDLC). LICs can achieve much more energy density than EDLC without sacrificing the high power performance advantage of capacitors over batteries. LIC pouch cells were assembled using activated carbon (AC) cathode and hard carbon (HC) + stabilized lithium metal power (SLMP®) anode. Different cathode configurations, various SLMP loadings on HC anode, and two types of separators were investigated to achieve the optimal electrochemical performance of the LIC. Firstly, the cathode binders study suggests that the PTFE binder offers improved energy and power performances for LIC in comparison to PVDF. Secondly, the mass ratio of SLMP to HC is at 1:7 to obtain the optimized electrochemical performance for LIC among all the various studied mass ratios between lithium loading amounts and active anode material. Finally, compared to the separator Celgard PP 3501, cellulose based TF40-30 is proven to be a preferred separator for LIC.

Social support, acculturation, and optimism: understanding positive health practices in Asian American college students.

PubMed

Ayres, Cynthia G; Mahat, Ganga

2012-07-01

This study developed and tested a theory to better understand positive health practices (PHP) among Asian Americans aged 18 to 21 years. It tested theoretical relationships postulated between PHP and (a) social support (SS), (b) optimism, and (c) acculturation, and between SS and optimism and acculturation. Optimism and acculturation were also tested as possible mediators in the relationship between SS and PHP. A correlational study design was used. A convenience sample of 163 Asian college students in an urban setting completed four questionnaires assessing SS, PHP, optimism, and acculturation and one demographic questionnaire. There were statistically significant positive relationships between SS and optimism with PHP, between acculturation and PHP, and between optimism and SS. Optimism mediated the relationship between SS and PHP, whereas acculturation did not. Findings extend knowledge regarding these relationships to a defined population of Asian Americans aged 18 to 21 years. Findings contribute to a more comprehensive knowledge base regarding health practices among Asian Americans. The theoretical and empirical findings of this study provide the direction for future research as well. Further studies need to be conducted to identify and test other mediators in order to better understand the relationship between these two variables.

Association between Optimism, Psychosocial Well Being and Oral Health: A Cross-Sectional Study.

PubMed

Thiruvenkadam, G; Asokan, Sharath; Baby John, J; Geetha Priya, P R

The aim of the study was to assess the association of optimism and psychosocial well being of school going children on their oral health status. The study included 12- to 15-year-old school going children (N = 2014) from Tamilnadu, India. Optimism was measured using the revised version of the Life Orientation Test (LOT-R). A questionnaire was sent to the parents regarding their child's psychosocial behavior which included shyness, feeling inferiority, unhappiness and friendliness. Clinical examination for each child was done to assess the DMFT score and OHI-S score. The data obtained were statistically analyzed using Pearson Chi-Square test, Mann-Whitney test and Kruskal-Wallis test with the aid of SPSS software (version 17). Odds Ratio (OR) was calculated with 95% Confidence Interval (CI). The p value ≤ 0.05 was considered statistically significant. Boys with high optimism had significantly lesser DMFT score than the boys with low optimism (p=0.001). Girls with high optimism had significantly higher DMFT score (p=0.001). In psychosocial outcomes, inferiority (p=0.002) and friendliness (p=0.001) showed significant association with DMFT score. Among the boys, children who felt less inferior (p=0.001), less unhappy (p=0.029) and more friendly (p=0.001) had lesser DMFT score. Among the psychosocial outcomes assessed, inferiority and friendliness had significant association with oral health of the children and hence, can be used as a proxy measures oral health.

Should Schools Be Optimistic? An Investigation of the Association between Academic Optimism of Schools and Student Achievement in Primary Education

ERIC Educational Resources Information Center

Boonen, Tinneke; Pinxten, Maarten; Van Damme, Jan; Onghena, Patrick

2014-01-01

Academic emphasis, collective efficacy, and faculty trust in students and parents (3 school characteristics positively associated with student achievement) are assumed to form a higher order latent construct, "academic optimism" (Hoy, Tarter, & Woolfolk Hoy, 2006a, 2006b). The aim of the present study is to corroborate the latent…

A Family Medicine Health Technology Strategy for Achieving the Triple Aim for US Health Care.

PubMed

Phillips, Robert L; Bazemore, Andrew W; DeVoe, Jennifer E; Weida, Thomas J; Krist, Alex H; Dulin, Michael F; Biagioli, Frances E

2015-09-01

Health information technology (health IT) and health technology, more broadly, offer tremendous promise for connecting, synthesizing, and sharing information critical to improving health care delivery, reducing health system costs, and achieving personal and community health. While efforts to spur adoption of electronic health records (EHRs) among US practices and hospitals have been highly successful, aspirations for effective data exchanges and translation of data into measureable improvements in health outcomes remain largely unrealized. There are shining examples of health enhancement through new technologies, and the discipline of family medicine is well poised to take advantage of these innovations to improve patient and population health. The Future of Family Medicine led to important family medicine health IT initiatives over the past decade. For example, the American Academy of Family Physicians (AAFP) Center for Health Information Technology and the Robert Graham Center provided important leadership for informing health IT policy and standard-setting, such as the Centers for Medicare and Medicaid Services EHR incentives programs (often referred to as "meaningful use."). As we move forward, there is a need for a new and more comprehensive family medicine strategy for technology. To inform the Family Medicine for America's Health (FMAHealth) initiative, this paper explores strategies and tactics that family medicine could pursue to improve the utility of technology for primary care and to help primary care become a leader in rapid development, testing, and implementation of new technologies. These strategies were also designed with a broader stakeholder audience in mind, intending to reach beyond the work being done by FMAHealth. Specific suggestions include: a shared primary care health IT center, meaningful primary care quality measures and capacity to assess/report them, increased primary care technology research, a national family medicine registry

Accelerators/decelerators of achieving universal access to sexual and reproductive health services: a case study of Iranian health system

PubMed Central

2013-01-01

Background At the 1994 International Conference on Population and Development (ICPD), held in Cairo, the global community agreed to the goal of achieving universal access to sexual and reproductive health (SRH) and rights by 2015. This research explores the accelerators and decelerators of achieving universal access to the sexual and reproductive health targets and accordingly makes some suggestions. Method We have critically reviewed the latest national reports and extracted the background data on each SRH indicator. The key stakeholders, both national and international, were visited and interviewed at two sites. A total of 55 in-depth interviews were conducted with religious leaders, policy-makers, senior managers, senior academics, and health care managers. Six focus-group discussions were also held among health care providers. The study was qualitative in nature. Results Obstacles on the road to achieving universal access to SRH can be viewed from two perspectives. One gap exists between current achievements and the targets. The other gap arises due to age, marital status, and residency status. The most recently observed trends in the indicators of the universal access to SRH shows that the achievements in the “unmet need for family planning” have been poor. Unmet need for family planning could directly be translated to unwanted pregnancies and unwanted childbirths; the former calls for sexual education to underserved people, including adolescents; and the latter calls for access to safe abortion. Local religious leaders have not actively attended international goal-setting programs. Therefore, they usually do not presume a positive attitude towards these goals. Such negative attitudes seem to be the most important factors hindering the progress towards universal access to SRH. Lack of international donors to fund for SRH programs is also another barrier. In national levels both state and the society are interactively playing their roles. We have used a

Accelerators/decelerators of achieving universal access to sexual and reproductive health services: a case study of Iranian health system.

PubMed

Akbari, Nahid; Ramezankhani, Ali; Pazargadi, Mehrnoosh

2013-07-01

At the 1994 International Conference on Population and Development (ICPD), held in Cairo, the global community agreed to the goal of achieving universal access to sexual and reproductive health (SRH) and rights by 2015. This research explores the accelerators and decelerators of achieving universal access to the sexual and reproductive health targets and accordingly makes some suggestions. We have critically reviewed the latest national reports and extracted the background data on each SRH indicator. The key stakeholders, both national and international, were visited and interviewed at two sites. A total of 55 in-depth interviews were conducted with religious leaders, policy-makers, senior managers, senior academics, and health care managers. Six focus-group discussions were also held among health care providers. The study was qualitative in nature. Obstacles on the road to achieving universal access to SRH can be viewed from two perspectives. One gap exists between current achievements and the targets. The other gap arises due to age, marital status, and residency status. The most recently observed trends in the indicators of the universal access to SRH shows that the achievements in the "unmet need for family planning" have been poor. Unmet need for family planning could directly be translated to unwanted pregnancies and unwanted childbirths; the former calls for sexual education to underserved people, including adolescents; and the latter calls for access to safe abortion. Local religious leaders have not actively attended international goal-setting programs. Therefore, they usually do not presume a positive attitude towards these goals. Such negative attitudes seem to be the most important factors hindering the progress towards universal access to SRH. Lack of international donors to fund for SRH programs is also another barrier. In national levels both state and the society are interactively playing their roles. We have used a cascade model for presenting the

Dispositional Optimism

PubMed Central

Carver, Charles S.; Scheier, Michael F.

2014-01-01

Optimism is a cognitive construct (expectancies regarding future outcomes) that also relates to motivation: optimistic people exert effort, whereas pessimistic people disengage from effort. Study of optimism began largely in health contexts, finding positive associations between optimism and markers of better psychological and physical health. Physical health effects likely occur through differences in both health-promoting behaviors and physiological concomitants of coping. Recently, the scientific study of optimism has extended to the realm of social relations: new evidence indicates that optimists have better social connections, partly because they work harder at them. In this review, we examine the myriad ways this trait can benefit an individual, and our current understanding of the biological basis of optimism. PMID:24630971

Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association.

PubMed

Gorelick, Philip B; Furie, Karen L; Iadecola, Costantino; Smith, Eric E; Waddy, Salina P; Lloyd-Jones, Donald M; Bae, Hee-Joon; Bauman, Mary Ann; Dichgans, Martin; Duncan, Pamela W; Girgus, Meighan; Howard, Virginia J; Lazar, Ronald M; Seshadri, Sudha; Testai, Fernando D; van Gaal, Stephen; Yaffe, Kristine; Wasiak, Hank; Zerna, Charlotte

2017-10-01

Cognitive function is an important component of aging and predicts quality of life, functional independence, and risk of institutionalization. Advances in our understanding of the role of cardiovascular risks have shown them to be closely associated with cognitive impairment and dementia. Because many cardiovascular risks are modifiable, it may be possible to maintain brain health and to prevent dementia in later life. The purpose of this American Heart Association (AHA)/American Stroke Association presidential advisory is to provide an initial definition of optimal brain health in adults and guidance on how to maintain brain health. We identify metrics to define optimal brain health in adults based on inclusion of factors that could be measured, monitored, and modified. From these practical considerations, we identified 7 metrics to define optimal brain health in adults that originated from AHA's Life's Simple 7: 4 ideal health behaviors (nonsmoking, physical activity at goal levels, healthy diet consistent with current guideline levels, and body mass index <25 kg/m 2 ) and 3 ideal health factors (untreated blood pressure <120/<80 mm Hg, untreated total cholesterol <200 mg/dL, and fasting blood glucose <100 mg/dL). In addition, in relation to maintenance of cognitive health, we recommend following previously published guidance from the AHA/American Stroke Association, Institute of Medicine, and Alzheimer's Association that incorporates control of cardiovascular risks and suggest social engagement and other related strategies. We define optimal brain health but recognize that the truly ideal circumstance may be uncommon because there is a continuum of brain health as demonstrated by AHA's Life's Simple 7. Therefore, there is opportunity to improve brain health through primordial prevention and other interventions. Furthermore, although cardiovascular risks align well with brain health, we acknowledge that other factors differing from those related to

Achieving value for money in health: a comparative analysis of OECD countries and regional countries.

PubMed

Çelik, Yusuf; Khan, Mahmud; Hikmet, Neşet

2017-10-01

To measure efficiency gains in health sector over the years 1995 to 2013 in OECD, EU, non-member European countries. An output-oriented DEA model with variable return to scale, and residuals estimated by regression equations were used to estimate efficiencies of health systems. Slacks for health care outputs and inputs were calculated by using DEA multistage method of estimating country efficiency scores. Better health outcomes of countries were related with higher efficiency. Japan, France, or Sweden were found to be peer-efficient countries when compared to other developed countries like Germany and United States. Increasing life expectancy beyond a certain high level becomes very difficult to achieve. Despite declining marginal productivity of inputs on health outcomes, some developed countries and developing countries were found to have lowered their inefficiencies in the use of health inputs. Although there was no systematic relationship between political system of countries and health system efficiency, the objectives of countries on social and health policy and the way of achieving these objectives might be a factor increasing the efficiency of health systems. Economic and political stability might be as important as health expenditure in improving health system goals. A better understanding of the value created by health expenditures, especially in developed countries, will require analysis of specific health interventions that can increase value for money in health. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

A globally optimal k-anonymity method for the de-identification of health data.

PubMed

El Emam, Khaled; Dankar, Fida Kamal; Issa, Romeo; Jonker, Elizabeth; Amyot, Daniel; Cogo, Elise; Corriveau, Jean-Pierre; Walker, Mark; Chowdhury, Sadrul; Vaillancourt, Regis; Roffey, Tyson; Bottomley, Jim

2009-01-01

Explicit patient consent requirements in privacy laws can have a negative impact on health research, leading to selection bias and reduced recruitment. Often legislative requirements to obtain consent are waived if the information collected or disclosed is de-identified. The authors developed and empirically evaluated a new globally optimal de-identification algorithm that satisfies the k-anonymity criterion and that is suitable for health datasets. Authors compared OLA (Optimal Lattice Anonymization) empirically to three existing k-anonymity algorithms, Datafly, Samarati, and Incognito, on six public, hospital, and registry datasets for different values of k and suppression limits. Measurement Three information loss metrics were used for the comparison: precision, discernability metric, and non-uniform entropy. Each algorithm's performance speed was also evaluated. The Datafly and Samarati algorithms had higher information loss than OLA and Incognito; OLA was consistently faster than Incognito in finding the globally optimal de-identification solution. For the de-identification of health datasets, OLA is an improvement on existing k-anonymity algorithms in terms of information loss and performance.

A new approach to optimal selection of services in health care organizations.

PubMed

Adolphson, D L; Baird, M L; Lawrence, K D

1991-01-01

A new reimbursement policy adopted by Medicare in 1983 caused financial difficulties for many hospitals and health care organizations. Several organizations responded to these difficulties by developing systems to carefully measure their costs of providing services. The purpose of such systems was to provide relevant information about the profitability of hospital services. This paper presents a new method of making hospital service selection decisions: it is based on an optimization model that avoids arbitrary cost allocations as a basis for computing the costs of offering a given service. The new method provides more reliable information about which services are profitable or unprofitable, and it provides an accurate measure of the degree to which a service is profitable or unprofitable. The new method also provides useful information about the sensitivity of the optimal decision to changes in costs and revenues. Specialized algorithms for the optimization model lead to very efficient implementation of the method, even for the largest health care organizations.

Behavioural contracting as a tool to help patients achieve better health.

PubMed

Neale, A V

1991-12-01

Behavioural contracting is an intervention technique in which a client signs an agreement to make certain behaviour changes within a specified time, usually with explicitly defined rewards for adherence or success. Contracting is being increasingly used by health professionals to assist patients in making beneficial life style changes. This paper presents data on the outcome of behavioural contracting interventions to lower serum cholesterol and to increase exercise activity. Of 223 primary care patients enrolled in a health promotion programme, 179 met with the project health educator to improve their cardiovascular risk profile; 144 of these were classified as having 'high cholesterol' and 51 signed contracts to adopt the American Heart Association guidelines diet within a 3-month period. Everyone was encouraged to sign a contract to engage in aerobic exercise three times per week; 96 did so. The results indicate that contractors achieved greater beneficial health changes than non-contractors, and that the group which fully met their contract obligations experienced the greatest health benefit of all (either a lowering of cholesterol or a decreased exercising heart rate).

Learning Optimal Individualized Treatment Rules from Electronic Health Record Data

PubMed Central

Wang, Yuanjia; Wu, Peng; Liu, Ying; Weng, Chunhua; Zeng, Donglin

2016-01-01

Medical research is experiencing a paradigm shift from “one-size-fits-all” strategy to a precision medicine approach where the right therapy, for the right patient, and at the right time, will be prescribed. We propose a statistical method to estimate the optimal individualized treatment rules (ITRs) that are tailored according to subject-specific features using electronic health records (EHR) data. Our approach merges statistical modeling and medical domain knowledge with machine learning algorithms to assist personalized medical decision making using EHR. We transform the estimation of optimal ITR into a classification problem and account for the non-experimental features of the EHR data and confounding by clinical indication. We create a broad range of feature variables that reflect both patient health status and healthcare data collection process. Using EHR data collected at Columbia University clinical data warehouse, we construct a decision tree for choosing the best second line therapy for treating type 2 diabetes patients. PMID:28503676

Creation of Artificial Landscapes Spatial Systems Optimizing Human Habitat on Southern Coasts of the Russian Far East

NASA Astrophysics Data System (ADS)

Golikov, S. Yu; Petukhov, V. I.; Maiorov, I. S.

2017-11-01

The features of artificial landscapes’ spatial systems created for the optimization of industry facilities and settlements (as well as forest and agricultural crops taking into account the optimality of the existing microclimate and the possibilities for its improvement) are discussed in the paper. They improve the population health (through the optimization of the environment of settlements), the health of farm animals, the state of crops (through optimization of the climate), watercourses and forests reducing catastrophes on the shores and slopes by the proper selection and placement of species for artificial planting. They are achieved by revegetation, greening, garden and landscape design. In general, their purpose is to optimize the human environment.

The association between academic engagement and achievement in health sciences students

PubMed Central

2013-01-01

Background Educational institutions play an important role in encouraging student engagement, being necessary to know how engaged are students at university and if this factor is involved in student success point and followed. To explore the association between academic engagement and achievement. Methods Cross-sectional study. The sample consisted of 304 students of Health Sciences. They were asked to fill out an on-line questionnaire. Academic achievements were calculated using three types of measurement. Results Positive correlations were found in all cases. Grade point average was the academic rate most strongly associated with engagement dimensions and this association is different for male and female students. The independent variables could explain between 18.9 and 23.9% of the variance (p < 0.05) in the population of university students being analyzed. Conclusions Engagement has been shown to be one of the many factors, which are positively involved, in the academic achievements of college students. PMID:23446005

The Role of Public Health Nutrition in Achieving the Sustainable Development Goals in the Asia Pacific Region.

PubMed

Binns, Colin; Lee, Mi Kyung; Low, Wah Yun; Zerfas, Alfred

2017-10-01

The Sustainable Development Goals (SDGs) replaced the Millennium Development Goals (MDCs) in 2015, which included several goals and targets primarily related to nutrition: to eradicate extreme poverty and hunger and to reduce child mortality and improve maternal health. In the Asia-Pacific Academic Consortium for Public Health (APACPH) member countries as a group, infant and child mortality were reduced by more than 65% between 1990 and 2015, achieving the MDG target of two-thirds reduction, although these goals were not achieved by several smaller countries. The SDGs are broader in focus than the MDGs, but include several goals that relate directly to nutrition: 2 (zero hunger-food), 3 (good health and well-being-healthy life), and 12 (responsible consumption and production-sustainability). Other SDGs that are closely related to nutrition are 4 and 5 (quality education and equality in gender-education and health for girls and mothers, which is very important for infant health) and 13 (climate action). Goal 3 is "good health and well-being," which includes targets for child mortality, maternal mortality, and reducing chronic disease. The Global Burden of Disease Project has confirmed that the majority of risk for these targets can be attributed to nutrition-related targets. Dietary Guidelines were developed to address public health nutrition risk in the Asia Pacific region at the 48th APACPH 2016 conference and they are relevant to the achievement of the SDGs. Iron deficiency increases the risk of maternal death from haemorrhage, a cause of 300000 deaths world-wide each year. Improving diets and iron supplementation are important public health interventions in the APACPH region. Chronic disease and obesity rates in the APACPH region are now a major challenge and healthy life course nutrition is a major public health priority in answering this challenge. This article discusses the role of public health nutrition in achieving the SDGs. It also examines the role of

Navy Strategy for Achieving Information Dominance, 2013-2017. Optimizing Navy’s Primacy in the Maritime and Information Domains

DTIC Science & Technology

2013-01-01

and resources to optimize decision making and maximize warfighting effects, Navy Information Dominance has become a leading Service priority. In 2009...This Strategy for Achieving Information Dominance provides the framework through which the Navy s information capabilities will be mainstreamed into...the Navy s culture as a distinct warfighting discipline. The strategy focuses on the three fundamental Information Dominance capabilities of Assured

Assessing organizational capacity for achieving meaningful use of electronic health records.

PubMed

Shea, Christopher M; Malone, Robb; Weinberger, Morris; Reiter, Kristin L; Thornhill, Jonathan; Lord, Jennifer; Nguyen, Nicholas G; Weiner, Bryan J

2014-01-01

Health care institutions are scrambling to manage the complex organizational change required for achieving meaningful use (MU) of electronic health records (EHR). Assessing baseline organizational capacity for the change can be a useful step toward effective planning and resource allocation. The aim of this article is to describe an adaptable method and tool for assessing organizational capacity for achieving MU of EHR. Data on organizational capacity (people, processes, and technology resources) and barriers are presented from outpatient clinics within one integrated health care delivery system; thus, the focus is on MU requirements for eligible professionals, not eligible hospitals. We conducted 109 interviews with representatives from 46 outpatient clinics. Most clinics had core elements of the people domain of capacity in place. However, the process domain was problematic for many clinics, specifically, capturing problem lists as structured data and having standard processes for maintaining the problem list in the EHR. Also, nearly half of all clinics did not have methods for tracking compliance with their existing processes. Finally, most clinics maintained clinical information in multiple systems, not just the EHR. The most common perceived barriers to MU for eligible professionals included EHR functionality, changes to workflows, increased workload, and resistance to change. Organizational capacity assessments provide a broad institutional perspective and an in-depth clinic-level perspective useful for making resource decisions and tailoring strategies to support the MU change effort for eligible professionals.

Optimizing point-of-care testing in clinical systems management.

PubMed

Kost, G J

1998-01-01

The goal of improving medical and economic outcomes calls for leadership based on fundamental principles. The manager of clinical systems works collaboratively within the acute care center to optimize point-of-care testing through systematic approaches such as integrative strategies, algorithms, and performance maps. These approaches are effective and efficacious for critically ill patients. Optimizing point-of-care testing throughout the entire health-care system is inherently more difficult. There is potential to achieve high-quality testing, integrated disease management, and equitable health-care delivery. Despite rapid change and economic uncertainty, a macro-strategic, information-integrated, feedback-systems, outcomes-oriented approach is timely, challenging, effective, and uplifting to the creative human spirit.

Optimizing the Office Visit for Adolescents with Special Health Care Needs.

PubMed

Nathawad, Rita; Hanks, Christopher

2017-08-01

Youth with special health care needs (YSHCN) experience health care disparities and often need additional support to receive optimal medical care, particularly in adolescence as they prepare to transition to adult care. Many medical practices struggle to address their needs. Here, we discuss approaches to improve medical care in office-based settings for YSHCN. Office visits can be optimized by training staff in developmentally appropriate care and ensuring that the physical office space facilitates care. Participating in previsit preparation, including managing patient registries of YSHCN, engaging in regular team huddles, and incorporating previsit planning, can improve preparation and ensure that important needs are not overlooked. Additionally, approaches to improve patient and medical provider comfort with office visits with YSHCN, including approaches to measuring vital signs, examining patients, and communicating with patients with various disabilities, are reviewed. Finally, we discuss methods of supporting adolescents with special health care needs in developing self-management skills that will allow them to be better prepared to enter adult health care settings when appropriate. Although YSHCN can present challenges to medical teams, their care can be improved by developing office-based changes and processes to support improved care for these patients. This may help overcome the health care disparities they experience and increase comfort for all members of the medical team. Copyright © 2017. Published by Elsevier Inc.

Optimism and spontaneous self-affirmation are associated with lower likelihood of cognitive impairment and greater positive affect among cancer survivors

PubMed Central

Taber, Jennifer M.; Klein, William M. P.; Ferrer, Rebecca A.; Kent, Erin E.; Harris, Peter R.

2016-01-01

Background Optimism and self-affirmation promote adaptive coping, goal achievement, and better health. Purpose To examine the associations of optimism and spontaneous self-affirmation (SSA) with physical, mental, and cognitive health and information seeking among cancer survivors. Methods Cancer survivors (n=326) completed the Health Information National Trends Survey 2013, a national survey of U.S. adults. Participants reported optimism, SSA, cognitive and physical impairment, affect, health status, and information seeking. Results Participants higher in optimism reported better health on nearly all indices examined, even when controlling for SSA. Participants higher in SSA reported lower likelihood of cognitive impairment, greater happiness and hopefulness, and greater likelihood of cancer information seeking. SSA remained significantly associated with greater hopefulness and cancer information seeking when controlling for optimism. Conclusions Optimism and SSA may be associated with beneficial health-related outcomes among cancer survivors. Given the demonstrated malleability of self-affirmation, these findings represent important avenues for future research. PMID:26497697

Optimism and Spontaneous Self-affirmation are Associated with Lower Likelihood of Cognitive Impairment and Greater Positive Affect among Cancer Survivors.

PubMed

Taber, Jennifer M; Klein, William M P; Ferrer, Rebecca A; Kent, Erin E; Harris, Peter R

2016-04-01

Optimism and self-affirmation promote adaptive coping, goal achievement, and better health. The aim of this study is to examine the associations of optimism and spontaneous self-affirmation (SSA) with physical, mental, and cognitive health and information seeking among cancer survivors. Cancer survivors (n = 326) completed the Health Information National Trends Survey 2013, a national survey of US adults. Participants reported optimism, SSA, cognitive and physical impairment, affect, health status, and information seeking. Participants higher in optimism reported better health on nearly all indices examined, even when controlling for SSA. Participants higher in SSA reported lower likelihood of cognitive impairment, greater happiness and hopefulness, and greater likelihood of cancer information seeking. SSA remained significantly associated with greater hopefulness and cancer information seeking when controlling for optimism. Optimism and SSA may be associated with beneficial health-related outcomes among cancer survivors. Given the demonstrated malleability of self-affirmation, these findings represent important avenues for future research.

Men's Health Index: a pragmatic approach to stratifying and optimizing men's health.

PubMed

Tan, Hui Meng; Tan, Wei Phin; Wong, Jun Hoe; Ho, Christopher Chee Kong; Teo, Chin Hai; Ng, Chirk Jenn

2014-11-01

The proposed Men's Health Index (MHI) aims to provide a practical and systematic framework for comprehensively assessing and stratifying older men with the intention of optimising their health and functional status. A literature search was conducted using PubMed from 1980 to 2012. We specifically looked for instruments which: assess men's health, frailty and fitness; predict life expectancy, mortality and morbidities. The instruments were assessed by the researchers who then agreed on the tools to be included in the MHI. When there was disagreements, the researchers discussed and reached a consensus guided by the principle that the MHI could be used in the primary care setting targetting men aged 55-65 years. The instruments chosen include the Charlson's Combined Comorbidity-Age Index; the International Index of Erectile Function-5; the International Prostate Symptom Score; the Androgen Deficiency in Aging Male; the Survey of Health, Ageing and Retirement in Europe Frailty Instrument; the Sitting-Rising Test; the Senior Fitness Test; the Fitness Assessment Score; and the Depression Anxiety Stress Scale-21. A pilot test on eight men was carried out and showed that the men's health index is viable. The concept of assessing, stratifying, and optimizing men's health should be incorporated into routine health care, and this can be implemented by using the MHI. This index is particularly useful to primary care physicians who are in a strategic position to engage men at the peri-retirement age in a conversation about their life goals based on their current and predicted health status.

Unequally Distributed Psychological Assets: Are There Social Disparities in Optimism, Life Satisfaction, and Positive Affect?

PubMed Central

Boehm, Julia K.; Chen, Ying; Williams, David R.; Ryff, Carol; Kubzansky, Laura D.

2015-01-01

Socioeconomic status is associated with health disparities, but underlying psychosocial mechanisms have not been fully identified. Dispositional optimism may be a psychosocial process linking socioeconomic status with health. We hypothesized that lower optimism would be associated with greater social disadvantage and poorer social mobility. We also investigated whether life satisfaction and positive affect showed similar patterns. Participants from the Midlife in the United States study self-reported their optimism, satisfaction, positive affect, and socioeconomic status (gender, race/ethnicity, education, occupational class and prestige, income). Social disparities in optimism were evident. Optimistic individuals tended to be white and highly educated, had an educated parent, belonged to higher occupational classes with more prestige, and had higher incomes. Findings were generally similar for satisfaction, but not positive affect. Greater optimism and satisfaction were also associated with educational achievement across generations. Optimism and life satisfaction are consistently linked with socioeconomic advantage and may be one conduit by which social disparities influence health. PMID:25671665

Unequally distributed psychological assets: are there social disparities in optimism, life satisfaction, and positive affect?

PubMed

Boehm, Julia K; Chen, Ying; Williams, David R; Ryff, Carol; Kubzansky, Laura D

2015-01-01

Socioeconomic status is associated with health disparities, but underlying psychosocial mechanisms have not been fully identified. Dispositional optimism may be a psychosocial process linking socioeconomic status with health. We hypothesized that lower optimism would be associated with greater social disadvantage and poorer social mobility. We also investigated whether life satisfaction and positive affect showed similar patterns. Participants from the Midlife in the United States study self-reported their optimism, satisfaction, positive affect, and socioeconomic status (gender, race/ethnicity, education, occupational class and prestige, income). Social disparities in optimism were evident. Optimistic individuals tended to be white and highly educated, had an educated parent, belonged to higher occupational classes with more prestige, and had higher incomes. Findings were generally similar for satisfaction, but not positive affect. Greater optimism and satisfaction were also associated with educational achievement across generations. Optimism and life satisfaction are consistently linked with socioeconomic advantage and may be one conduit by which social disparities influence health.

Formative Assessment and Academic Achievement in Pre-Graduate Students of Health Sciences

ERIC Educational Resources Information Center

Carrillo-de-la-Pena, Maria T.; Bailles, Eva; Caseras, Xavier; Martinez, Alvar; Ortet, Generos; Perez, Jorge

2009-01-01

Although educational experts recommend the use of formative assessment, there is a dearth of empirical studies on its impact on academic achievement. In this research the authors analyse to what extent participation and performance in formative assessment are associated with positive academic outcomes of pre-graduate students of health sciences. A…

Financing of health systems to achieve the health Millennium Development Goals in low-income countries.

PubMed

Fryatt, Robert; Mills, Anne; Nordstrom, Anders

2010-01-30

Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

Robust Airfoil Optimization to Achieve Consistent Drag Reduction Over a Mach Range

NASA Technical Reports Server (NTRS)

Li, Wu; Huyse, Luc; Padula, Sharon; Bushnell, Dennis M. (Technical Monitor)

2001-01-01

We prove mathematically that in order to avoid point-optimization at the sampled design points for multipoint airfoil optimization, the number of design points must be greater than the number of free-design variables. To overcome point-optimization at the sampled design points, a robust airfoil optimization method (called the profile optimization method) is developed and analyzed. This optimization method aims at a consistent drag reduction over a given Mach range and has three advantages: (a) it prevents severe degradation in the off-design performance by using a smart descent direction in each optimization iteration, (b) there is no random airfoil shape distortion for any iterate it generates, and (c) it allows a designer to make a trade-off between a truly optimized airfoil and the amount of computing time consumed. For illustration purposes, we use the profile optimization method to solve a lift-constrained drag minimization problem for 2-D airfoil in Euler flow with 20 free-design variables. A comparison with other airfoil optimization methods is also included.

The economics of optimal health and productivity in the commercial dairy.

PubMed

Galligan, D T

1999-08-01

Dairy production practices are changing; in order to remain viable, producers must optimise the health and productivity of dairy herds in economic terms. Health care is important in economic terms because disease can substantially reduce the productivity of individual animals. Preventive disease control programmes can thus result in economic gains for the dairy producer. The author describes new approaches to preventing postpartum diseases and dealing with fertility problems which can result from these diseases. Other aspects of dairy production are also changing, employing new technologies where these are judged to be profitable. Innovations include: the use of bovine somatotropin; systematic breeding/culling programmes; new mathematical modelling techniques to determine optimum feed composition and to define optimal growth levels for accelerated heifer-rearing programmes; the use of computers to collect, store and analyse data on animal production and health; and semen selection programmes. Increasing awareness of bio-security is also vital, not least because of the large investment present in dairy herds. Whatever practices are employed, they must offer economic returns to producers that compete with alternative uses of capital. Optimal levels of disease control must be determined for a particular production situation, taking into account not only the economic health of the producer, but also the well-being of the animals.

NASA Human Health and Performance Information Architecture Panel

NASA Technical Reports Server (NTRS)

Johnson-Throop, Kathy; Kadwa, Binafer; VanBaalen, Mary

2014-01-01

The Human Health and Performance (HH&P) Directorate at NASA's Johnson Space Center has a mission to enable optimization of human health and performance throughout all phases of spaceflight. All HH&P functions are ultimately aimed at achieving this mission. Our activities enable mission success, optimizing human health and productivity in space before, during, and after the actual spaceflight experience of our crews, and include support for ground-based functions. Many of our spaceflight innovations also provide solutions for terrestrial challenges, thereby enhancing life on Earth.

Impatience versus achievement strivings in the Type A pattern: Differential effects on students' health and academic achievement

NASA Technical Reports Server (NTRS)

Spence, Janet T.; Helmreich, Robert L.; Pred, Robert S.

1987-01-01

Psychometric analyses of college students' responses to the Jenkins Activity Survey, a self-report measure of the Type A behavior pattern, revealed the presence of two relatively independent factors. Based on these analyses, two scales, labeled Achievement Strivings (AS) and Impatience and Irritability (II), were developed. In two samples of male and female college students, scores on AS but not on II were found to be significantly correlated with grade point average. Responses to a health survey, on the other hand, indicated that frequency of physical complaints was significantly correlated with II but not with AS. These results suggest that there are two relatively independent factors in the Type A pattern that have differential effects on performance and health. Future research on the personality factors related to coronary heart disease and other disorders might more profitably focus on the syndrome reflected in the II scale than on the Type A pattern.

Can Turkey's general health insurance system achieve universal coverage?

PubMed

Yasar, Gulbiye Yenimahalleli; Ugurluoglu, Ece

2011-01-01

This study aims to evaluate the General Health Insurance System (GHIS) in Turkey implemented since 1 October 2008, in order to assess whether the GHIS will be able to achieve its objective of universal coverage. Both the breadth and depth of coverage will be taken into account. The study notes out that some socio-economic problems, such as a significant informal economy, high unemployment rate, inefficiency in the creation of adequate employment opportunities, inequitable income distribution, and widespread poverty, are the main problems preventing the GHIS from reaching breadth of coverage in Turkey. Contribution conditions for entitlement to health services prevent the GHIS from providing breadth of coverage too. Outof- pocket payments, which are higher than in European and OECD countries, narrow the depth of coverage, but the GHIS brings additional user fees. Statistics show that despite its objective, the GHIS struggles to provide universal coverage. It seems the GHIS will not be able to provide universal coverage in the near future because of the socio-economic conditions and conditions for entitlement to health services. In this case the government will either introduce radical arrangements to cope with the socio-economic problems and issues with the funding system or should consider switching from an insurance-based system towards a tax-based system.

PLAN or get SLAM'ed: Optimal management of invasive species in the presence of indirect health externalities.

PubMed

Jones, Benjamin A; McDermott, Shana M; Chermak, Janie M

2016-09-15

This paper examines invasive species management when invasive species impact health outcomes indirectly through changes to environmental quality. For example, the emerald ash borer (EAB) has destroyed millions of ash trees throughout North America and has the potential to impact rates of cardiorespiratory mortality and morbidity through ash trees' ability to capture airborne pollutants. Optimal management inclusive of indirect health externalities may be different than status quo plans because the links between nature and health are complex, dynamic, and spatially heterogeneous. We produce a novel dynamic bioeconomic-health model to determine optimal EAB management in the face of such health effects. Our results show that including health increases net benefits of management substantially and that a "one size fits all" management approach is suboptimal given forest cover and demographic spatial heterogeneity. Net benefits to society are 873% higher and air pollution related mortality incidence is 82% lower when health externalities are included in management profiles using insecticide treatments and non-ash tree preemptive plantings without removal. Additionally, constrained managers optimally substitute toward preemptive tree plantings and away from insecticide use in the presence of indirect health externalities as a way to minimize disruptions to air quality. This paper has policy implications for the optimal management of environmental amenities. Copyright © 2016 Elsevier Ltd. All rights reserved.

What Is Most Important: Social Factors, Health Selection, and Adolescent Educational Achievement

ERIC Educational Resources Information Center

Roos, Leslie L.; Hiebert, Brett; Manivong, Phongsack; Edgerton, Jason; Walld, Randy; MacWilliam, Leonard; de Rocquigny, Janelle

2013-01-01

This paper explores the relative importance of social factors and health measures in predicting educational achievement in early and late adolescence using population-based administrative data. The sample was made up of 41,943 children born in Manitoba, Canada between 1982 and 1989 and remaining in the province until age 18. Multilevel modeling…

Influence of Health Education and Healthy Lifestyle on Students' Academic Achievement in Biology in Nigeria

ERIC Educational Resources Information Center

Babatunde, Ezekiel Olusegun

2017-01-01

The positive effects of health education and healthy lifestyle on adolescent academic achievement cannot be over emphasized as learning experiences to help students accurately assess the level of risk-taking behaviour among their peers, emphasis on the value of good health that reinforces health-enhancing attitudes and beliefs are paramount.…

A free gingival impression for achieving optimal interdental papilla height: a case report.

PubMed

Nozawa, Takeshi; Kitami, Norikazu; Tsurumaki, Shunzo; Enomoto, Hiroaki; Ito, Koichi

2011-02-01

Failure to tend to inadequate crown contours in the crown trial can cause long-term disharmony of the free gingival form. This case report describes a novel technique for free gingival impression from a final provisional restoration to a zirconia crown. Two die casts were manufactured from a silicone impression. The first die cast was for the zirconia crown; the second die cast was for the final provisional restoration and the provisionalized transfer coping. A free gingival impression was taken using a provisionalized transfer coping, and a soft gingival model was manufactured. The proximal contact position was managed using the predicted convex curve of the interdental papillae. One year after zirconia crown placement, no inflammation was observed around the pyramidal interdental papillae, and symmetric interdental papilla heights were evident. A free gingival impression using a two die-cast technique appears to be useful for achieving optimal interdental papilla height.

Optimal groundwater security management policies by control of inexact health risks under dual uncertainty in slope factors.

PubMed

Lu, Hongwei; Li, Jing; Ren, Lixia; Chen, Yizhong

2018-05-01

Groundwater remediation is a complicated system with time-consuming and costly challenges, which should be carefully controlled by appropriate groundwater management. This study develops an integrated optimization method for groundwater remediation management regarding cost, contamination distribution and health risk under multiple uncertainties. The integration of health risk into groundwater remediation optimization management is capable of not only adequately considering the influence of health risk on optimal remediation strategies, but also simultaneously completing remediation optimization design and risk assessment. A fuzzy chance-constrained programming approach is presented to handle multiple uncertain properties in the process of health risk assessment. The capabilities and effectiveness of the developed method are illustrated through an application of a naphthalene contaminated case in Anhui, China. Results indicate that (a) the pump-and-treat remediation system leads to a low naphthalene contamination but high remediation cost for a short-time remediation, and natural attenuation significantly affects naphthalene removal from groundwater for a long-time remediation; (b) the weighting coefficients have significant influences on the remediation cost and the performances both for naphthalene concentrations and health risks; (c) an increased level of slope factor (sf) for naphthalene corresponds to more optimal strategies characterized by higher environmental benefits and lower economic sacrifice. The developed method could be simultaneously beneficial for public health and environmental protection. Decision makers could obtain the most appropriate remediation strategies according to their specific requirements with high flexibility of economic, environmental, and risk concerns. Copyright © 2018 Elsevier Ltd. All rights reserved.

"Racelessnes" in a Canadian Context? Exploring the Link between Black Students' Identity, Achievement, and Mental Health.

ERIC Educational Resources Information Center

Smith, Andrea; Lalonde, Richard N.

2003-01-01

Explored the relationship between racial identity, academic achievement, and mental health among 107 black Canadian college students, using Fordham's "racelessness" framework. Results from student surveys and achievement data found no evidence of students adopting a raceless strategy. Racial identity was not directly related to…

Optimism and hope as predictors of subjective health in post-myocardial infarction patients: A comparison of the role of coping strategies.

PubMed

Wlodarczyk, Dorota

2017-03-01

This study explored the effects intervening in the linkages of optimism and hope with subjective health in the short term after myocardial infarction. A two-wave study design was used. The sample consisted of 222 myocardial infarction survivors. When adopting a cross-sectional design, optimism and hope predicted subjective health at Time 1 and Time 2. After controlling for baseline subjective health, they were no longer significant predictors of subjective health at Time 2. Parallel indirect effects of seeking social support and problem solving were significant for both optimism and hope. After controlling for the shared variance between optimism and hope, these effects remained significant only for optimism.

The Cumulative Effect of Health Adversities on Children's Later Academic Achievement.

PubMed

Quach, Jon; Nguyen, Cattram; O'Connor, Meredith; Wake, Melissa

We aimed to determine whether the accumulation of physical, psychosocial, and combined health adversities measured at age 8 to 9 years predicts worsening of academic scores cross-sectionally at 8 to 9 and longitudinally at 10 to 11 years. Design: Longitudinal data from Waves 3 and 4 in the Longitudinal Study of Australian Children (83% of 4983 retained). Exposures (8-9 years): Physical health adversities (yes/no; summed range, 0-5): overweight, special health care needs, chronic illness, PedsQL Physical, and global health. Psychosocial health adversities (yes/no; summed range, 0-4): parent- and teacher-reported behavior, PedsQL Psychosocial, sleep problems. Combined health adversities (range 0-9). Outcomes (8-9, and 10-11 years): National academic standardized test scores. Generalized estimating equations, accounting for multiple academic domains in each year and socioeconomic position and cognition. At 8 to 9 years, 23.9%, 9.9%, and 5.3% had 1, 2, or ≥3 physical health adversities, respectively, while 27.2%, 9.5%, and 4.9% had 1, 2, or ≥3 psychosocial health adversities. For each additional health adversity at 8 to 9 years, academic scores fell incrementally in year 3 and year 5 (both P < .001), with reductions of at least 0.4 SDs for ≥3 health adversities. Number was more important than type (physical, psychosocial) of adversity. The accumulation of health adversities predicts poorer academic achievement up to 2 years later. Interventions might need to address multiple domains to improve child academic outcomes and be delivered across the health-education interface. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Are People Healthier If Their Partners Are More Optimistic? The Dyadic Effect of Optimism On Health Among Older Adults

PubMed Central

Kim, Eric S.; Chopik, William J.; Smith, Jacqui

2015-01-01

Objective Optimism has been linked with an array of positive health outcomes at the individual level. However, researchers have not examined how a spouse's optimism might impact an individual's health. We hypothesized that being optimistic (and having an optimistic spouse) would both be associated with better health. Methods Participants were 3,940 adults (1,970 couples) from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. Participants were tracked for four years and outcomes included: physical functioning, self-rated health, and number of chronic illnesses. We analyzed the dyadic data using the actor partner interdependence model. Results After controlling for several psychological and demographic factors, a person's own optimism and their spouse's optimism predicted better self-rated health and physical functioning (b's = .08-.25, p's < .01). More optimistic people also reported better physical functioning (b = −.11, p < .01) and fewer chronic illnesses (b = −.01, p < .05) over time. Further, having an optimistic spouse uniquely predicted better physical functioning (b = −.09, p < .01) and fewer chronic illnesses (b = −.01, p < .05) over time. The strength of the relationship between optimism and health did not diminish over time. Conclusions Being optimistic and having an optimistic spouse were both associated with better health. Examining partner effects is important because such analyses reveal the unique role that spouses play in promoting health. These findings may have important implications for future health interventions. PMID:24840138

Workplace wellness recognition for optimizing workplace health: a presidential advisory from the American Heart Association.

PubMed

Fonarow, Gregg C; Calitz, Chris; Arena, Ross; Baase, Catherine; Isaac, Fikry W; Lloyd-Jones, Donald; Peterson, Eric D; Pronk, Nico; Sanchez, Eduardo; Terry, Paul E; Volpp, Kevin G; Antman, Elliott M

2015-05-19

The workplace is an important setting for promoting cardiovascular health and cardiovascular disease and stroke prevention in the United States. Well-designed, comprehensive workplace wellness programs have the potential to improve cardiovascular health and to reduce mortality, morbidity, and disability resulting from cardiovascular disease and stroke. Nevertheless, widespread implementation of comprehensive workplace wellness programs is lacking, and program composition and quality vary. Several organizations provide worksite wellness recognition programs; however, there is variation in recognition criteria, and they do not specifically focus on cardiovascular disease and stroke prevention. Although there is limited evidence to suggest that company performance on employer health management scorecards is associated with favorable healthcare cost trends, these data are not currently robust, and further evaluation is needed. As a recognized national leader in evidence-based guidelines, care systems, and quality programs, the American Heart Association/American Stroke Association is uniquely positioned and committed to promoting the adoption of comprehensive workplace wellness programs, as well as improving program quality and workforce health outcomes. As part of its commitment to improve the cardiovascular health of all Americans, the American Heart Association/American Stroke Association will promote science-based best practices for comprehensive workplace wellness programs and establish benchmarks for a national workplace wellness recognition program to assist employers in applying the best systems and strategies for optimal programming. The recognition program will integrate identification of a workplace culture of health and achievement of rigorous standards for cardiovascular health based on Life's Simple 7 metrics. In addition, the American Heart Association/American Stroke Association will develop resources that assist employers in meeting these rigorous

The neglected role of adolescent emotional well-being in national educational achievement: bridging the gap between education and mental health policies.

PubMed

Sznitman, Sharon R; Reisel, Liza; Romer, Daniel

2011-02-01

Although child poverty is recognized as a critical determinant of poor educational achievement in the United States, policy discussions on raising academic achievement rarely include the importance of the effects of poverty on the mental health of adolescents. This article examines the role of adolescent emotional well-being (indicators of depression) as a mediator of the effects of poverty on differences in educational achievement at the national and U.S. state levels. Differences in standardized adolescent academic achievement across 23 developed countries and 39 U.S. states were analyzed using path analytic techniques to test the hypothesis that indicators of adolescent emotional well-being mediate relations between child poverty rates and academic achievement. Child poverty rates were related to both adolescent emotional well-being and educational achievement across both U.S. states and developed countries. Path analyses showed that the status of a country's or state's adolescent emotional well-being is a strong predictor of its educational achievement and that emotional well-being mediates the relationship between poverty and educational achievement. Policies designed to ameliorate the adverse effects of poverty on mental health are critical as they are likely to improve both average educational achievement and student emotional well-being. Attention to improving mental health care not only has the potential to reduce societal and individual costs directly related to health but also to reduce the indirect costs of poor educational achievement. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety: An Assessment of Corporate Health Achievement Award Applicants.

PubMed

Fabius, Raymond; Loeppke, Ronald R; Hohn, Todd; Fabius, Dan; Eisenberg, Barry; Konicki, Doris L; Larson, Paul

2016-01-01

The aim of this study was to assess the hypothesis that stock market performance of companies achieving high scores on either health or safety in the Corporate Health Achievement Award (CHAA) process will be superior to average index performance. The stock market performance of portfolios of CHAA winners was examined under six different scenarios using simulation and past market performance in tests of association framed to inform the investor community. CHAA portfolios out-performed the S&P average on all tests. This study adds to the growing evidence that a healthy and safe workforce correlates with a company's performance and its ability to provide positive returns to shareholders. It advances the idea that a proven set of health and safety metrics based on the CHAA evaluation process merits inclusion with existing measures for market valuation.

Achievements and future path of Tehran municipality in urban health domain: An Iranian experience

PubMed Central

Damari, Behzad; Riazi-Isfahani, Sahand

2016-01-01

Background: According to national laws and world experiences; provision, maintenance, and improving citizens’ health are considered to be the essential functions of municipalities as a "social institute". In order to equitably promote health conditions at urban level, particularly in marginal areas, since 2004 targeted efforts have been implemented in the municipality of Tehran metropolis. This study was intended to identify and analyze these targeted measures and tries to analyze health interventions in a conceptual framework and propose a future path. Methods: This is a qualitative study with content analysis approach. Reviewing documents and structured interviews with national health policy making and planning experts and executive managers of 22-region municipalities of Tehran metropolis were used to collect data. The data were analyzed on the basis of conceptual framework prepared for urban health in 4 domains including municipal interventions, goal achievements, drivers and obstacles of success, and the way forward. Results: From the viewpoint of interviewees, these new health actions of Tehran municipality are more based on public participation and the municipality was able to prioritize health issue in the programs and policies of Tehran city council. Tehran municipality has accomplished three types of interventions to improve health, which in orders of magnitude are: facilitative, promotional, and mandatory interventions. Development and institutionalization of public participation is the greatest achievement in health-oriented actions; and expansion of environmental and physical health-oriented facilities and promoting a healthy lifestyle are next in ranks. Conclusion: Since management alterations seriously challenges institutionalization of actions and innovations especially in the developing countries, it is suggested that mayors of metropolitan cities like Tehran document and review municipal health measures as soon as possible and while eliminating

Health Manpower Requirements for the Achievement of Health for All by the Year 2000 through Primary Health Care. Report of a WHO Expert Committee. Technical Report Series 717.

ERIC Educational Resources Information Center

World Health Organization, Geneva (Switzerland).

This report explains what will be necessary to achieve health for all people in the world by the year 2000 through primary health care. The booklet is organized in six chapters. The first chapter introduces the premise and describes current socioeconomic development and prospects for the future, along with current problems of health personnel…

Optimizing human factors in dentistry

PubMed Central

Gupta, Arpit; Ankola, Anil V.; Hebbal, Mamata

2013-01-01

Occupational health hazards among dental professionals are on a continuous rise and they have a significant negative overall impact on daily life. This review is intended to provide the information regarding risk factors and to highlight the prevention strategies for optimizing human factors in dentistry. Risk factors among dentists are multifactorial, which can be categorized into biomechanical and psychosocial. To achieve a realistic target of safety and health at work, prevention is clearly the best approach; therefore, musculoskeletal disorders can be reduced through proper positioning of dental worker and patient, regular rest breaks, general good health, using ergonomic equipment, and exercises designed to counteract the particular risk factors for the dental occupation. However, substantial evidences are still required to elucidate the potential risk factors and to formulate effective prevention programs. PMID:23946745

Optimizing human factors in dentistry.

PubMed

Gupta, Arpit; Ankola, Anil V; Hebbal, Mamata

2013-03-01

Occupational health hazards among dental professionals are on a continuous rise and they have a significant negative overall impact on daily life. This review is intended to provide the information regarding risk factors and to highlight the prevention strategies for optimizing human factors in dentistry. Risk factors among dentists are multifactorial, which can be categorized into biomechanical and psychosocial. To achieve a realistic target of safety and health at work, prevention is clearly the best approach; therefore, musculoskeletal disorders can be reduced through proper positioning of dental worker and patient, regular rest breaks, general good health, using ergonomic equipment, and exercises designed to counteract the particular risk factors for the dental occupation. However, substantial evidences are still required to elucidate the potential risk factors and to formulate effective prevention programs.

[Legal aspects of prevention. The constitutional principle of optimal health protection].

PubMed

von Wartburg, W P

1978-12-01

With respect to the health services, a State founded upon the rule of law is in duty bound to act with restraint. Its aim should be to guarantee that public health is maintained in optimal fashion. For this purpose it must endeavour to exert an effective influence on environmental factors. The three main categories of activity with which the health services are concerned, i.e. protection of health, promotion of health, and health care should be governed by the principles inherent in a State based upon the rule of law. As regards preventive measures, this means that the State has to shape the environment and society in such a way as to meet the requirements of a modern system for the protection of public health, its objective in this context being to eliminate or minimise health risks. A rational government programme for the promotion of public health must also be designed to promote a more health-conscious pattern of behaviour in the population at large and to encourage those citizens requiring treatment to invoke the aid of the health care services without delay.

Minimizing the health and climate impacts of emissions from heavy-duty public transportation bus fleets through operational optimization.

PubMed

Gouge, Brian; Dowlatabadi, Hadi; Ries, Francis J

2013-04-16

In contrast to capital control strategies (i.e., investments in new technology), the potential of operational control strategies (e.g., vehicle scheduling optimization) to reduce the health and climate impacts of the emissions from public transportation bus fleets has not been widely considered. This case study demonstrates that heterogeneity in the emission levels of different bus technologies and the exposure potential of bus routes can be exploited though optimization (e.g., how vehicles are assigned to routes) to minimize these impacts as well as operating costs. The magnitude of the benefits of the optimization depend on the specific transit system and region. Health impacts were found to be particularly sensitive to different vehicle assignments and ranged from worst to best case assignment by more than a factor of 2, suggesting there is significant potential to reduce health impacts. Trade-offs between climate, health, and cost objectives were also found. Transit agencies that do not consider these objectives in an integrated framework and, for example, optimize for costs and/or climate impacts alone, risk inadvertently increasing health impacts by as much as 49%. Cost-benefit analysis was used to evaluate trade-offs between objectives, but large uncertainties make identifying an optimal solution challenging.

Teachers' Autonomy Support, Autonomy Suppression and Conditional Negative Regard as Predictors of Optimal Learning Experience among High-Achieving Bedouin Students

ERIC Educational Resources Information Center

Kaplan, Haya

2018-01-01

The study is based on self-determination theory and focuses on the motivation of high-achieving Bedouin students who belong to a hierarchical-collectivist society. The study focuses on the question: What are the relations between teachers' autonomy support and control and an optimal learning experience among students? The study is unique in its…

Housing Affordability And Children's Cognitive Achievement.

PubMed

Newman, Sandra; Holupka, C Scott

2016-11-01

Housing cost burden-the fraction of income spent on housing-is the most prevalent housing problem affecting the healthy development of millions of low- and moderate-income children. By affecting disposable income, a high burden affects parents' expenditures on both necessities for and enrichment of their children, as well as investments in their children. Reducing those expenditures and investments, in turn, can affect children's development, including their cognitive skills and physical, social, and emotional health. This article summarizes the first empirical evidence of the effects of housing affordability on children's cognitive achievement and on one factor that appears to contribute to these effects: the larger expenditures on child enrichment by families in affordable housing. We found that housing cost burden has the same relationship to both children's cognitive achievement and enrichment spending on children, exhibiting an inverted U shape in both cases. The maximum benefit occurs when housing cost burden is near 30 percent of income-the long-standing rule-of-thumb definition of affordable housing. The effect of the burden is stronger on children's math ability than on their reading comprehension and is more pronounced with burdens above the 30 percent standard. For enrichment spending, the curve is "shallower" (meaning the effect of optimal affordability is less pronounced) but still significant. Project HOPE—The People-to-People Health Foundation, Inc.

Achieving Conservation when Opportunity Costs Are High: Optimizing Reserve Design in Alberta's Oil Sands Region

PubMed Central

Schneider, Richard R.; Hauer, Grant; Farr, Dan; Adamowicz, W. L.; Boutin, Stan

2011-01-01

Recent studies have shown that conservation gains can be achieved when the spatial distributions of biological benefits and economic costs are incorporated in the conservation planning process. Using Alberta, Canada, as a case study we apply these techniques in the context of coarse-filter reserve design. Because targets for ecosystem representation and other coarse-filter design elements are difficult to define objectively we use a trade-off analysis to systematically explore the relationship between conservation targets and economic opportunity costs. We use the Marxan conservation planning software to generate reserve designs at each level of conservation target to ensure that our quantification of conservation and economic outcomes represents the optimal allocation of resources in each case. Opportunity cost is most affected by the ecological representation target and this relationship is nonlinear. Although petroleum resources are present throughout most of Alberta, and include highly valuable oil sands deposits, our analysis indicates that over 30% of public lands could be protected while maintaining access to more than 97% of the value of the region's resources. Our case study demonstrates that optimal resource allocation can be usefully employed to support strategic decision making in the context of land-use planning, even when conservation targets are not well defined. PMID:21858046

A Public Health Achievement Under Adversity: The Eradication of Poliomyelitis From Peru, 1991

PubMed Central

Cueto, Marcos

2014-01-01

The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America’s story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public–private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru’s Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements. PMID:25322297

A public health achievement under adversity: the eradication of poliomyelitis from Peru, 1991.

PubMed

Sobti, Deepak; Cueto, Marcos; He, Yuan

2014-12-01

The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America's story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public-private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru's Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.

Sustainable food systems for optimal planetary health.

PubMed

Canavan, Chelsey R; Noor, Ramadhani A; Golden, Christopher D; Juma, Calestous; Fawzi, Wafaie

2017-06-01

Sustainable food systems are an important component of a planetary health strategy to reduce the threat of infectious disease, minimize environmental footprint and promote nutrition. Human population trends and dietary transition have led to growing demand for food and increasing production and consumption of meat, amid declining availability of arable land and water. The intensification of livestock production has serious environmental and infectious disease impacts. Land clearing for agriculture alters ecosystems, increases human-wildlife interactions and leads to disease proliferation. Context-specific interventions should be evaluated towards optimizing nutrition resilience, minimizing environmental footprint and reducing animal and human disease risk. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

New Grandparents' Mental Health: The Protective Role of Optimism, Self-Mastery, and Social Support

ERIC Educational Resources Information Center

Ben Shlomo, Shirley; Taubman - Ben-Ari, Orit

2012-01-01

The current study examines the contribution of optimism, self-mastery, perceived social support, and background variables (age, physical health, economic status) to mental health following the transition to grandparenthood. The sample consisted of 257 first-time Israeli grandparents (grandmothers and grandfathers, maternal and paternal) who were…

Learning optimal embedded cascades.

PubMed

Saberian, Mohammad Javad; Vasconcelos, Nuno

2012-10-01

The problem of automatic and optimal design of embedded object detector cascades is considered. Two main challenges are identified: optimization of the cascade configuration and optimization of individual cascade stages, so as to achieve the best tradeoff between classification accuracy and speed, under a detection rate constraint. Two novel boosting algorithms are proposed to address these problems. The first, RCBoost, formulates boosting as a constrained optimization problem which is solved with a barrier penalty method. The constraint is the target detection rate, which is met at all iterations of the boosting process. This enables the design of embedded cascades of known configuration without extensive cross validation or heuristics. The second, ECBoost, searches over cascade configurations to achieve the optimal tradeoff between classification risk and speed. The two algorithms are combined into an overall boosting procedure, RCECBoost, which optimizes both the cascade configuration and its stages under a detection rate constraint, in a fully automated manner. Extensive experiments in face, car, pedestrian, and panda detection show that the resulting detectors achieve an accuracy versus speed tradeoff superior to those of previous methods.

Achieving progress through clinical governance? A national study of health care managers' perceptions in the NHS in England

PubMed Central

Freeman, T; Walshe, K

2004-01-01

Background: A national cross sectional study was undertaken to explore the perceptions concerning the importance of, and progress in, aspects of clinical governance among board level and directorate managers in English acute, ambulance, and mental health/learning disabilities (MH/LD) trusts. Participants: A stratified sample of acute, ambulance, and mental health/learning disabilities trusts in England (n = 100), from each of which up to 10 board level and 10 directorate level managers were randomly sampled. Methods: Fieldwork was undertaken between April and July 2002 using the Organisational Progress in Clinical Governance (OPCG) schedule to explore managers' perceptions of the importance of, and organisational achievement in, 54 clinical governance competency items in five aggregated domains: improving quality; managing risks; improving staff performance; corporate accountability; and leadership and collaboration. The difference between ratings of importance and achievement was termed a shortfall. Results: Of 1916 individuals surveyed, 1177 (61.4%) responded. The competency items considered most important and recording highest perceived achievement related to corporate accountability structures and clinical risks. The highest shortfalls between perceived importance and perceived achievement were reported in joint working across local health communities, feedback of performance data, and user involvement. When aggregated into domains, greatest achievement was perceived in the assurance related areas of corporate accountability and risk management, with considerably less perceived achievement and consequently higher shortfalls in quality improvement and leadership and collaboration. Directorate level managers' perceptions of achievement were found to be significantly lower than those of their board level colleagues on all domains other than improving performance. No differences were found in perceptions of achievement between different types of trusts, or between

Achieving progress through clinical governance? A national study of health care managers' perceptions in the NHS in England.

PubMed

Freeman, T; Walshe, K

2004-10-01

A national cross sectional study was undertaken to explore the perceptions concerning the importance of, and progress in, aspects of clinical governance among board level and directorate managers in English acute, ambulance, and mental health/learning disabilities (MH/LD) trusts. A stratified sample of acute, ambulance, and mental health/learning disabilities trusts in England (n = 100), from each of which up to 10 board level and 10 directorate level managers were randomly sampled. Fieldwork was undertaken between April and July 2002 using the Organisational Progress in Clinical Governance (OPCG) schedule to explore managers' perceptions of the importance of, and organisational achievement in, 54 clinical governance competency items in five aggregated domains: improving quality; managing risks; improving staff performance; corporate accountability; and leadership and collaboration. The difference between ratings of importance and achievement was termed a shortfall. Of 1916 individuals surveyed, 1177 (61.4%) responded. The competency items considered most important and recording highest perceived achievement related to corporate accountability structures and clinical risks. The highest shortfalls between perceived importance and perceived achievement were reported in joint working across local health communities, feedback of performance data, and user involvement. When aggregated into domains, greatest achievement was perceived in the assurance related areas of corporate accountability and risk management, with considerably less perceived achievement and consequently higher shortfalls in quality improvement and leadership and collaboration. Directorate level managers' perceptions of achievement were found to be significantly lower than those of their board level colleagues on all domains other than improving performance. No differences were found in perceptions of achievement between different types of trusts, or between trusts at different stages in the Commission

Achieving Broad Participation in Congregational Health Surveys at African American and Latino Churches

ERIC Educational Resources Information Center

Hawes-Dawson, Jennifer; Derose, Kathryn P.; Aunon, Frances M.; Dominguez, Blanca X.; Felton, Alexandria; Mata, Michael A.; Oden, Clyde W.; Paffen, Sandra

2017-01-01

Congregation-based health program evaluations often rely on surveys, but little documentation is available regarding specific methods and challenges. Here we describe methods used to achieve acceptable response rates (73-79%) in a survey of HIV-related attitudes and behaviors in two African American and three Latino churches in high HIV-prevalence…

Helping the decision maker effectively promote various experts' views into various optimal solutions to China's institutional problem of health care provider selection through the organization of a pilot health care provider research system.

PubMed

Tang, Liyang

2013-04-04

The main aim of China's Health Care System Reform was to help the decision maker find the optimal solution to China's institutional problem of health care provider selection. A pilot health care provider research system was recently organized in China's health care system, and it could efficiently collect the data for determining the optimal solution to China's institutional problem of health care provider selection from various experts, then the purpose of this study was to apply the optimal implementation methodology to help the decision maker effectively promote various experts' views into various optimal solutions to this problem under the support of this pilot system. After the general framework of China's institutional problem of health care provider selection was established, this study collaborated with the National Bureau of Statistics of China to commission a large-scale 2009 to 2010 national expert survey (n = 3,914) through the organization of a pilot health care provider research system for the first time in China, and the analytic network process (ANP) implementation methodology was adopted to analyze the dataset from this survey. The market-oriented health care provider approach was the optimal solution to China's institutional problem of health care provider selection from the doctors' point of view; the traditional government's regulation-oriented health care provider approach was the optimal solution to China's institutional problem of health care provider selection from the pharmacists' point of view, the hospital administrators' point of view, and the point of view of health officials in health administration departments; the public private partnership (PPP) approach was the optimal solution to China's institutional problem of health care provider selection from the nurses' point of view, the point of view of officials in medical insurance agencies, and the health care researchers' point of view. The data collected through a pilot health care

Twentieth anniversary of the European Union health mandate: taking stock of perceived achievements, failures and missed opportunities - a qualitative study.

PubMed

Rosenkötter, Nicole; Clemens, Timo; Sørensen, Kristine; Brand, Helmut

2013-11-14

The European Union (EU) health mandate was initially defined in the Maastricht Treaty in 1992. The twentieth anniversary of the Treaty offers a unique opportunity to take stock of EU health actions by giving an overview of influential public health related EU-level policy outputs and a summary of policy outputs or actions perceived as an achievement, a failure or a missed opportunity. Semi-structured expert interviews (N = 20) were conducted focusing on EU-level actions that were relevant for health. Respondents were asked to name EU policies or actions that they perceived as an achievement, a failure or a missed opportunity. A directed content analysis approach was used to identify expert perceptions on achievements, failures and missed opportunities in the interviews. Additionally, a nominal group technique was applied to identify influential and public health relevant EU-level policy outputs. The ranking of influential policy outputs resulted in top positions of adjudications and legislations, agencies, European Commission (EC) programmes and strategies, official networks, cooperative structures and exchange efforts, the work on health determinants and uptake of scientific knowledge. The assessment of EU health policies as being an achievement, a failure or a missed opportunity was often characterized by diverging respondent views. Recurring topics that emerged were the Directorate General for Health and Consumers (DG SANCO), EU agencies, life style factors, internal market provisions as well as the EU Directive on patients' rights in cross-border healthcare. Among these recurring topics, expert perceptions on the establishment of DG SANCO, EU public health agencies, and successes in tobacco control were dominated by aspects of achievements. The implementation status of the Health in All Policy approach was perceived as a missed opportunity. When comparing the emerging themes from the interviews conducted with the responsibilities defined in the EU health

Health 2020--achieving health and development in today's Europe.

PubMed

Jakab, Zsuzsanna; Tsouros, Agis D

2014-06-01

The 21st-century health landscape is shaped by growing global, regional and local interdependence and an increasingly complex array of interlinking factors that influence health and well-being. Most of today's major public health challenges, including noncommunicable diseases, antimicrobial resistance, health inequalities and the health effects of austerity measures in some countries, cannot be addressed effectively without intersectoral and coordinated action at supranational, national and local levels. The 53 countries of the WHO European Region developed and adopted a European policy framework and strategy for the 21st century (Health 2020) as a common, evidence-informed policy framework to support and encourage coordinated action by policy-makers at all levels and in all sectors to improve population health and well-being. This article presents the development process of Health 2020 and its main strategic goals, objectives and content. Further, we describe what is needed to successfully implement Health 2020 in countries and how can WHO provide technical assistance to countries that embark on developing health policy aligned with the Health 2020 policy framework.

Telecourse Study Guide to "Here's to Your Health."

ERIC Educational Resources Information Center

Richards, Donna

This study guide was prepared to accompany "Here's to Your Health," a telecourse focusing on lifestyle factors influencing health, which was designed to provide the tools necessary for achieving and maintaining an optimal, healthy lifestyle. For each of 27 lessons, the study guide presents learning objectives, an overview of content, study…

Selective robust optimization: A new intensity-modulated proton therapy optimization strategy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Yupeng; Niemela, Perttu; Siljamaki, Sami

2015-08-15

Purpose: To develop a new robust optimization strategy for intensity-modulated proton therapy as an important step in translating robust proton treatment planning from research to clinical applications. Methods: In selective robust optimization, a worst-case-based robust optimization algorithm is extended, and terms of the objective function are selectively computed from either the worst-case dose or the nominal dose. Two lung cancer cases and one head and neck cancer case were used to demonstrate the practical significance of the proposed robust planning strategy. The lung cancer cases had minimal tumor motion less than 5 mm, and, for the demonstration of the methodology,more » are assumed to be static. Results: Selective robust optimization achieved robust clinical target volume (CTV) coverage and at the same time increased nominal planning target volume coverage to 95.8%, compared to the 84.6% coverage achieved with CTV-based robust optimization in one of the lung cases. In the other lung case, the maximum dose in selective robust optimization was lowered from a dose of 131.3% in the CTV-based robust optimization to 113.6%. Selective robust optimization provided robust CTV coverage in the head and neck case, and at the same time improved controls over isodose distribution so that clinical requirements may be readily met. Conclusions: Selective robust optimization may provide the flexibility and capability necessary for meeting various clinical requirements in addition to achieving the required plan robustness in practical proton treatment planning settings.« less

Measuring the performance of telephone-based disease surveillance systems in local health departments.

PubMed

Dausey, David J; Chandra, Anita; Schaefer, Agnes G; Bahney, Ben; Haviland, Amelia; Zakowski, Sarah; Lurie, Nicole

2008-09-01

We tested telephone-based disease surveillance systems in local health departments to identify system characteristics associated with consistent and timely responses to urgent case reports. We identified a stratified random sample of 74 health departments and conducted a series of unannounced tests of their telephone-based surveillance systems. We used regression analyses to identify system characteristics that predicted fast connection with an action officer (an appropriate public health professional). Optimal performance in consistently connecting callers with an action officer in 30 minutes or less was achieved by 31% of participating health departments. Reaching a live person upon dialing, regardless of who that person was, was the strongest predictor of optimal performance both in being connected with an action officer and in consistency of connection times. Health departments can achieve optimal performance in consistently connecting a caller with an action officer in 30 minutes or less and may improve performance by using a telephone-based disease surveillance system in which the phone is answered by a live person at all times.

Optimal Cut-Off Points on the Health Anxiety Inventory, Illness Attitude Scales and Whiteley Index to Identify Severe Health Anxiety

PubMed Central

Hedman, Erik; Lekander, Mats; Ljótsson, Brjánn; Lindefors, Nils; Rück, Christian; Andersson, Gerhard; Andersson, Erik

2015-01-01

Background Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis. PMID:25849477

McMaster Optimal Aging Portal: an evidence-based database for geriatrics-focused health professionals.

PubMed

Barbara, Angela M; Dobbins, Maureen; Brian Haynes, R; Iorio, Alfonso; Lavis, John N; Raina, Parminder; Levinson, Anthony J

2017-07-11

The objective of this work was to provide easy access to reliable health information based on good quality research that will help health care professionals to learn what works best for seniors to stay as healthy as possible, manage health conditions and build supportive health systems. This will help meet the demands of our aging population that clinicians provide high quality care for older adults, that public health professionals deliver disease prevention and health promotion strategies across the life span, and that policymakers address the economic and social need to create a robust health system and a healthy society for all ages. The McMaster Optimal Aging Portal's (Portal) professional bibliographic database contains high quality scientific evidence about optimal aging specifically targeted to clinicians, public health professionals and policymakers. The database content comes from three information services: McMaster Premium LiteratUre Service (MacPLUS™), Health Evidence™ and Health Systems Evidence. The Portal is continually updated, freely accessible online, easily searchable, and provides email-based alerts when new records are added. The database is being continually assessed for value, usability and use. A number of improvements are planned, including French language translation of content, increased linkages between related records within the Portal database, and inclusion of additional types of content. While this article focuses on the professional database, the Portal also houses resources for patients, caregivers and the general public, which may also be of interest to geriatric practitioners and researchers.

Strategies for optimizing maternal nutrition to promote infant development.

PubMed

Hambidge, K Michael; Krebs, Nancy F

2018-06-22

The growing appreciation of the multi-faceted importance of optimal maternal nutrition to the health and development of the infant and young child is tempered by incompletely resolved strategies for combatting challenges. To review the importance of maternal nutrition and strategies being employed to optimize outcomes. Selected data from recent literature with special focus on rationale for and currently published results of maternal nutrition supplements, including lipid based nutrition supplements. 1) An impelling rationale for improving the maternal and in utero environment of low resource populations has emerged to achieve improved fetal and post-natal growth and development. 2) Based partly on population increases in adult height over one-two generations, much can be achieved by reducing poverty. 3) Maternal, newborn and infant characteristics associated with low resource environments include evidence of undernutrition, manifested by underweight and impaired linear growth. 4) Apart from broad public health and educational initiatives, to date, most specific efforts to improve fetal growth and development have included maternal nutrition interventions during gestation. 5) The relatively limited but real benefits of both iron/folic acid (IFA) and multiple micronutrient (MMN) maternal supplements during gestation have now been reasonably defined. 6) Recent investigations of a maternal lipid-based primarily micronutrient supplement (LNS) have not demonstrated a consistent benefit beyond MMN alone. 7) However, effects of both MMN and LNS appear to be enhanced by commencing early in gestation. Poor maternal nutritional status is one of a very few specific factors in the human that not only contributes to impaired fetal and early post-natal growth but for which maternal interventions have demonstrated improved in utero development, documented primarily by both improvements in low birth weights and by partial corrections of impaired birth length. A clearer definition

Achieving Optimal Privacy in Trust-Aware Social Recommender Systems

NASA Astrophysics Data System (ADS)

Dokoohaki, Nima; Kaleli, Cihan; Polat, Huseyin; Matskin, Mihhail

Collaborative filtering (CF) recommenders are subject to numerous shortcomings such as centralized processing, vulnerability to shilling attacks, and most important of all privacy. To overcome these obstacles, researchers proposed for utilization of interpersonal trust between users, to alleviate many of these crucial shortcomings. Till now, attention has been mainly paid to strong points about trust-aware recommenders such as alleviating profile sparsity or calculation cost efficiency, while least attention has been paid on investigating the notion of privacy surrounding the disclosure of individual ratings and most importantly protection of trust computation across social networks forming the backbone of these systems. To contribute to addressing problem of privacy in trust-aware recommenders, within this paper, first we introduce a framework for enabling privacy-preserving trust-aware recommendation generation. While trust mechanism aims at elevating recommender's accuracy, to preserve privacy, accuracy of the system needs to be decreased. Since within this context, privacy and accuracy are conflicting goals we show that a Pareto set can be found as an optimal setting for both privacy-preserving and trust-enabling mechanisms. We show that this Pareto set, when used as the configuration for measuring the accuracy of base collaborative filtering engine, yields an optimized tradeoff between conflicting goals of privacy and accuracy. We prove this concept along with applicability of our framework by experimenting with accuracy and privacy factors, and we show through experiment how such optimal set can be inferred.

Latin America and the Caribbean: Assessment of the Advances in Public Health for the Achievement of the Millennium Development Goals

PubMed Central

Mitra, Amal K.; Rodriguez-Fernandez, Gisela

2010-01-01

To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC. PMID:20623022

Latin America and the Caribbean: assessment of the advances in public health for the achievement of the Millennium Development Goals.

PubMed

Mitra, Amal K; Rodriguez-Fernandez, Gisela

2010-05-01

To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC.

Optimal Flow.

ERIC Educational Resources Information Center

Norman, Donald A.

1996-01-01

Discusses the educational applications of experimental psychologist Mihaly Csikszentmihalyi's theory of peak experience, or optimal flow. Optimal flow refers to the receptive state people achieve when they are engaged in interesting and challenging activity. Includes an insightful critique of multimedia instruction from this perspective. (MJP)

Moving beyond the treatment package approach to developing behavioral interventions: addressing questions that arose during an application of the Multiphase Optimization Strategy (MOST).

PubMed

Wyrick, David L; Rulison, Kelly L; Fearnow-Kenney, Melodie; Milroy, Jeffrey J; Collins, Linda M

2014-09-01

Given current pressures to increase the public health contributions of behavioral interventions, intervention scientists may wish to consider moving beyond the classical treatment package approach that focuses primarily on achieving statistical significance. They may wish also to focus on goals directly related to optimizing public health impact. The Multiphase Optimization Strategy (MOST) is an innovative methodological framework that draws on engineering principles to achieve more potent behavioral interventions. MOST is increasingly being adopted by intervention scientists seeking a systematic framework to engineer an optimized intervention. As with any innovation, there are challenges that arise with early adoption. This article describes the solutions to several critical questions that we addressed during the first-ever iterative application of MOST. Specifically, we describe how we have applied MOST to optimize an online program (myPlaybook) for the prevention of substance use among college student-athletes. Our application of MOST can serve as a blueprint for other intervention scientists who wish to design optimized behavioral interventions. We believe using MOST is feasible and has the potential to dramatically improve program effectiveness thereby advancing the public health impact of behavioral interventions.

[The introduction of the achievements of medical science in public health practice with using modern information technologies].

PubMed

Horban', A Ie

2012-01-01

The article analyzes some factors that complicate the availability of scholarly communication professionals of health of Ukraine to introduce the achievements of medical science into practice. Improved access will help the implementation created by the Ministry of Health of Ukraine United e-data-processing system.

Appraising Reading Achievement.

ERIC Educational Resources Information Center

Ediger, Marlow

To determine quality sequence in pupil progress, evaluation approaches need to be used which guide the teacher to assist learners to attain optimally. Teachers must use a variety of procedures to appraise student achievement in reading, because no one approach is adequate. Appraisal approaches might include: (1) observation and subsequent…

Leveraging health information technology to achieve the "triple aim" of healthcare reform.

PubMed

Sheikh, Aziz; Sood, Harpreet S; Bates, David W

2015-07-01

To investigate experiences with leveraging health information technology (HIT) to improve patient care and population health, and reduce healthcare expenditures. In-depth qualitative interviews with federal government employees, health policy, HIT and medico-legal experts, health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States. The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to "kick the legs from underneath the fee-for-service model" and replace it with a data-driven reimbursement system that rewards high quality care. The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm-addressing these issues therefore needs to be the federal government's main policy target. © The Author 2015

[Optimism of 13-year olds in Poland in the context of self-assessment of health and selected family characteristics].

PubMed

Stalmach, Małgorzata; Jodkowska, Maria; Tabak, Izabela; Oblacińska, Anna

2013-01-01

To examine the level of optimism in 13-year-olds and the relationship between optimism and self-reported health and family psychosocial and economic factors. Adolescents at the age of 13 years (n=605) and their parents, identified in the third stage of a prospective cohort study in 2008, was analysed. To examine the level of optimism the short Polish version of the Wagnilda and Young scale (Resilience Scale) were used. The level of optimism and the relationship between family socio-economic factors and family functioning in the family (parenting practices, satisfaction with family contacts) were examined. For the evaluation of probability of a high level of optimism among 13-year-old girls and boys the multivariate model of logistic was used. Girls had a significantly higher level of optimism. Girls and boys with positive attitude to life rated their health significantly better than their peers with negative attitude. Univariate analyses showed that with the level of optimism father's education level among girls and the professional status of the parents among boys, was significantly associated. Family affluence reported by children, positive parenting and satisfaction with family contacts, were significantly associated with the attitude to life, both in girls and boys. The level of optimism among boys was also related with the level of discipline by the mother and the level of control exercised by both parents. Finally, for girls multiple regression analyses showed that father's positive parenting was a predictor of high level of optimism [OR=0,45; CI(OR):0,23-0,85; p=0,014]. In boys, mother's positive parenting [OR=0,39; CI(OR):0,19-0,82; p=0,013] and appropriate father's control were found to be significant predictors of optimism [OR=0,33; CI(OR): 0,13-0,84; p=0,020]. Very high self-reported health by the majority of young people with positive attitude to life shows that optimism is a strong predictor of subjective health. Positive parenting practices and good

Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a 'tobacco-free' UK.

PubMed

Hunt, Daniel; Knuchel-Takano, André; Jaccard, Abbygail; Bhimjiyani, Arti; Retat, Lise; Selvarajah, Chit; Brown, Katrina; Webber, Laura L; Brown, Martin

2018-03-01

Smoking is still the most preventable cause of cancer, and a leading cause of premature mortality and health inequalities in the UK. This study modelled the health and economic impacts of achieving a 'tobacco-free' ambition (TFA) where, by 2035, less than 5% of the population smoke tobacco across all socioeconomic groups. A non-linear multivariate regression model was fitted to cross-sectional smoking data to create projections to 2035. These projections were used to predict the future incidence and costs of 17 smoking-related diseases using a microsimulation approach. The health and economic impacts of achieving a TFA were evaluated against a predicted baseline scenario, where current smoking trends continue. If trends continue, the prevalence of smoking in the UK was projected to be 10% by 2035-well above a TFA. If this ambition were achieved by 2035, it could mean 97 300 +/- 5 300 new cases of smoking-related diseases are avoided by 2035 (tobacco-related cancers: 35 900+/- 4 100; chronic obstructive pulmonary disease: 29 000 +/- 2 700; stroke: 24 900 +/- 2 700; coronary heart disease: 7600 +/- 2 700), including around 12 350 diseases avoided in 2035 alone. The consequence of this health improvement is predicted to avoid £67 +/- 8 million in direct National Health Service and social care costs, and £548 million in non-health costs, in 2035 alone. These findings strengthen the case to set bold targets on long-term declines in smoking prevalence to achieve a tobacco 'endgame'. Results demonstrate the health and economic benefits that meeting a TFA can achieve over just 20 years. Effective ambitions and policy interventions are needed to reduce the disease and economic burden of smoking. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Addressing disparities and achieving equity: cultural competence, ethics, and health-care transformation.

PubMed

Betancourt, Joseph R; Corbett, James; Bondaryk, Matthew R

2014-01-01

The passage of health-care reform and current efforts in payment reform signal the beginning of a significant transformation of the US health-care system. An entire new set of structures is being developed to facilitate increased access to care that is cost-effective and of high quality. As described in The Institute of Medicine report "Crossing the Quality Chasm," our nation is charting a path toward quality health care that aims to be safe, efficient, effective, timely, patient-centered, and equitable. As our health-care system rapidly undergoes dramatic transformation, several truths-and challenges-remain. First, racial and ethnic disparities in health care persist and are a clear sign of inequality in quality. Second, although the root causes for these disparities are complex, there exists a well-developed set of evidence-based approaches to address them; among these is improving the cultural competence of health-care providers and the health-care system. Third, as part of our care redesign, we must assure that we are prepared to meet the ethical challenges ahead and reassert the importance of equity, fairness, and caring as key building blocks of a new care delivery system. As we move ahead, it is critical to assure that our health-care system is culturally competent and has the capacity to deliver high-quality care for all, while eliminating disparities and assuring equity. Disparities are unjust, unethical, costly, and unacceptable-and integrating strategies to achieve equity as part of our health-care system's transformation will give us an incredible opportunity to comprehensively address them.

The Future of Home Health Care: A Strategic Framework for Optimizing Value.

PubMed

Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J; McCann, Barbara A; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

2016-11-01

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on "The Future of Home Health Care," the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework.

The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement.

PubMed

Langford, Rebecca; Bonell, Christopher P; Jones, Hayley E; Pouliou, Theodora; Murphy, Simon M; Waters, Elizabeth; Komro, Kelli A; Gibbs, Lisa F; Magnus, Daniel; Campbell, Rona

2014-04-16

The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of

Achieving the health Millennium Development Goals for South Africa: challenges and priorities.

PubMed

Chopra, Mickey; Lawn, Joy E; Sanders, David; Barron, Peter; Abdool Karim, Salim S; Bradshaw, Debbie; Jewkes, Rachel; Abdool Karim, Quarraisha; Flisher, Alan J; Mayosi, Bongani M; Tollman, Stephen M; Churchyard, Gavin J; Coovadia, Hoosen

2009-09-19

15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). However The Lancet's Series on South Africa has identified several examples of leadership and innovation that point towards a different future scenario. We discuss the type of vision, leadership, and priority actions needed to achieve such a change. We still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country--will they do so or will another opportunity and many more lives be lost?

Solving Disparities Through Payment And Delivery System Reform: A Program To Achieve Health Equity.

PubMed

DeMeester, Rachel H; Xu, Lucy J; Nocon, Robert S; Cook, Scott C; Ducas, Andrea M; Chin, Marshall H

2017-06-01

Payment systems generally do not directly encourage or support the reduction of health disparities. In 2013 the Finding Answers: Solving Disparities through Payment and Delivery System Reform program of the Robert Wood Johnson Foundation sought to understand how alternative payment models might intentionally incorporate a disparities-reduction component to promote health equity. A qualitative analysis of forty proposals to the program revealed that applicants generally did not link payment reform tightly to disparities reduction. Most proposed general pay-for-performance, global payment, or shared savings plans, combined with multicomponent system interventions. None of the applicants proposed making any financial payments contingent on having successfully reduced disparities. Most applicants did not address how they would optimize providers' intrinsic and extrinsic motivation to reduce disparities. A better understanding of how payment and care delivery models might be designed and implemented to reduce health disparities is essential. Project HOPE—The People-to-People Health Foundation, Inc.

Interleaved segment correction achieves higher improvement factors in using genetic algorithm to optimize light focusing through scattering media

NASA Astrophysics Data System (ADS)

Li, Runze; Peng, Tong; Liang, Yansheng; Yang, Yanlong; Yao, Baoli; Yu, Xianghua; Min, Junwei; Lei, Ming; Yan, Shaohui; Zhang, Chunmin; Ye, Tong

2017-10-01

Focusing and imaging through scattering media has been proved possible with high resolution wavefront shaping. A completely scrambled scattering field can be corrected by applying a correction phase mask on a phase only spatial light modulator (SLM) and thereby the focusing quality can be improved. The correction phase is often found by global searching algorithms, among which Genetic Algorithm (GA) stands out for its parallel optimization process and high performance in noisy environment. However, the convergence of GA slows down gradually with the progression of optimization, causing the improvement factor of optimization to reach a plateau eventually. In this report, we propose an interleaved segment correction (ISC) method that can significantly boost the improvement factor with the same number of iterations comparing with the conventional all segment correction method. In the ISC method, all the phase segments are divided into a number of interleaved groups; GA optimization procedures are performed individually and sequentially among each group of segments. The final correction phase mask is formed by applying correction phases of all interleaved groups together on the SLM. The ISC method has been proved significantly useful in practice because of its ability to achieve better improvement factors when noise is present in the system. We have also demonstrated that the imaging quality is improved as better correction phases are found and applied on the SLM. Additionally, the ISC method lowers the demand of dynamic ranges of detection devices. The proposed method holds potential in applications, such as high-resolution imaging in deep tissue.

Neonatal period: linking best nutrition practices at birth to optimize maternal and infant health and survival.

PubMed

Lutter, Chessa K; Chaparro, Camila M

2009-06-01

Delayed umbilical cord clamping, immediate skin-to-skin contact, and early initiation of breastfeeding have been shown to be simple, safe, and effective and should be implemented in all deliveries, with very few exceptions. Although these practices can also prevent death, their importance extends beyond survival and optimizes both short-and long-term neonatal and maternal health and nutrition. Their implementation requires that they be integrated with one another and included with other standard lifesaving care practices. Leveraging knowledge of efficacious interventions into high-quality programs with broad coverage is often the main obstacle to improving neonatal and maternal health in low-income countries. To achieve results at-scale, attention must be given to increasing access to scientific information supporting evidence-based practices and addressing the skills needed to implement the recommended practices; establishing and communicating global, national, and local policies and guidelines for implementation in conjunction with advocacy and synchronization with other maternal and neonatal care efforts; reorganizing delivery care services; and monitoring and evaluation. This will require international investments similar to those being made for other lifesaving neonatal interventions. Neonatal vitamin A supplementation, recommended for implementation in Asia, is controversial, and the evidence for and against this recommendation is reviewed.

Multidisciplinary optimization for engineering systems - Achievements and potential

NASA Technical Reports Server (NTRS)

Sobieszczanski-Sobieski, Jaroslaw

1989-01-01

The currently common sequential design process for engineering systems is likely to lead to suboptimal designs. Recently developed decomposition methods offer an alternative for coming closer to optimum by breaking the large task of system optimization into smaller, concurrently executed and, yet, coupled tasks, identified with engineering disciplines or subsystems. The hierarchic and non-hierarchic decompositions are discussed and illustrated by examples. An organization of a design process centered on the non-hierarchic decomposition is proposed.

Multidisciplinary optimization for engineering systems: Achievements and potential

NASA Technical Reports Server (NTRS)

Sobieszczanski-Sobieski, Jaroslaw

1989-01-01

The currently common sequential design process for engineering systems is likely to lead to suboptimal designs. Recently developed decomposition methods offer an alternative for coming closer to optimum by breaking the large task of system optimization into smaller, concurrently executed and, yet, coupled tasks, identified with engineering disciplines or subsystems. The hierarchic and non-hierarchic decompositions are discussed and illustrated by examples. An organization of a design process centered on the non-hierarchic decomposition is proposed.

Twentieth anniversary of the European Union health mandate: taking stock of perceived achievements, failures and missed opportunities – a qualitative study

PubMed Central

2013-01-01

Background The European Union (EU) health mandate was initially defined in the Maastricht Treaty in 1992. The twentieth anniversary of the Treaty offers a unique opportunity to take stock of EU health actions by giving an overview of influential public health related EU-level policy outputs and a summary of policy outputs or actions perceived as an achievement, a failure or a missed opportunity. Methods Semi-structured expert interviews (N = 20) were conducted focusing on EU-level actions that were relevant for health. Respondents were asked to name EU policies or actions that they perceived as an achievement, a failure or a missed opportunity. A directed content analysis approach was used to identify expert perceptions on achievements, failures and missed opportunities in the interviews. Additionally, a nominal group technique was applied to identify influential and public health relevant EU-level policy outputs. Results The ranking of influential policy outputs resulted in top positions of adjudications and legislations, agencies, European Commission (EC) programmes and strategies, official networks, cooperative structures and exchange efforts, the work on health determinants and uptake of scientific knowledge. The assessment of EU health policies as being an achievement, a failure or a missed opportunity was often characterized by diverging respondent views. Recurring topics that emerged were the Directorate General for Health and Consumers (DG SANCO), EU agencies, life style factors, internal market provisions as well as the EU Directive on patients’ rights in cross-border healthcare. Among these recurring topics, expert perceptions on the establishment of DG SANCO, EU public health agencies, and successes in tobacco control were dominated by aspects of achievements. The implementation status of the Health in All Policy approach was perceived as a missed opportunity. Conclusions When comparing the emerging themes from the interviews conducted with the

Strategy Developed for Selecting Optimal Sensors for Monitoring Engine Health

NASA Technical Reports Server (NTRS)

2004-01-01

Sensor indications during rocket engine operation are the primary means of assessing engine performance and health. Effective selection and location of sensors in the operating engine environment enables accurate real-time condition monitoring and rapid engine controller response to mitigate critical fault conditions. These capabilities are crucial to ensure crew safety and mission success. Effective sensor selection also facilitates postflight condition assessment, which contributes to efficient engine maintenance and reduced operating costs. Under the Next Generation Launch Technology program, the NASA Glenn Research Center, in partnership with Rocketdyne Propulsion and Power, has developed a model-based procedure for systematically selecting an optimal sensor suite for assessing rocket engine system health. This optimization process is termed the systematic sensor selection strategy. Engine health management (EHM) systems generally employ multiple diagnostic procedures including data validation, anomaly detection, fault-isolation, and information fusion. The effectiveness of each diagnostic component is affected by the quality, availability, and compatibility of sensor data. Therefore systematic sensor selection is an enabling technology for EHM. Information in three categories is required by the systematic sensor selection strategy. The first category consists of targeted engine fault information; including the description and estimated risk-reduction factor for each identified fault. Risk-reduction factors are used to define and rank the potential merit of timely fault diagnoses. The second category is composed of candidate sensor information; including type, location, and estimated variance in normal operation. The final category includes the definition of fault scenarios characteristic of each targeted engine fault. These scenarios are defined in terms of engine model hardware parameters. Values of these parameters define engine simulations that generate

SU-D-206-01: Employing a Novel Consensus Optimization Strategy to Achieve Iterative Cone Beam CT Reconstruction On a Multi-GPU Platform

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, B; Southern Medical University, Guangzhou, Guangdong; Tian, Z

Purpose: While compressed sensing-based cone-beam CT (CBCT) iterative reconstruction techniques have demonstrated tremendous capability of reconstructing high-quality images from undersampled noisy data, its long computation time still hinders wide application in routine clinic. The purpose of this study is to develop a reconstruction framework that employs modern consensus optimization techniques to achieve CBCT reconstruction on a multi-GPU platform for improved computational efficiency. Methods: Total projection data were evenly distributed to multiple GPUs. Each GPU performed reconstruction using its own projection data with a conventional total variation regularization approach to ensure image quality. In addition, the solutions from GPUs were subjectmore » to a consistency constraint that they should be identical. We solved the optimization problem with all the constraints considered rigorously using an alternating direction method of multipliers (ADMM) algorithm. The reconstruction framework was implemented using OpenCL on a platform with two Nvidia GTX590 GPU cards, each with two GPUs. We studied the performance of our method and demonstrated its advantages through a simulation case with a NCAT phantom and an experimental case with a Catphan phantom. Result: Compared with the CBCT images reconstructed using conventional FDK method with full projection datasets, our proposed method achieved comparable image quality with about one third projection numbers. The computation time on the multi-GPU platform was ∼55 s and ∼ 35 s in the two cases respectively, achieving a speedup factor of ∼ 3.0 compared with single GPU reconstruction. Conclusion: We have developed a consensus ADMM-based CBCT reconstruction method which enabled performing reconstruction on a multi-GPU platform. The achieved efficiency made this method clinically attractive.« less

Time-optimal control with finite bandwidth

NASA Astrophysics Data System (ADS)

Hirose, M.; Cappellaro, P.

2018-04-01

Time-optimal control theory provides recipes to achieve quantum operations with high fidelity and speed, as required in quantum technologies such as quantum sensing and computation. While technical advances have achieved the ultrastrong driving regime in many physical systems, these capabilities have yet to be fully exploited for the precise control of quantum systems, as other limitations, such as the generation of higher harmonics or the finite response time of the control apparatus, prevent the implementation of theoretical time-optimal control. Here we present a method to achieve time-optimal control of qubit systems that can take advantage of fast driving beyond the rotating wave approximation. We exploit results from time-optimal control theory to design driving protocols that can be implemented with realistic, finite-bandwidth control fields, and we find a relationship between bandwidth limitations and achievable control fidelity.

Helping the decision maker effectively promote various experts’ views into various optimal solutions to China’s institutional problem of health care provider selection through the organization of a pilot health care provider research system

PubMed Central

2013-01-01

Background The main aim of China’s Health Care System Reform was to help the decision maker find the optimal solution to China’s institutional problem of health care provider selection. A pilot health care provider research system was recently organized in China’s health care system, and it could efficiently collect the data for determining the optimal solution to China’s institutional problem of health care provider selection from various experts, then the purpose of this study was to apply the optimal implementation methodology to help the decision maker effectively promote various experts’ views into various optimal solutions to this problem under the support of this pilot system. Methods After the general framework of China’s institutional problem of health care provider selection was established, this study collaborated with the National Bureau of Statistics of China to commission a large-scale 2009 to 2010 national expert survey (n = 3,914) through the organization of a pilot health care provider research system for the first time in China, and the analytic network process (ANP) implementation methodology was adopted to analyze the dataset from this survey. Results The market-oriented health care provider approach was the optimal solution to China’s institutional problem of health care provider selection from the doctors’ point of view; the traditional government’s regulation-oriented health care provider approach was the optimal solution to China’s institutional problem of health care provider selection from the pharmacists’ point of view, the hospital administrators’ point of view, and the point of view of health officials in health administration departments; the public private partnership (PPP) approach was the optimal solution to China’s institutional problem of health care provider selection from the nurses’ point of view, the point of view of officials in medical insurance agencies, and the health care researchers’ point

Changing dentate status of adults, use of dental health services, and achievement of national dental health goals in Denmark by the year 2000.

PubMed

Petersen, Poul Erik; Kjøller, Mette; Christensen, Lisa Bøge; Krustrup, Ulla

2004-01-01

This study analyzes the current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, assesses the impact on dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and highlights the changes over time in dental health conditions among adults. Finally, the intention of the study was to evaluate the Danish dental health care system's level of achievement of the official goals for the year 2000 as formulated by the World Health Organization and the National Board of Health. The subjects of this study included a national representative sample of 16,690 Danish citizens aged 16 years and older (response rate=74.2%). A subsample (n=3,818) took part in a survey of dental care habits in childhood and prevalence of removable dentures; 66 percent of persons selected responded. Personal interviews were used to collect information on dentate status, use of dental health services and living conditions; data on dental care habits in childhood and prevalence of removable dentures were collected by self-administered questionnaires. In all, 8 percent of interviewed persons were edentulous, while 80 percent had 20 or more natural teeth. At age 65-74 years, 27 percent were edentulous and 40 percent had 20 teeth or more; 58 percent wore removable dentures. Dentate status and prevalence of dentures were highly related to educational background and income, particularly for older age groups. Among persons interviewed, 80 percent paid regular dental visits and visits were most frequent among persons of high education and income. At age 35-44 years 95 percent had participated in regular dental care in childhood compared to 49 percent of 65-74-year-olds. Multivariate analyses revealed that sociobehavioral factors had significant effects on dentate status. Compared to similar studies carried out in 1987 and 1994, the present survey indicates a positive trend of improved dentate

Progress towards achieving and maintaining maternal and neonatal tetanus elimination in the African region.

PubMed

Ridpath, Alison Delano; Scobie, Heather Melissa; Shibeshi, Messeret Eshetu; Yakubu, Ahmadu; Zulu, Flint; Raza, Azhar Abid; Masresha, Balcha; Tohme, Rania

2017-01-01

Despite the availability of effective tetanus prevention strategies, as of 2016, Maternal and Neonatal Tetanus Elimination (MNTE) has not yet been achieved in 18 countries globally. In this paper, we review the status of MNTE in the World Health Organization African Region (AFR),and provide recommendations for achieving and maintaining MNTE in AFR. As of November 2016, 37 (79%) AFR countries have achieved MNTE, with 10 (21%) countries remaining. DTP3 coverage increased from 52% in 2000 to 76% in 2015. In 2015, coverage with at least 2 doses of tetanus containing vaccine (TT2+) and proportion of newborns protected at birth (PAB) were 69% and 77%, compared with 44% and 62% in 2000, respectively. Since 1999, over 79 million women of reproductive age (WRA) have been vaccinated with TT2+ through supplementary immunization activities (SIAs). Despite the progress, only 54% of births were attended by skilled birth attendants (SBAs), 5 (11%) countries provided the 3 WHO-recommended booster doses to both sexes, and about 5.5 million WRA still need to be reached with SIAs. Coverage disparities still exist between countries that have achieved MNTE and those that have not. In 2015, coverage with DTP3 and PAB were higher in MNTE countries compared with those yet to achieve MNTE: 84% vs. 68% and 86% vs. 69%, respectively. Challenges to achieving MNTE in the remaining AFR countries include weak health systems, competing priorities, insufficient funding, insecurity, and sub-optimal neonatal tetanus (NT) surveillance. To achieve and maintain MNTE in AFR, increasing SBAs and tetanus vaccination coverage, integrating tetanus vaccination with other opportunities (e.g., polio and measles campaigns, mother and child health days), and providing appropriately spaced booster doses are needed. Strengthening NT surveillance and conducting serosurveys would ensure appropriate targeting of MNTE activities and high-quality information for validating the achievement and maintenance of elimination.

Progress towards achieving and maintaining maternal and neonatal tetanus elimination in the African region

PubMed Central

Ridpath, Alison Delano; Scobie, Heather Melissa; Shibeshi, Messeret Eshetu; Yakubu, Ahmadu; Zulu, Flint; Raza, Azhar Abid; Masresha, Balcha; Tohme, Rania

2017-01-01

Despite the availability of effective tetanus prevention strategies, as of 2016, Maternal and Neonatal Tetanus Elimination (MNTE) has not yet been achieved in 18 countries globally. In this paper, we review the status of MNTE in the World Health Organization African Region (AFR),and provide recommendations for achieving and maintaining MNTE in AFR. As of November 2016, 37 (79%) AFR countries have achieved MNTE, with 10 (21%) countries remaining. DTP3 coverage increased from 52% in 2000 to 76% in 2015. In 2015, coverage with at least 2 doses of tetanus containing vaccine (TT2+) and proportion of newborns protected at birth (PAB) were 69% and 77%, compared with 44% and 62% in 2000, respectively. Since 1999, over 79 million women of reproductive age (WRA) have been vaccinated with TT2+ through supplementary immunization activities (SIAs). Despite the progress, only 54% of births were attended by skilled birth attendants (SBAs), 5 (11%) countries provided the 3 WHO-recommended booster doses to both sexes, and about 5.5 million WRA still need to be reached with SIAs. Coverage disparities still exist between countries that have achieved MNTE and those that have not. In 2015, coverage with DTP3 and PAB were higher in MNTE countries compared with those yet to achieve MNTE: 84% vs. 68% and 86% vs. 69%, respectively. Challenges to achieving MNTE in the remaining AFR countries include weak health systems, competing priorities, insufficient funding, insecurity, and sub-optimal neonatal tetanus (NT) surveillance. To achieve and maintain MNTE in AFR, increasing SBAs and tetanus vaccination coverage, integrating tetanus vaccination with other opportunities (e.g., polio and measles campaigns, mother and child health days), and providing appropriately spaced booster doses are needed. Strengthening NT surveillance and conducting serosurveys would ensure appropriate targeting of MNTE activities and high-quality information for validating the achievement and maintenance of elimination

Measuring the influence of a mental health training module on the therapeutic optimism of advanced nurse practitioner students in the United Kingdom.

PubMed

Hemingway, Steve; Rogers, Melanie; Elsom, Stephen

2014-03-01

To evaluate the influence of a mental health training module on the therapeutic optimism of advanced nurse practitioner (ANP) students in primary care (family practice). Three cohorts of ANPs who undertook a Mental Health Problems in Primary Care Module as part of their MSc ANP (primary care) run by the University of Huddersfield completed the Elsom Therapeutic Optimism Scale (ETOS), in a pre- and postformat. The ETOS is a 10-item, self-administered scale, which has been used to evaluate therapeutic optimism previously in mental health professionals. All three cohorts who completed the scale showed an improvement in their therapeutic optimism scores. With stigma having such a detrimental effect for people diagnosed with a mental health problem, ANPs who are more mental health literate facilitated by education and training in turn facilitates them to have the skills and confidence to engage and inspire hope for the person diagnosed with mental health problems. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

The Contributions of Physical Activity and Fitness to Optimal Health and Wellness

ERIC Educational Resources Information Center

Ohuruogu, Ben

2016-01-01

The paper examined the role of physical activity and fitness more especially in the area of disease prevention and control by looking at the major ways by which regular physical activity and fitness contributes to optimal health and wellness. The Surgeor General's Report (1996), stressed that physical inactivity is a national problem which…

Optimization of Medication Use at Accountable Care Organizations.

PubMed

Wilks, Chrisanne; Krisle, Erik; Westrich, Kimberly; Lunner, Kristina; Muhlestein, David; Dubois, Robert

2017-10-01

Optimized medication use involves the effective use of medications for better outcomes, improved patient experience, and lower costs. Few studies systematically gather data on the actions accountable care organizations (ACOs) have taken to optimize medication use. To (a) assess how ACOs optimize medication use; (b) establish an association between efforts to optimize medication use and achievement on financial and quality metrics; (c) identify organizational factors that correlate with optimized medication use; and (d) identify barriers to optimized medication use. This cross-sectional study consisted of a survey and interviews that gathered information on the perceptions of ACO leadership. The survey contained a medication practices inventory (MPI) composed of 38 capabilities across 6 functional domains related to optimizing medication use. ACOs completed self-assessments that included rating each component of the MPI on a scale of 1 to 10. Fisher's exact tests, 2-proportions tests, t-tests, and logistic regression were used to test for associations between ACO scores on the MPI and performance on financial and quality metrics, and on ACO descriptive characteristics. Of the 847 ACOs that were contacted, 49 provided usable survey data. These ACOs rated their own system's ability to manage the quality and costs of optimizing medication use, providing a 64% and 31% affirmative response, respectively. Three ACOs achieved an overall MPI score of 8 or higher, 45 scored between 4 and 7.9, and 1 scored between 0 and 3.9. Using the 3 score groups, the study did not identify a relationship between MPI scores and achievement on financial or quality benchmarks, ACO provider type, member volume, date of ACO creation, or the presence of a pharmacist in a leadership position. Barriers to optimizing medication use relate to reimbursement for pharmacist integration, lack of health information technology interoperability, lack of data, feasibility issues, and physician buy

A Structural Health Monitoring Software Tool for Optimization, Diagnostics and Prognostics

DTIC Science & Technology

2011-01-01

A Structural Health Monitoring Software Tool for Optimization, Diagnostics and Prognostics Seth S . Kessler1, Eric B. Flynn2, Christopher T...technology more accessible, and commercially practical. 1. INTRODUCTION Currently successful laboratory non- destructive testing and monitoring...PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES

Indigenous Children in Australia: Health, Education and Optimism for the Future

ERIC Educational Resources Information Center

Lyons, Zaza; Janca, Aleksandar

2012-01-01

In Australia, Indigenous children are disproportionately affected by poor health. The combined consequences of illness and social factors in this population have an adverse affect on educational outcomes for Indigenous children, resulting in lower levels of achievement and attainment compared with non-Indigenous children. From early childhood,…

Optimized distributed systems achieve significant performance improvement on sorted merging of massive VCF files.

PubMed

Sun, Xiaobo; Gao, Jingjing; Jin, Peng; Eng, Celeste; Burchard, Esteban G; Beaty, Terri H; Ruczinski, Ingo; Mathias, Rasika A; Barnes, Kathleen; Wang, Fusheng; Qin, Zhaohui S

2018-06-01

Sorted merging of genomic data is a common data operation necessary in many sequencing-based studies. It involves sorting and merging genomic data from different subjects by their genomic locations. In particular, merging a large number of variant call format (VCF) files is frequently required in large-scale whole-genome sequencing or whole-exome sequencing projects. Traditional single-machine based methods become increasingly inefficient when processing large numbers of files due to the excessive computation time and Input/Output bottleneck. Distributed systems and more recent cloud-based systems offer an attractive solution. However, carefully designed and optimized workflow patterns and execution plans (schemas) are required to take full advantage of the increased computing power while overcoming bottlenecks to achieve high performance. In this study, we custom-design optimized schemas for three Apache big data platforms, Hadoop (MapReduce), HBase, and Spark, to perform sorted merging of a large number of VCF files. These schemas all adopt the divide-and-conquer strategy to split the merging job into sequential phases/stages consisting of subtasks that are conquered in an ordered, parallel, and bottleneck-free way. In two illustrating examples, we test the performance of our schemas on merging multiple VCF files into either a single TPED or a single VCF file, which are benchmarked with the traditional single/parallel multiway-merge methods, message passing interface (MPI)-based high-performance computing (HPC) implementation, and the popular VCFTools. Our experiments suggest all three schemas either deliver a significant improvement in efficiency or render much better strong and weak scalabilities over traditional methods. Our findings provide generalized scalable schemas for performing sorted merging on genetics and genomics data using these Apache distributed systems.

Optimizing Decision Support for Tailored Health Behavior Change Applications.

PubMed

Kukafka, Rita; Jeong, In cheol; Finkelstein, Joseph

2015-01-01

The Tailored Lifestyle Change Decision Aid (TLC DA) system was designed to provide support for a person to make an informed choice about which behavior change to work on when multiple unhealthy behaviors are present. TLC DA can be delivered via web, smartphones and tablets. The system collects a significant amount of information that is used to generate tailored messages to consumers to persuade them in certain healthy lifestyles. One limitation is the necessity to collect vast amounts of information from users who manually enter. By identifying an optimal set of self-reported parameters we will be able to minimize the data entry burden of the app users. The study was to identify primary determinants of health behavior choices made by patients after using the system. Using discriminant analysis an optimal set of predictors was identified. The resulting set included smoking status, smoking cessation success estimate, self-efficacy, body mass index and diet status. Predicting smoking cessation choice was the most accurate, followed by weight management. Physical activity and diet choices were better identified in a combined cluster.

Optimal distribution of medical backpacks and health surveillance assistants in Malawi.

PubMed

Kunkel, Amber G; Van Itallie, Elizabeth S; Wu, Duo

2014-09-01

Despite recent progress, Malawi continues to perform poorly on key health indicators such as child mortality and life expectancy. These problems are exacerbated by a severe lack of access to health care. Health Surveillance Assistants (HSAs) help bridge this gap by providing community-level access to basic health care services. However, the success of these HSAs is limited by a lack of supplies and long distances between HSAs and patients. To address this issue, we used large-scale weighted p-median and capacitated facility location problems to create a scalable, three-tiered plan for optimal allocation of HSAs, HSA designated medical backpacks, and backpack resupply centers. Our analysis uses real data on the location and characteristics of hospitals, health centers, and the general population. In addition to offering specific recommendations for HSA, backpack, and resupply center locations, it provides general insights into the scope of the proposed HSA backpack program scale-up. In particular, it demonstrates the importance of local health centers to the resupply network. The proposed assignments are robust to changes in the underlying population structure, and could significantly improve access to medical supplies for both HSAs and patients.

Scale-up of HIV Treatment Through PEPFAR: A Historic Public Health Achievement

PubMed Central

El-Sadr, Wafaa M.; Holmes, Charles B.; Mugyenyi, Peter; Thirumurthy, Harsha; Ellerbrock, Tedd; Ferris, Robert; Sanne, Ian; Asiimwe, Anita; Hirnschall, Gottfried; Nkambule, Rejoice N.; Stabinski, Lara; Affrunti, Megan; Teasdale, Chloe; Zulu, Isaac; Whiteside, Alan

2012-01-01

Since its inception in 2003, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems. PMID:22797746

Scale-up of HIV treatment through PEPFAR: a historic public health achievement.

PubMed

El-Sadr, Wafaa M; Holmes, Charles B; Mugyenyi, Peter; Thirumurthy, Harsha; Ellerbrock, Tedd; Ferris, Robert; Sanne, Ian; Asiimwe, Anita; Hirnschall, Gottfried; Nkambule, Rejoice N; Stabinski, Lara; Affrunti, Megan; Teasdale, Chloe; Zulu, Isaac; Whiteside, Alan

2012-08-15

Since its inception in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems.

An Efficient Taguchi Approach for the Performance Optimization of Health, Safety, Environment and Ergonomics in Generation Companies.

PubMed

Azadeh, Ali; Sheikhalishahi, Mohammad

2015-06-01

A unique framework for performance optimization of generation companies (GENCOs) based on health, safety, environment, and ergonomics (HSEE) indicators is presented. To rank this sector of industry, the combination of data envelopment analysis (DEA), principal component analysis (PCA), and Taguchi are used for all branches of GENCOs. These methods are applied in an integrated manner to measure the performance of GENCO. The preferred model between DEA, PCA, and Taguchi is selected based on sensitivity analysis and maximum correlation between rankings. To achieve the stated objectives, noise is introduced into input data. The results show that Taguchi outperforms other methods. Moreover, a comprehensive experiment is carried out to identify the most influential factor for ranking GENCOs. The approach developed in this study could be used for continuous assessment and improvement of GENCO's performance in supplying energy with respect to HSEE factors. The results of such studies would help managers to have better understanding of weak and strong points in terms of HSEE factors.

The Medication Optimization Value Proposition: Aligning Teams and Education to Improve Care.

PubMed

Easter, Jon C; DeWalt, Darren A

2017-01-01

United States health care lags behind other countries in quality and cost. The present health care system is unsustainable, and there is now a quick movement toward value-based care. This article lays out essential care delivery elements, and makes the case for medication optimization to enable new value-based models. Success factors include enhancing team-based care and interdisciplinary education to achieve patient-centered care. ©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Vaccination ecosystem health check: achieving impact today and sustainability for tomorrow.

PubMed

Saadatian-Elahi, Mitra; Bloom, David; Plotkin, Stanley; Picot, Valentina; Louis, Jacques; Watson, Michael

2017-01-01

Vaccination is a complex ecosystem with several components that interact with one another and with the environment. Today's vaccine ecosystem is defined by the pursuit of polio eradication, the drive to get as many of the new vaccines to as many people as possible and the research and development against immunologically challenging diseases. Despite these successes, vaccine ecosystem is facing keys issues with regard to supply/distribution and cost/profitability asymmetry that risk slowing its global growth. The conference "Vaccination ecosystem health check: achieving impact today and sustainability for tomorrow" held in Annecy-France (January 19-21, 2015) took stock of the health of today's vaccination ecosystem and its ability to reliably and sustainably supply high-quality vaccines while investing in tomorrow's needed innovation. Small and decreasing numbers of suppliers/manufacturing facilities; paucity of research-driven companies; regulatory pressures; market uncertainties; political prioritization; anti-vaccine movements/complacency; and technological and programmatic issues were acknowledged as the major challenges that could weaken today's vaccination ecosystem. The expert panel discussed also drivers and barriers to a sustainable vaccination ecosystem; the metrics of a vaccination ecosystem; and what should be added, removed, increased, or reduced to maintain the health of the vaccination ecosystem.

Global commitments and China's endeavors to promote health and achieve sustainable development goals.

PubMed

Tan, Xiaodong; Wu, Qian; Shao, Haiyan

2018-04-12

With its immense population and as the largest developing country in the world, China has made remarkable achievements in health promotion at a relatively low cost. However, China is still faced with challenges such as changes of disease spectrum, the coming era of an aging society, and the risk of environmental pollution. On October 25, 2016, China formally passed the blueprint of "Healthy China 2030," working towards the national goal of reaching a health standard on par with developed countries by 2030, which was also a response to realize the 2030 United Nations Sustainable Development Goals. "Healthy China 2030" is comprised of 29 chapters that cover five health areas. China is sparing no effort to transfer from being merely the most populous country, to becoming a leading nation in health education. In "Healthy China 2030," collaborated construction and resource sharing were clearly stated as the core strategy. A shift in concentration towards coordinated development of health-based economy from a previous pursuit of rapid economic growth was also underlined. There are also several major issues, such as severely aging population, the burden of chronic diseases, the insufficiency of health expenditure, and the great demand on health protection, waiting to be dealt with during the implementation process of "Healthy China 2030". "Healthy China 2030" is a momentous move to enhance public health, which is also a response to the global commitments. We also need to rethink our approach to reach the living standards and maintain a better environment.

Framework for computationally efficient optimal irrigation scheduling using ant colony optimization

USDA-ARS?s Scientific Manuscript database

A general optimization framework is introduced with the overall goal of reducing search space size and increasing the computational efficiency of evolutionary algorithm application for optimal irrigation scheduling. The framework achieves this goal by representing the problem in the form of a decisi...

Utilization of Ayurveda in health care: an approach for prevention, health promotion, and treatment of disease. Part 1--Ayurveda, the science of life.

PubMed

Sharma, Hari; Chandola, H M; Singh, Gurdip; Basisht, Gopal

2007-11-01

Ayurveda is a natural health care system that originated in India more than 5000 years ago. Its main objective is to achieve optimal health and well-being through a comprehensive approach that addresses mind, body, behavior, and environment. Ayurveda emphasizes prevention and health promotion, and provides treatment for disease. It considers the development of consciousness to be essential for optimal health and meditation as the main technique for achieving this. Treatment of disease is highly individualized and depends on the psychophysiologic constitution of the patient. There are different dietary and lifestyle recommendations for each season of the year. Common spices are utilized in treatment, as well as herbs and herbal mixtures, and special preparations known as Rasayanas are used for rejuvenation, promotion of longevity, and slowing of the aging process. A group of purification procedures known as Panchakarma removes toxins from the physiology. Whereas Western allopathic medicine is excellent in handling acute medical crises, Ayurveda demonstrates an ability to manage chronic disorders that Western medicine has been unable to. It may be projected from Ayurveda's comprehensive approach, emphasis on prevention, and ability to manage chronic disorders that its widespread use would improve the health status of the world's population.

Leveraging health information technology to achieve the “triple aim” of healthcare reform

PubMed Central

Sood, Harpreet S; Bates, David W

2015-01-01

Objective To investigate experiences with leveraging health information technology (HIT) to improve patient care and population health, and reduce healthcare expenditures. Materials and methods In-depth qualitative interviews with federal government employees, health policy, HIT and medico-legal experts, health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States. Results The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to “kick the legs from underneath the fee-for-service model” and replace it with a data-driven reimbursement system that rewards high quality care. Conclusions The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm—addressing these issues therefore needs to be the federal

The quest for universal health coverage: achieving social protection for all in Mexico.

PubMed

Knaul, Felicia Marie; González-Pier, Eduardo; Gómez-Dantés, Octavio; García-Junco, David; Arreola-Ornelas, Héctor; Barraza-Lloréns, Mariana; Sandoval, Rosa; Caballero, Francisco; Hernández-Avila, Mauricio; Juan, Mercedes; Kershenobich, David; Nigenda, Gustavo; Ruelas, Enrique; Sepúlveda, Jaime; Tapia, Roberto; Soberón, Guillermo; Chertorivski, Salomón; Frenk, Julio

2012-10-06

Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries. Copyright

The effects of optimism and gratitude on adherence, functioning and mental health following an acute coronary syndrome.

PubMed

Millstein, Rachel A; Celano, Christopher M; Beale, Eleanor E; Beach, Scott R; Suarez, Laura; Belcher, Arianna M; Januzzi, James L; Huffman, Jeff C

This study examined the effects of optimism and gratitude on self-reported health behavior adherence, physical functioning and emotional well-being after an acute coronary syndrome (ACS). Among 156 patients, we examined associations between optimism and gratitude measured 2 weeks post-ACS and 6-month outcomes: adherence to medical recommendations, mental and physical health-related quality of life (HRQoL), physical functioning, depressive symptoms and anxiety. Multivariable linear regression models were used, controlling for increasing levels of adjustment. Optimism [β=.11, standard error (S.E.)=.05, P=.038] and gratitude (β=.10, S.E.=.05, P=.027) at 2 weeks were associated with subsequent self-reported adherence to medical recommendations (diet, exercise, medication adherence, stress reduction) at 6 months in fully adjusted models. Two-week optimism and gratitude were associated with improvements in mental HRQoL (optimism: β=.44, S.E.=.13, P=.001; gratitude: β=.33, S.E.=.12, P=.005) and reductions in symptoms of depression (optimism: β=-.11, S.E.=.05, P=.039; gratitude: β=-.10, S.E.=.05, P=.028) and anxiety (optimism: β=-.15, S.E.=.05, P=.004; gratitude: β=-.10, S.E.=.05, P=.034) at 6 months. Optimism and gratitude at 2 weeks post-ACS were associated with higher self-reported adherence and improved emotional well-being 6 months later, independent of negative emotional states. Optimism and gratitude may help recovery from an ACS. Interventions promoting these positive constructs could help improve adherence and well-being. Copyright © 2016 Elsevier Inc. All rights reserved.

The Relationship Between Nutrition and Student Achievement, Behavior, and Health: A Review of the Literature.

ERIC Educational Resources Information Center

Tseng, Rose Y. L., Comp.; And Others

The punpose of this report is to review existing research concerned with the relationship of nutrition to student achievement, behavior and health. Information was obtained through searches of computerized data bases, review of journal citations, discussions and correspondence with nutrition personnel as well as reviews of materials available from…

An integrated strategy of knowledge application for optimal e-health implementation: A multi-method study protocol

PubMed Central

Gagnon, Marie-Pierre; Légaré, France; Fortin, Jean-Paul; Lamothe, Lise; Labrecque, Michel; Duplantie, Julie

2008-01-01

Background E-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system. Methods A three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed

Optimized distributed systems achieve significant performance improvement on sorted merging of massive VCF files

PubMed Central

Gao, Jingjing; Jin, Peng; Eng, Celeste; Burchard, Esteban G; Beaty, Terri H; Ruczinski, Ingo; Mathias, Rasika A; Barnes, Kathleen; Wang, Fusheng

2018-01-01

Abstract Background Sorted merging of genomic data is a common data operation necessary in many sequencing-based studies. It involves sorting and merging genomic data from different subjects by their genomic locations. In particular, merging a large number of variant call format (VCF) files is frequently required in large-scale whole-genome sequencing or whole-exome sequencing projects. Traditional single-machine based methods become increasingly inefficient when processing large numbers of files due to the excessive computation time and Input/Output bottleneck. Distributed systems and more recent cloud-based systems offer an attractive solution. However, carefully designed and optimized workflow patterns and execution plans (schemas) are required to take full advantage of the increased computing power while overcoming bottlenecks to achieve high performance. Findings In this study, we custom-design optimized schemas for three Apache big data platforms, Hadoop (MapReduce), HBase, and Spark, to perform sorted merging of a large number of VCF files. These schemas all adopt the divide-and-conquer strategy to split the merging job into sequential phases/stages consisting of subtasks that are conquered in an ordered, parallel, and bottleneck-free way. In two illustrating examples, we test the performance of our schemas on merging multiple VCF files into either a single TPED or a single VCF file, which are benchmarked with the traditional single/parallel multiway-merge methods, message passing interface (MPI)–based high-performance computing (HPC) implementation, and the popular VCFTools. Conclusions Our experiments suggest all three schemas either deliver a significant improvement in efficiency or render much better strong and weak scalabilities over traditional methods. Our findings provide generalized scalable schemas for performing sorted merging on genetics and genomics data using these Apache distributed systems. PMID:29762754

Global optimization method based on ray tracing to achieve optimum figure error compensation

NASA Astrophysics Data System (ADS)

Liu, Xiaolin; Guo, Xuejia; Tang, Tianjin

2017-02-01

Figure error would degrade the performance of optical system. When predicting the performance and performing system assembly, compensation by clocking of optical components around the optical axis is a conventional but user-dependent method. Commercial optical software cannot optimize this clocking. Meanwhile existing automatic figure-error balancing methods can introduce approximate calculation error and the build process of optimization model is complex and time-consuming. To overcome these limitations, an accurate and automatic global optimization method of figure error balancing is proposed. This method is based on precise ray tracing to calculate the wavefront error, not approximate calculation, under a given elements' rotation angles combination. The composite wavefront error root-mean-square (RMS) acts as the cost function. Simulated annealing algorithm is used to seek the optimal combination of rotation angles of each optical element. This method can be applied to all rotational symmetric optics. Optimization results show that this method is 49% better than previous approximate analytical method.

The Ha Noi Expert Statement: recognition of maternal mental health in resource-constrained settings is essential for achieving the Millennium Development Goals.

PubMed

Fisher, Jane Rw; de Mello, Meena Cabral; Izutsu, Takashi; Tran, Tuan

2011-01-07

Mental health problems in women during pregnancy and after childbirth and their adverse consequences for child health and development have received sustained detailed attention in high-income countries. In contrast, evidence has only been generated more recently in resource-constrained settings.In June 2007 the United Nations Population Fund, the World Health Organization, the Key Centre for Women's Health in Society, a WHO Collaborating Centre for Women's Health and the Research and Training Centre for Community Development in Vietnam convened the first international expert meeting on maternal mental health and child health and development in resource-constrained settings. It aimed to appraise the evidence about the nature, prevalence and risks for common perinatal mental disorders in women; the consequences of these for child health and development and ameliorative strategies in these contexts.The substantial disparity in rates of perinatal mental disorders between women living in high- and low-income settings, suggests social rather than biological determinants. Risks in resource-constrained contexts include: poverty; crowded living situations; limited reproductive autonomy; unintended pregnancy; lack of empathy from the intimate partner; rigid gender stereotypes about responsibility for household work and infant care; family violence; poor physical health and discrimination. Development is adversely affected if infants lack day-to-day interactions with a caregiver who can interpret their cues, and respond effectively. Women with compromised mental health are less able to provide sensitive, responsive infant care. In resource-constrained settings infants whose mothers are depressed are less likely to thrive and to receive optimal care than those whose mothers are well.The meeting outcome is the Hanoi Expert Statement (Additional file 1). It argues that the Millennium Development Goals to improve maternal health, reduce child mortality, promote gender equality

Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage

PubMed Central

2013-01-01

The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage. PMID:23294982

42 CFR 3.304 - Principles for achieving compliance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Principles for achieving compliance. 3.304 Section 3.304 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... Principles for achieving compliance. (a) Cooperation. The Secretary will, to the extent practicable, seek the...

Optimizing density patterns to achieve desired light extraction for displays

NASA Astrophysics Data System (ADS)

Davenport, T. L. R.; Cassarly, W. J.

2007-01-01

In displays such as backlights and signage, it is often desirable to produce a particular spatial luminance distribution of light. This work demonstrates an iterative optimization technique for determining the density of light extractors required to produce desired luminance distributions.

Future's Learning Environments in Health Education: The Effects of Smart Classrooms on the Academic Achievements of the Students at Health College

ERIC Educational Resources Information Center

Sevindik, Tuncay

2010-01-01

The aim of this study is to determine the effectiveness of smart classrooms on the academic achievement of the nursing students. The sample of the research included 66 Health College students in Elazig. The sampling group was randomly chosen from second year students of Nursing and Midwife Education. The research was carried out with experimental…

Using health technology assessment to support optimal use of technologies in current practice: the challenge of "disinvestment".

PubMed

Henshall, Chris; Schuller, Tara; Mardhani-Bayne, Logan

2012-07-01

Health systems face rising patient expectations and economic pressures; decision makers seek to enhance efficiency to improve access to appropriate care. There is international interest in the role of HTA to support decisions to optimize use of established technologies, particularly in "disinvesting" from low-benefit uses. This study summarizes main points from an HTAi Policy Forum meeting on this topic, drawing on presentations, discussions among attendees, and an advance background paper. Optimization involves assessment or re-assessment of a technology, a decision on optimal use, and decision implementation. This may occur within a routine process to improve safety and quality and create "headroom" for new technologies, or ad hoc in response to financial constraints. The term "disinvestment" is not always helpful in describing these processes. HTA contributes to optimization, but there is scope to increase its role in many systems. Stakeholders may have strong views on access to technology, and stakeholder involvement is essential. Optimization faces challenges including loss aversion and entitlement, stakeholder inertia and entrenchment, heterogeneity in patient outcomes, and the need to demonstrate convincingly absence of benefit. While basic HTA principles remain applicable, methodological developments are needed better to support optimization. These include mechanisms for candidate technology identification and prioritization, enhanced collection and analysis of routine data, and clinician engagement. To maximize value to decision makers, HTA should consider implementation strategies and barriers. Improving optimization processes calls for a coordinated approach, and actions are identified for system leaders, HTA and other health organizations, and industry.

Identifying factors for optimal development of health-related websites: a delphi study among experts and potential future users.

PubMed

Schneider, Francine; van Osch, Liesbeth; de Vries, Hein

2012-02-14

The Internet has become a popular medium for offering tailored and targeted health promotion programs to the general public. However, suboptimal levels of program use in the target population limit the public health impact of these programs. Optimizing program development is considered as one of the main processes to increase usage rates. To distinguish factors potentially related to optimal development of health-related websites by involving both experts and potential users. By considering and incorporating the opinions of experts and potential users in the development process, involvement in the program is expected to increase, consequently resulting in increased appreciation, lower levels of attrition, and higher levels of sustained use. We conducted a systematic three-round Delphi study through the Internet. Both national and international experts (from the fields of health promotion, health psychology, e-communication, and technical Web design) and potential users were invited via email to participate. During this study an extensive list of factors potentially related to optimal development of health-related websites was identified, by focusing on factors related to layout, general and risk information provision, questionnaire use, additional services, and ease of use. Furthermore, we assessed the extent to which experts and potential users agreed on the importance of these factors. Differences as well as similarities among experts and potentials users were deduced. In total, 20 of 62 contacted experts participated in the first round (32% response rate); 60 of 200 contacted experts (30% response rate) and 210 potential users (95% response rate) completed the second-round questionnaire, and 32 of 60 contacted experts completed the third round (53% response rate). Results revealed important factors consented upon by experts and potential users (eg, ease of use, clear structure, and detailed health information provision), as well as differences regarding

Technical assistance from state health departments for communities engaged in policy, systems, and environmental change: the ACHIEVE Program.

PubMed

Hefelfinger, Jenny; Patty, Alice; Ussery, Ann; Young, Walter

2013-10-24

This study assessed the value of technical assistance provided by state health department expert advisors and by the staff of the National Association of Chronic Disease Directors (NACDD) to community groups that participated in the Action Communities for Health, Innovation, and Environmental Change (ACHIEVE) Program, a CDC-funded health promotion program. We analyzed quantitative and qualitative data reported by community project coordinators to assess the nature and value of technical assistance provided by expert advisors and NACDD staff and the usefulness of ACHIEVE resources in the development and implementation of community action plans. A grounded theory approach was used to analyze and categorize phrases in text data provided by community coordinators. Open coding placed conceptual labels on text phrases. Frequency distributions of the quantitative data are described and discussed. The most valuable technical assistance and program support resources were those determined to be in the interpersonal domain (ie, interactions with state expert advisors, NACDD staff, and peer-to-peer support). The most valuable technical assistance events were action institutes, coaches' meetings, webinars, and technical assistance conference calls. This analysis suggests that ACHIEVE communities valued the management and training assistance provided by expert advisors and NACDD staff. State health department expert advisors provided technical guidance and support, including such skills or knowledge-based services as best-practice strategies, review and discussion of community assessment data, sustainability planning, and identification of possible funding opportunities. NACDD staff led development and implementation of technical assistance events.

The Relation among School District Health, Total Quality Principles for School Organization and Student Achievement

ERIC Educational Resources Information Center

Marshall, Jon; Pritchard, Ruie; Gunderson, Betsey

2004-01-01

The purpose of this study was to determine the congruence among W. E. Deming's 14 points for Total Quality Management (TQM), the organizational health of school districts, and student achievement. Based on Kanter's (1983) concept of a Culture of Pride with a Climate of Success, healthy districts were defined as having an organizational culture…

Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics.

PubMed

Vonk, Robert A A; Schut, Frederik T

2018-05-07

For almost a century, the Netherlands was marked by a large market for voluntary private health insurance alongside state-regulated social health insurance. Throughout this period, private health insurers tried to safeguard their position within an expanding welfare state. From an institutional logics perspective, we analyze how private health insurers tried to reconcile the tension between a competitive insurance market pressuring for selective underwriting and actuarially fair premiums (the insurance logic), and an upcoming welfare state pressuring for universal access and socially fair premiums (the welfare state logic). Based on primary sources and the extant historiography, we distinguish six periods in which the balance between both logics changed significantly. We identify various strategies employed by private insurers to reconcile the competing logics. Some of these were temporarily successful, but required measures that were incompatible with the idea of free entrepreneurship and consumer choice. We conclude that universal access can only be achieved in a competitive individual private health insurance market if this market is effectively regulated and mandatory cross-subsidies are effectively enforced. The Dutch case demonstrates that achieving universal access in a competitive private health insurance market is institutionally complex and requires broad political and societal support.

Optimism as a predictor of health-related quality of life in psoriatics

PubMed Central

Miniszewska, Joanna; Chodkiewicz, Jan; Zalewska-Janowska, Anna

2013-01-01

Introduction Psoriasis is a chronic and relapsing disease which significantly affects the quality of life and social functioning of the affected people. It is one of the so-called psychodermatological diseases, which means that there exists a psychological component in the image of the disease. Aim To examine the relationship between health-related quality of life (HRQoL) in psoriatics and selected demographic, medical and psychological (dispositional optimism) variables and to determine the predictors of HRQoL in the examined group. Material and methods The study consisted of 138 patients with the diagnosis of psoriasis vulgaris. Most respondents (125) had psoriasis on exposed parts of the body. Methods used: SKINDEX, Life Orientation Test, PASI. Results The gender does not differentiate patients in terms of HRQoL and optimism. Almost all of analyzed variables correlate with HRQoL and all examined variables explain the results variability for overall HRQoL but only optimism explains the highest percentage of the variability (β = –0.35). Conclusions The study demonstrated a very interesting relationship – the stronger optimism the better quality of life in psoriatics. So, a generalized expectation of positive life events is related to better assessment of HRQoL. PMID:24278054

How Positive Is Their Future? Assessing the Role of Optimism and Social Support in Understanding Mental Health Symptomatology among Homeless Adults.

PubMed

Fitzpatrick, Kevin M

2017-04-01

Optimism has been noted as a primary protective factor in understanding mental health symptomatology in clinical and non-clinical settings. Any exploration of optimism has been absent in understanding mental health outcomes among homeless people. This study, using intensive interviews with 168 homeless adults in Northwest Arkansas, examines the role that social support and optimism play in lessening the negative impact of homeless circumstances/experiences on mental health symptomatology. Using OLS, findings support a mediating/protective role that social support and optimism play in lowering the negative effects of childhood life experiences on depressive symptoms among homeless persons. Despite the overwhelming conditions of homelessness, persons with higher levels of optimism and social support report lower depression and anxiety symptoms. The findings are discussed paying particular attention to the importance of developing and maintaining the perception of support and resiliency in preserving a positive outlook for the future among homeless persons facing often-debilitating circumstances. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Do we have the right models for scaling up health services to achieve the Millennium Development Goals?

PubMed

Subramanian, Savitha; Naimoli, Joseph; Matsubayashi, Toru; Peters, David H

2011-12-14

There is widespread agreement on the need for scaling up in the health sector to achieve the Millennium Development Goals (MDGs). But many countries are not on track to reach the MDG targets. The dominant approach used by global health initiatives promotes uniform interventions and targets, assuming that specific technical interventions tested in one country can be replicated across countries to rapidly expand coverage. Yet countries scale up health services and progress against the MDGs at very different rates. Global health initiatives need to take advantage of what has been learned about scaling up. A systematic literature review was conducted to identify conceptual models for scaling up health in developing countries, with the articles assessed according to the practical concerns of how to scale up, including the planning, monitoring and implementation approaches. We identified six conceptual models for scaling up in health based on experience with expanding pilot projects and diffusion of innovations. They place importance on paying attention to enhancing organizational, functional, and political capabilities through experimentation and adaptation of strategies in addition to increasing the coverage and range of health services. These scaling up approaches focus on fostering sustainable institutions and the constructive engagement between end users and the provider and financing organizations. The current approaches to scaling up health services to reach the MDGs are overly simplistic and not working adequately. Rather than relying on blueprint planning and raising funds, an approach characteristic of current global health efforts, experience with alternative models suggests that more promising pathways involve "learning by doing" in ways that engage key stakeholders, uses data to address constraints, and incorporates results from pilot projects. Such approaches should be applied to current strategies to achieve the MDGs.

Aircraft optimization by a system approach: Achievements and trends

NASA Technical Reports Server (NTRS)

Sobieszczanski-Sobieski, Jaroslaw

1992-01-01

Recently emerging methodology for optimal design of aircraft treated as a system of interacting physical phenomena and parts is examined. The methodology is found to coalesce into methods for hierarchic, non-hierarchic, and hybrid systems all dependent on sensitivity analysis. A separate category of methods has also evolved independent of sensitivity analysis, hence suitable for discrete problems. References and numerical applications are cited. Massively parallel computer processing is seen as enabling technology for practical implementation of the methodology.

mHealthMon: toward energy-efficient and distributed mobile health monitoring using parallel offloading.

PubMed

Ahnn, Jong Hoon; Potkonjak, Miodrag

2013-10-01

Although mobile health monitoring where mobile sensors continuously gather, process, and update sensor readings (e.g. vital signals) from patient's sensors is emerging, little effort has been investigated in an energy-efficient management of sensor information gathering and processing. Mobile health monitoring with the focus of energy consumption may instead be holistically analyzed and systematically designed as a global solution to optimization subproblems. This paper presents an attempt to decompose the very complex mobile health monitoring system whose layer in the system corresponds to decomposed subproblems, and interfaces between them are quantified as functions of the optimization variables in order to orchestrate the subproblems. We propose a distributed and energy-saving mobile health platform, called mHealthMon where mobile users publish/access sensor data via a cloud computing-based distributed P2P overlay network. The key objective is to satisfy the mobile health monitoring application's quality of service requirements by modeling each subsystem: mobile clients with medical sensors, wireless network medium, and distributed cloud services. By simulations based on experimental data, we present the proposed system can achieve up to 10.1 times more energy-efficient and 20.2 times faster compared to a standalone mobile health monitoring application, in various mobile health monitoring scenarios applying a realistic mobility model.

Childhood vaccination: achievements and challenges.

PubMed

Ndumbe, P

1996-09-01

As the goal of eradicating smallpox was being met, the World Health Organization created its Expanded Programme on Immunisation (EPI) in 1974 and reached its initial goal of achieving full vaccination of 80% of the world's children by 1990. This effort was aided by the creation of "cold chain" delivery systems and resulted in the annual saving of 3.5 million children in less-developed countries. Current EPI vaccination goals include 1) eradication of poliomyelitis by the year 2000, 2) elimination of neonatal tetanus by the year 1995, 3) control of measles and hepatitis B, and 4) immunization of 90% of the world's children 1 year or younger by the year 2000. Goals of the Children's Vaccine Initiative (formed in 1991) include 1) provision of an adequate supply of affordable, safe, and effective vaccines; 2) production of improved and new vaccines; and 3) simplification of the logistics of vaccine delivery. Future challenges are to sustain high vaccination coverage, reach the unreached, achieve proper storage of vaccines and reduce waste, integrate new vaccines into national programs, and achieve vaccine self-sufficiency. The fact that these challenges will be difficult to achieve is illustrated by the situation in Africa where the high immunization levels achieved in 1990 have dropped dramatically. Those who must act to implement immunization programs are health personnel, families, governments, and development partners. In order to achieve equity in health, every child must be reached, governments must be made accountable for programs, health workers must convince families of the importance of vaccination, delivery systems must be in place to take advantage of the new vaccines being delivered, and a multisectoral approach must be taken to assure sustainability.

Achieving Population Health in Accountable Care Organizations

PubMed Central

Walker, Deborah Klein

2013-01-01

Although “population health” is one of the Institute for Healthcare Improvement’s Triple Aim goals, its relationship to accountable care organizations (ACOs) remains ill-defined and lacks clarity as to how the clinical delivery system intersects with the public health system. Although defining population health as “panel” management seems to be the default definition, we called for a broader “community health” definition that could improve relationships between clinical delivery and public health systems and health outcomes for communities. We discussed this broader definition and offered recommendations for linking ACOs with the public health system toward improving health for patients and their communities. PMID:23678910

Optimized survey design for electrical resistivity tomography: combined optimization of measurement configuration and electrode placement

NASA Astrophysics Data System (ADS)

Uhlemann, Sebastian; Wilkinson, Paul B.; Maurer, Hansruedi; Wagner, Florian M.; Johnson, Timothy C.; Chambers, Jonathan E.

2018-07-01

Within geoelectrical imaging, the choice of measurement configurations and electrode locations is known to control the image resolution. Previous work has shown that optimized survey designs can provide a model resolution that is superior to standard survey designs. This paper demonstrates a methodology to optimize resolution within a target area, while limiting the number of required electrodes, thereby selecting optimal electrode locations. This is achieved by extending previous work on the `Compare-R' algorithm, which by calculating updates to the resolution matrix optimizes the model resolution in a target area. Here, an additional weighting factor is introduced that allows to preferentially adding measurement configurations that can be acquired on a given set of electrodes. The performance of the optimization is tested on two synthetic examples and verified with a laboratory study. The effect of the weighting factor is investigated using an acquisition layout comprising a single line of electrodes. The results show that an increasing weight decreases the area of improved resolution, but leads to a smaller number of electrode positions. Imaging results superior to a standard survey design were achieved using 56 per cent fewer electrodes. The performance was also tested on a 3-D acquisition grid, where superior resolution within a target at the base of an embankment was achieved using 22 per cent fewer electrodes than a comparable standard survey. The effect of the underlying resistivity distribution on the performance of the optimization was investigated and it was shown that even strong resistivity contrasts only have minor impact. The synthetic results were verified in a laboratory tank experiment, where notable image improvements were achieved. This work shows that optimized surveys can be designed that have a resolution superior to standard survey designs, while requiring significantly fewer electrodes. This methodology thereby provides a means for

Optimized survey design for Electrical Resistivity Tomography: combined optimization of measurement configuration and electrode placement

NASA Astrophysics Data System (ADS)

Uhlemann, Sebastian; Wilkinson, Paul B.; Maurer, Hansruedi; Wagner, Florian M.; Johnson, Timothy C.; Chambers, Jonathan E.

2018-03-01

Within geoelectrical imaging, the choice of measurement configurations and electrode locations is known to control the image resolution. Previous work has shown that optimized survey designs can provide a model resolution that is superior to standard survey designs. This paper demonstrates a methodology to optimize resolution within a target area, while limiting the number of required electrodes, thereby selecting optimal electrode locations. This is achieved by extending previous work on the `Compare-R' algorithm, which by calculating updates to the resolution matrix optimizes the model resolution in a target area. Here, an additional weighting factor is introduced that allows to preferentially adding measurement configurations that can be acquired on a given set of electrodes. The performance of the optimization is tested on two synthetic examples and verified with a laboratory study. The effect of the weighting factor is investigated using an acquisition layout comprising a single line of electrodes. The results show that an increasing weight decreases the area of improved resolution, but leads to a smaller number of electrode positions. Imaging results superior to a standard survey design were achieved using 56 per cent fewer electrodes. The performance was also tested on a 3D acquisition grid, where superior resolution within a target at the base of an embankment was achieved using 22 per cent fewer electrodes than a comparable standard survey. The effect of the underlying resistivity distribution on the performance of the optimization was investigated and it was shown that even strong resistivity contrasts only have minor impact. The synthetic results were verified in a laboratory tank experiment, where notable image improvements were achieved. This work shows that optimized surveys can be designed that have a resolution superior to standard survey designs, while requiring significantly fewer electrodes. This methodology thereby provides a means for improving

"Masculinity, Femininity, Achievement Conflicts and Health."

ERIC Educational Resources Information Center

Olds, Debra Eaton

The objective of this study is to measure achievement motivation in terms of psychological masculinity and femininity rather than in terms of biological gender. The terms, psychological masculinity and femininity, refer to sets of characteristics desirable for both sexes. Masculine characteristics include independence, self-confidence,…

The association between optimal lifestyle-related health behaviors and employee productivity.

PubMed

Katz, Abigail S; Pronk, Nicolaas P; Lowry, Marcia

2014-07-01

To investigate the association between lifestyle-related health behaviors including sleep and the cluster of physical activity, no tobacco use, fruits and vegetables intake, and alcohol consumption termed the "Optimal Lifestyle Metric" (OLM), and employee productivity. Data were obtained from employee health assessments (N = 18,079). Regression techniques were used to study the association between OLM and employee productivity, sleep and employee productivity, and the interaction of both OLM and sleep on employee productivity. Employees who slept less or more than 7 or 8 hours per night experienced significantly more productivity loss. Employees who adhered to all four OLM behaviors simultaneously experienced less productivity loss compared with those who did not. Adequate sleep and adherence to the OLM cluster of behaviors are associated with significantly less productivity loss.

An Efficient Taguchi Approach for the Performance Optimization of Health, Safety, Environment and Ergonomics in Generation Companies

PubMed Central

Azadeh, Ali; Sheikhalishahi, Mohammad

2014-01-01

Background A unique framework for performance optimization of generation companies (GENCOs) based on health, safety, environment, and ergonomics (HSEE) indicators is presented. Methods To rank this sector of industry, the combination of data envelopment analysis (DEA), principal component analysis (PCA), and Taguchi are used for all branches of GENCOs. These methods are applied in an integrated manner to measure the performance of GENCO. The preferred model between DEA, PCA, and Taguchi is selected based on sensitivity analysis and maximum correlation between rankings. To achieve the stated objectives, noise is introduced into input data. Results The results show that Taguchi outperforms other methods. Moreover, a comprehensive experiment is carried out to identify the most influential factor for ranking GENCOs. Conclusion The approach developed in this study could be used for continuous assessment and improvement of GENCO's performance in supplying energy with respect to HSEE factors. The results of such studies would help managers to have better understanding of weak and strong points in terms of HSEE factors. PMID:26106505

Technical Assistance From State Health Departments for Communities Engaged in Policy, Systems, and Environmental Change: The ACHIEVE Program

PubMed Central

Hefelfinger, Jenny; Patty, Alice; Ussery, Ann

2013-01-01

Introduction This study assessed the value of technical assistance provided by state health department expert advisors and by the staff of the National Association of Chronic Disease Directors (NACDD) to community groups that participated in the Action Communities for Health, Innovation, and Environmental Change (ACHIEVE) Program, a CDC-funded health promotion program. Methods We analyzed quantitative and qualitative data reported by community project coordinators to assess the nature and value of technical assistance provided by expert advisors and NACDD staff and the usefulness of ACHIEVE resources in the development and implementation of community action plans. A grounded theory approach was used to analyze and categorize phrases in text data provided by community coordinators. Open coding placed conceptual labels on text phrases. Frequency distributions of the quantitative data are described and discussed. Results The most valuable technical assistance and program support resources were those determined to be in the interpersonal domain (ie, interactions with state expert advisors, NACDD staff, and peer-to-peer support). The most valuable technical assistance events were action institutes, coaches’ meetings, webinars, and technical assistance conference calls. Conclusion This analysis suggests that ACHIEVE communities valued the management and training assistance provided by expert advisors and NACDD staff. State health department expert advisors provided technical guidance and support, including such skills or knowledge-based services as best-practice strategies, review and discussion of community assessment data, sustainability planning, and identification of possible funding opportunities. NACDD staff led development and implementation of technical assistance events. PMID:24157078

Vitamin D in corticosteroid-naïve and corticosteroid-treated Duchenne muscular dystrophy: what dose achieves optimal 25(OH) vitamin D levels?

PubMed

Alshaikh, Nahla; Brunklaus, Andreas; Davis, Tracey; Robb, Stephanie A; Quinlivan, Ros; Munot, Pinki; Sarkozy, Anna; Muntoni, Francesco; Manzur, Adnan Y

2016-10-01

Assessment of the efficacy of vitamin D replenishment and maintenance doses required to attain optimal levels in boys with Duchenne muscular dystrophy (DMD). 25(OH)-vitamin D levels and concurrent vitamin D dosage were collected from retrospective case-note review of boys with DMD at the Dubowitz Neuromuscular Centre. Vitamin D levels were stratified as deficient at <25 nmol/L, insufficient at 25-49 nmol/L, adequate at 50-75 nmol/L and optimal at >75 nmol/L. 617 vitamin D samples were available from 197 boys (range 2-18 years)-69% from individuals on corticosteroids. Vitamin D-naïve boys (154 samples) showed deficiency in 28%, insufficiency in 42%, adequate levels in 24% and optimal levels in 6%. The vitamin D-supplemented group (463 samples) was tested while on different maintenance/replenishment doses. Three-month replenishment of daily 3000 IU (23 samples) or 6000 IU (37 samples) achieved optimal levels in 52% and 84%, respectively. 182 samples taken on 400 IU revealed deficiency in 19 (10%), insufficiency in 84 (47%), adequate levels in 67 (37%) and optimal levels in 11 (6%). 97 samples taken on 800 IU showed deficiency in 2 (2%), insufficiency in 17 (17%), adequate levels in 56 (58%) and optimal levels in 22 (23%). 81 samples were on 1000 IU and 14 samples on 1500 IU, with optimal levels in 35 (43%) and 9 (64%), respectively. No toxic level was seen (highest level 230 nmol/L). The prevalence of vitamin D deficiency and insufficiency in DMD is high. A 2-month replenishment regimen of 6000 IU and maintenance regimen of 1000-1500 IU/day was associated with optimal vitamin D levels. These data have important implications for optimising vitamin D dosing in DMD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Transportation or CT scanners: a theory and method of health resources allocation.

PubMed Central

Greenwald, H P; Woodward, J M; Berg, D H

1979-01-01

Cost containment and access to appropriate care are the two most frequently discussed issues in contemporary health policy. Conceiving of the health services available in specific regions as "packages" of diverse items, the authors of this article consider the economic trade-offs among the various resources needed for appropriate care. In the discussion that follows, we examine the trade-offs between two divergent offering of the health care system: high technology medicine and support services. Specifically, we examine several strategies designed to achieve an optimal mix of investments in CT scanners and transportation resources in the South Chicago region. Using linear programming as a method for examining these options, the authors found that 1) the proper location of CT scanners is as important for cost containment as optimal number, and 2) excess capacity in the utilization of a single resource--CT scanners--need not imply inefficiency in the overall delivery of the service. These findings help demonstrate the importance of viewing health care as a package of interrelated services, both for achieving cost containment and for providing access to appropriate care. PMID:391772

Two Blades-Up Runs Using the JetStream Navitus Atherectomy Device Achieve Optimal Tissue Debulking of Nonocclusive In-Stent Restenosis: Observations From a Porcine Stent/Balloon Injury Model.

PubMed

Shammas, Nicolas W; Aasen, Nicole; Bailey, Lynn; Budrewicz, Jay; Farago, Trent; Jarvis, Gary

2015-08-01

To determine the number of runs with blades up (BU) using the JetStream Navitus to achieving optimal debulking in a porcine model of femoropopliteal artery in-stent restenosis (ISR). In this porcine model, 8 limbs were implanted with overlapping nitinol self-expanding stents. ISR was treated initially with 2 blades-down (BD) runs followed by 4 BU runs (BU1 to BU4). Quantitative vascular angiography (QVA) was performed at baseline, after 2 BD runs, and after each BU run. Plaque surface area and percent stenosis within the treated stented segment were measured. Intravascular ultrasound (IVUS) was used to measure minimum lumen area (MLA) and determine IVUS-derived plaque surface area. QVA showed that plaque surface area was significantly reduced between baseline (83.9%±14.8%) and 2 BD (67.7%±17.0%, p=0.005) and BU1 (55.4%±9.0%, p=0.005) runs, and between BU1 and BU2 runs (50.7%±9.7%, p<0.05). Percent stenosis behaved similarly with no further reduction after BU2. There were no further reductions in plaque surface area or percent stenosis with BU 3 and 4 runs (p=0.10). Similarly, IVUS (24 lesions) confirmed optimal results with BU2 runs and no additional gain in MLA or reduction in plaque surface area with BU3 and 4. IVUS confirmed no orbital cutting with JetStream Navitus. There were no stent strut discontinuities on high-resolution radiographs following atherectomy. JetStream Navitus achieved optimal tissue debulking after 2 BD and 2 BU runs with no further statistical gain in debulking after the BU2 run. Operators treating ISR with JetStream Navitus may be advised to limit their debulking to 2 BD and 2 BU runs to achieve optimal debulking. © The Author(s) 2015.

Can three-dimensional patient-specific cutting guides be used to achieve optimal correction for high tibial osteotomy? Pilot study.

PubMed

Munier, M; Donnez, M; Ollivier, M; Flecher, X; Chabrand, P; Argenson, J-N; Parratte, S

2017-04-01

Treatment of medial tibiofemoral osteoarthritis with a high-tibial osteotomy (HTO) is most effective when the optimal angular correction is achieved. However, conventional instrumentation is limited when multiplanar correction is needed. Use of patient-specific cutting guides (PSCGs) for HTO provides an accurate correction (difference<2°) relative to the preoperative planning. Between February 2014 and February 2015, 10 patients (mean age: 46 years [range: 31-59]; grade 1 or 2 osteoarthritis in Ahlbäck's classification) were included prospectively in this reliability and safety study. All patients were operated using the same medial opening-wedge osteotomy technique. Preoperative planning was based on long-leg radiographs and CT scans with 3D reconstruction. The PSGCs were used to align the osteotomy cut and position the screw holes for the plate. The desired correction was achieved in the three planes when the holes on the plate were aligned with the holes drilled based on the PSCG. Preoperatively, the mean HKA angle was 171.9° (range: 166-179°), the mean proximal tibial angle was 87° (86-88°) and the mean tibial slope was 7.8° (1-22°). The postoperative correction was compared to the planned correction using 3D CT scan transformations. Intraoperative and postoperative complications were assessed at a minimum follow-up of 1 year. The procedure was successfully carried out in all patients with the PSCGs. On postoperative long-leg radiographs, the mean HKA was 182.3° (180-185°); on the CT scan, the mean tibial mechanical angle was 94° (90-98°) and the mean tibial slope was 7.1° (4-11°). In 19 out of 20 postoperative HKA and slope measurements, the difference between the planned and achieved correction was <2° based on the 3D analysis of the three planes in space; in the other case, the slope was 13° instead of the planned 10°. The intra-class correlation coefficients between the postoperative and planned parameters were 0.98 [0.92-0.99] for

School Values: A Comparison of Academic Motivation, Mental Health Promotion, and School Belonging with Student Achievement

ERIC Educational Resources Information Center

Allen, Kelly-Ann; Kern, Margaret L.; Vella-Brodrick, Dianne; Waters, Lea

2017-01-01

School vision and mission statements are an explicit indication of a school's priorities. Research has found academic motivation, mental health promotion, and school belonging to be the most frequently cited themes in these statements. The present study sought to examine whether these themes relate to student academic achievement, as indicated by…

Why has the Universal Coverage Scheme in Thailand achieved a pro-poor public subsidy for health care?

PubMed Central

2012-01-01

Background Thailand has achieved universal health coverage since 2002 through the implementation of the Universal Coverage Scheme (UCS) for 47 million of the population who were neither private sector employees nor government employees. A well performing UCS should achieve health equity goals in terms of health service use and distribution of government subsidy on health. With these goals in mind, this paper assesses the magnitude and trend of government health budget benefiting the poor as compared to the rich UCS members. Method Benefit incidence analysis was conducted using the nationally representative household surveys, Health and Welfare Surveys, between 2003 and 2009. UCS members are grouped into five different socio-economic status using asset indexes and wealth quintiles. Findings The total government subsidy, net of direct household payment, for combined outpatient (OP) and inpatient (IP) services to public hospitals and health facilities provided to UCS members, had increased from 30 billion Baht (US$ 1 billion) in 2003 to 40-46 billion Baht in 2004-2009. In 2003 for 23% and 12% of the UCS members who belonged to the poorest and richest quintiles of the whole-country populations respectively, the share of public subsidies for OP service was 28% and 7% for the poorest and the richest quintiles, whereby for IP services the share was 27% and 6% for the poorest and richest quintiles respectively. This reflects a pro-poor outcome of public subsidies to healthcare. The OP and IP public subsidies remained consistently pro-poor in subsequent years. The pro-poor benefit incidence is determined by higher utilization by the poorest than the richest quintiles, especially at health centres and district hospitals. Thus the probability and the amount of household direct health payment for public facilities by the poorest UCS members were less than their richest counterparts. Conclusions Higher utilization and better financial risk protection benefiting the poor UCS

Optimism is universal: exploring the presence and benefits of optimism in a representative sample of the world.

PubMed

Gallagher, Matthew W; Lopez, Shane J; Pressman, Sarah D

2013-10-01

Current theories of optimism suggest that the tendency to maintain positive expectations for the future is an adaptive psychological resource associated with improved well-being and physical health, but the majority of previous optimism research has been conducted in industrialized nations. The present study examined (a) whether optimism is universal, (b) what demographic factors predict optimism, and (c) whether optimism is consistently associated with improved subjective well-being and perceived health worldwide. The present study used representative samples of 142 countries that together represent 95% of the world's population. The total sample of 150,048 individuals had a mean age of 38.28 (SD = 16.85) and approximately equal sex distribution (51.2% female). The relationships between optimism, subjective well-being, and perceived health were examined using hierarchical linear modeling. Results indicated that most individuals and most countries worldwide are optimistic and that higher levels of optimism are associated with improved subjective well-being and perceived health worldwide. The present study provides compelling evidence that optimism is a universal phenomenon and that the associations between optimism and improved psychological functioning are not limited to industrialized nations. © 2012 Wiley Periodicals, Inc.

Client/patient perceptions of achieving equity in primary health care: a mixed methods study.

PubMed

Akhavan, Sharareh; Tillgren, Per

2015-08-12

To provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. Reducing inequalities in care has been a central and recurring theme in Swedish health reforms. The aim of this study is to describe and assess client/patient experiences and perceptions of care in four primary health care units (PHCUs) involved in Sweden's national Care on Equal Terms project. Mixed Method Research (MMR) was chosen to describe and assess client/patient experiences and perceptions of health care with regard to equity. There was a focus group discussion, and individual interviews with 21 clients/patients and three representatives of patient associations. Data from the Swedish National Patient Survey (NPS), conducted in 2011 and followed up in 2013, were also used. The interview data were divided into two main categories and three subcategories. The first category "Perception of equitable health care" had two subcategories, namely "Health care providers' perceptions" and "Fairness and participation". The second category "To achieve more equitable health care" had four subcategories: "Encounter", "Access", "Interpreters and bilingual/diverse health care providers" and "Time pressure and continuity". Results from the NPS showed that two of the PHCUs improved in some aspects of patient perceived quality of care (PPQC) while two were not so successful. Clients/patients perceived health care providers' perceptions of their ethnic origin and mental health status as important for equitable health care. Discriminatory perceptions may lead to those in need of care refraining from seeking it. More equitable care means longer consultations, better accessibility in terms of longer opening hours, and ways of communicating other than just via voice mail. It also involves continuity in care and access to an interpreter

Mental health care system optimization from a health-economics perspective: where to sow and where to reap?

PubMed

Lokkerbol, Joran; Weehuizen, Rifka; Mavranezouli, Ifigeneia; Mihalopoulos, Cathrine; Smit, Filip

2014-06-01

Health care expenditure (as % of GDP) has been rising in all OECD countries over the last decades. Now, in the context of the economic downturn, there is an even more pressing need to better guarantee the sustainability of health care systems. This requires that policy makers are informed about optimal allocation of budgets. We take the Dutch mental health system in the primary care setting as an example of new ways to approach optimal allocation. To demonstrate how health economic modelling can help in identifying opportunities to improve the Dutch mental health care system for patients presenting at their GP with symptoms of anxiety, stress, symptoms of depression, alcohol abuse/dependence, anxiety disorder or depressive disorder such that changes in the health care system have the biggest leverage in terms of improved cost-effectiveness. Investigating such scenarios may serve as a starting point for setting an agenda for innovative and sustainable health care policies. A health economic simulation model was used to synthesize clinical and economic evidence. The model was populated with data from GPs' national register on the diagnosis, treatment, referral and prescription of their patients in the year 2009. A series of `what-if' analyses was conducted to see what parameters (uptake, adherence, effectiveness and the costs of the interventions) are associated with the most substantial impact on the cost-effectiveness of the health care system overall. In terms of improving the overall cost-effectiveness of the primary mental health care system, substantial benefits could be derived from increasing uptake of psycho-education by GPs for patients presenting with stress and when low cost interventions are made available that help to increase the patients' compliance with pharmaceutical interventions, particularly in patients presenting with symptoms of anxiety. In terms of intervention costs, decreasing the costs of antidepressants is expected to yield the biggest

Combining agreement and frequency rating scales to optimize psychometrics in measuring behavioral health functioning.

PubMed

Marfeo, Elizabeth E; Ni, Pengsheng; Chan, Leighton; Rasch, Elizabeth K; Jette, Alan M

2014-07-01

The goal of this article was to investigate optimal functioning of using frequency vs. agreement rating scales in two subdomains of the newly developed Work Disability Functional Assessment Battery: the Mood & Emotions and Behavioral Control scales. A psychometric study comparing rating scale performance embedded in a cross-sectional survey used for developing a new instrument to measure behavioral health functioning among adults applying for disability benefits in the United States was performed. Within the sample of 1,017 respondents, the range of response category endorsement was similar for both frequency and agreement item types for both scales. There were fewer missing values in the frequency items than the agreement items. Both frequency and agreement items showed acceptable reliability. The frequency items demonstrated optimal effectiveness around the mean ± 1-2 standard deviation score range; the agreement items performed better at the extreme score ranges. Findings suggest an optimal response format requires a mix of both agreement-based and frequency-based items. Frequency items perform better in the normal range of responses, capturing specific behaviors, reactions, or situations that may elicit a specific response. Agreement items do better for those whose scores are more extreme and capture subjective content related to general attitudes, behaviors, or feelings of work-related behavioral health functioning. Copyright © 2014 Elsevier Inc. All rights reserved.

Obligations of low income countries in ensuring equity in global health financing.

PubMed

Barugahare, John; Lie, Reidar K

2015-09-08

Despite common recognition of joint responsibility for global health by all countries particularly to ensure justice in global health, current discussions of countries' obligations for global health largely ignore obligations of developing countries. This is especially the case with regards to obligations relating to health financing. Bearing in mind that it is not possible to achieve justice in global health without achieving equity in health financing at both domestic and global levels, our aim is to show how fulfilling the obligation we propose will make it easy to achieve equity in health financing at both domestic and international levels. Achieving equity in global health financing is a crucial step towards achieving justice in global health. Our general view is that current discussions on global health equity largely ignore obligations of Low Income Country (LIC) governments and we recommend that these obligations should be mainstreamed in current discussions. While we recognise that various obligations need to be fulfilled in order to ultimately achieve justice in global health, for lack of space we prioritise obligations for health financing. Basing on the evidence that in most LICs health is not given priority in annual budget allocations, we propose that LIC governments should bear an obligation to allocate a certain minimum percent of their annual domestic budget resources to health, while they await external resources to supplement domestic ones. We recommend and demonstrate a mechanism for coordinating this obligation so that if the resulting obligations are fulfilled by both LIC and HIC governments it will be easy to achieve equity in global health financing. Although achieving justice in global health will depend on fulfillment of different categories of obligations, ensuring inter- and intra-country equity in health financing is pivotal. This can be achieved by requiring all LIC governments to allocate a certain optimal per cent of their domestic

Implementing optimal thinning strategies

Treesearch

Kurt H. Riitters; J. Douglas Brodie

1984-01-01

Optimal thinning regimes for achieving several management objectives were derived from two stand-growth simulators by dynamic programming. Residual mean tree volumes were then plotted against stand density management diagrams. The results supported the use of density management diagrams for comparing, checking, and implementing the results of optimization analyses....

Early childhood trajectories of separation anxiety: Bearing on mental health, academic achievement, and physical health from mid-childhood to preadolescence.

PubMed

Battaglia, Marco; Garon-Carrier, Gabrielle; Côté, Sylvana M; Dionne, Ginette; Touchette, Evelyne; Vitaro, Frank; Tremblay, Richard E; Boivin, Michel

2017-10-01

Separation anxiety disorder is the most prevalent childhood anxiety condition, but no study assessed children for separation anxiety at preschool age and followed them longitudinally and directly until mid-childhood/early adolescence. Multi-informant (children, teachers, family), multipoint (at age 8, 10, 12, 13) assessments of 1,290 children of the Quebec Longitudinal Study of Child Development, who had been categorized between age 1.5 and 6 into four specific separation anxiety trajectories (1, low-persistent; 2, low-increasing; 3, high-decreasing, and the less common: 4, high-increasing) by growth mixture modeling. Participants in the high-increasing trajectory were compared to participants in the other three trajectories for: (a) child's internalizing and externalizing problem behavior; (b) physical health; (c) academic achievement; (d) maternal anxiety. Multivariate analyses of variance/covariance at separate time points showed the high-increasing trajectory mostly associated with: (a) higher internalizing, but not externalizing, behavior; (b) worse academic achievement (most consistently by comparisons to the normative low-persistent trajectory; (c) higher rates of maternal panic/agoraphobic anxiety; (d) worse physical health (most consistently by comparisons to the low-persistent trajectory). The high-increasing trajectory had twofold to threefold higher incidences of physical illnesses than the normative low-persistent group; this was specific for headaches at age 12 years, chronic asthma at age 10 and 13, and having received asthma-related medication during the past 12 months. High-increasing separation anxiety in preschool maintains longitudinal relationships to independent health and academic outcomes, at least until preadolescence. This knowledge can inform the deployment of clinical resources at the earlier signs of the more impairing manifestations. © 2017 Wiley Periodicals, Inc.

Multiple health behaviours: overview and implications

PubMed Central

Spring, Bonnie; Moller, Arlen C.; Coons, Michael J.

2012-01-01

Background More remains unknown than known about how to optimize multiple health behaviour change. Methods After reviewing the prevalence and comorbidities among major chronic disease risk behaviours for adults and youth, we consider the origins and applicability of high-risk and population strategies to foster multiple health behaviour change. Results Findings indicate that health risk behaviours are prevalent, increase with age and co-occur as risk behaviour clusters or bundles. Conclusions We conclude that both population and high-risk strategies for health behaviour intervention are warranted, potentially synergistic and need intervention design that accounts for substitute and complementary relationships among bundled health behaviours. To maximize positive public health impact, a pressing need exists for bodies of basic and translational science that explain health behaviour bundling. Also needed is applied science that elucidates the following: (1) the optimal number of behaviours to intervene upon; (2) how target behaviours are best selected (e.g. greatest health impact; patient preference or positive effect on bundled behaviours); (3) whether to increase healthy or decrease unhealthy behaviours; (4) whether to intervene on health behaviours simultaneously or sequentially and (5) how to achieve positive synergies across individual-, group- and population-level intervention approaches. PMID:22363028

Predicting Early Adolescents' Academic Achievement, Social Competence, and Physical Health from Parenting, Ego Resilience, and Engagement Coping

ERIC Educational Resources Information Center

Swanson, Jodi; Valiente, Carlos; Lemery-Chalfant, Kathryn; O'Brien, T. Caitlin

2011-01-01

This study examined ego resilience and engagement coping as mediators of the relationships between supportive and controlling parenting practices and early adolescents' academic achievement, social competence, and physical health. Participants were 240 predominantly Mexican American early adolescents, their parents, and their teachers. There were…

Portfolio optimization with mean-variance model

NASA Astrophysics Data System (ADS)

Hoe, Lam Weng; Siew, Lam Weng

2016-06-01

Investors wish to achieve the target rate of return at the minimum level of risk in their investment. Portfolio optimization is an investment strategy that can be used to minimize the portfolio risk and can achieve the target rate of return. The mean-variance model has been proposed in portfolio optimization. The mean-variance model is an optimization model that aims to minimize the portfolio risk which is the portfolio variance. The objective of this study is to construct the optimal portfolio using the mean-variance model. The data of this study consists of weekly returns of 20 component stocks of FTSE Bursa Malaysia Kuala Lumpur Composite Index (FBMKLCI). The results of this study show that the portfolio composition of the stocks is different. Moreover, investors can get the return at minimum level of risk with the constructed optimal mean-variance portfolio.

Differential evolution-based multi-objective optimization for the definition of a health indicator for fault diagnostics and prognostics

NASA Astrophysics Data System (ADS)

Baraldi, P.; Bonfanti, G.; Zio, E.

2018-03-01

The identification of the current degradation state of an industrial component and the prediction of its future evolution is a fundamental step for the development of condition-based and predictive maintenance approaches. The objective of the present work is to propose a general method for extracting a health indicator to measure the amount of component degradation from a set of signals measured during operation. The proposed method is based on the combined use of feature extraction techniques, such as Empirical Mode Decomposition and Auto-Associative Kernel Regression, and a multi-objective Binary Differential Evolution (BDE) algorithm for selecting the subset of features optimal for the definition of the health indicator. The objectives of the optimization are desired characteristics of the health indicator, such as monotonicity, trendability and prognosability. A case study is considered, concerning the prediction of the remaining useful life of turbofan engines. The obtained results confirm that the method is capable of extracting health indicators suitable for accurate prognostics.

Living donor liver transplantation for hepatocellular carcinoma achieves better outcomes.

PubMed

Lin, Chih-Che; Chen, Chao-Long

2016-10-01

Liver transplantation (LT) for hepatocellular carcinoma (HCC) at Kaohsiung Chang Gung Memorial Hospital mainly relies on live donor LT (LDLT). Owing to taking the risk of LD, we are obligated to adopt strict selection criteria for HCC patients and optimize the pre-transplant conditions to ensure a high disease-free survival similar to those without HCC, even better than deceased donor LT (DDLT). Better outcomes are attributed to excellent surgical results and optimal patient selection. The hospital mortality of primary and salvage LDLT are lower than 2% in our center. Although Taiwan Health Insurance Policy extended the Milan to University of California, San Francisco (UCSF) criteria in 2006, selection criteria will not be consolidated to take into account only by the morphologic size/number of tumors but also by their biology. The criteria are divided into modifiable image morphology, alpha fetoprotein (AFP), and positron emission tomography (PET) scan with standard uptake value (SUV) and unmodifiable unfavorable pathology such as HCC combined with cholangiocarcinoma (CC), sarcomatoid type, and poor differentiation. Downstaging therapy is necessary for HCC patients beyond criteria to fit all modifiable standards. The upper limit of downstaging treatment seems to be extended by more effective drug eluting transarterial chemoembolization in cases without absolute contraindications. In contrast, the pitfall of unmodifiable tumor pathology should be excluded by the findings of pretransplant core biopsy/resection if possible. More recently, achieving complete tumor necrosis in explanted liver could almost predict no recurrence after transplant. Necrotizing therapy is advised if possible before transplant even the tumor status within criteria to minimize the possibility of tumor recurrence. LDLT with low surgical mortality in experienced centers provides the opportunities of optimizing the pre-transplant tumor conditions and timing of transplant to achieve better

Barriers, Facilitators, and Solutions to Optimal Patient Portal and Personal Health Record Use: A Systematic Review of the Literature

PubMed Central

Zhao, Jane Y.; Song, Buer; Anand, Edwin; Schwartz, Diane; Panesar, Mandip; Jackson, Gretchen P.; Elkin, Peter L.

2017-01-01

Patient portal and personal health record adoption and usage rates have been suboptimal. A systematic review of the literature was performed to capture all published studies that specifically addressed barriers, facilitators, and solutions to optimal patient portal and personal health record enrollment and use. Consistent themes emerged from the review. Patient attitudes were critical as either barrier or facilitator. Institutional buy-in, information technology support, and aggressive tailored marketing were important facilitators. Interface redesign was a popular solution. Quantitative studies identified many barriers to optimal patient portal and personal health record enrollment and use, and qualitative and mixed methods research revealed thoughtful explanations for why they existed. Our study demonstrated the value of qualitative and mixed research methodologies in understanding the adoption of consumer health technologies. Results from the systematic review should be used to guide the design and implementation of future patient portals and personal health records, and ultimately, close the digital divide. PMID:29854263

Achieving public and global health competencies: A teaching case study of Botswana's cervical cancer screening program.

PubMed

Okatch, Harriet; Sowicz, Timothy Joseph; Teng, Helen; Ramogola-Masire, Doreen; Buttenheim, Alison M

2018-05-01

To design and implement a case study on the cervical cancer screening program in Botswana to teach public and global health competencies to undergraduate nursing students. The case study was developed following a review of the literature on the epidemiology and health policies of cervical cancer in Botswana, and an interview with an obstetrician/gynecologist engaged in both clinical practice and research in Botswana. The case study has been implemented over seven semesters to students enrolled in the Nursing in the Community course at the University of Pennsylvania. Approximately 75-100 students are enrolled each semester. Student's perceptions of epidemiologic skills gained and group functioning. Students responded to an open-ended question about lessons learned and offered suggestions to improve the learning experience. Faculty assessment of student deliverables demonstrated that students achieved the learning objectives and mastered necessary competencies. More than 70% (n = 69) of the students indicated that they acquired relevant skills at greater than a satisfactory level. Generally, students had great experiences working in groups measured across five dimensions: engagement/contribution, creativity/resilience, on task/works independently, social interaction/communication, and preparedness. However, isolated cases of poor group functioning were reported for engagement/contribution, and creativity/resilience. The case study, which has been revised with respect to length, content and group processes, has been valuable in educating undergraduate nursing students in a more engaging way that mimics real life public health nursing scenarios. Students achieved both public and global health competencies through participation in the case study. © 2018 Wiley Periodicals, Inc.

Integrating big data and actionable health coaching to optimize wellness.

PubMed

Hood, Leroy; Lovejoy, Jennifer C; Price, Nathan D

2015-01-09

The Hundred Person Wellness Project (HPWP) is a 10-month pilot study of 100 'well' individuals where integrated data from whole-genome sequencing, gut microbiome, clinical laboratory tests and quantified self measures from each individual are used to provide actionable results for health coaching with the goal of optimizing wellness and minimizing disease. In a commentary in BMC Medicine, Diamandis argues that HPWP and similar projects will likely result in 'unnecessary and potential harmful over-testing'. We argue that this new approach will ultimately lead to lower costs, better healthcare, innovation and economic growth. The central points of the HPWP are: 1) it is focused on optimizing wellness through longitudinal data collection, integration and mining of individual data clouds, enabling development of predictive models of wellness and disease that will reveal actionable possibilities; and 2) by extending this study to 100,000 well people, we will establish multiparameter, quantifiable wellness metrics and identify markers for wellness to early disease transitions for most common diseases, which will ultimately allow earlier disease intervention, eventually transitioning the individual early on from a disease back to a wellness trajectory.

Bayesian Optimization for Neuroimaging Pre-processing in Brain Age Classification and Prediction

PubMed Central

Lancaster, Jenessa; Lorenz, Romy; Leech, Rob; Cole, James H.

2018-01-01

Neuroimaging-based age prediction using machine learning is proposed as a biomarker of brain aging, relating to cognitive performance, health outcomes and progression of neurodegenerative disease. However, even leading age-prediction algorithms contain measurement error, motivating efforts to improve experimental pipelines. T1-weighted MRI is commonly used for age prediction, and the pre-processing of these scans involves normalization to a common template and resampling to a common voxel size, followed by spatial smoothing. Resampling parameters are often selected arbitrarily. Here, we sought to improve brain-age prediction accuracy by optimizing resampling parameters using Bayesian optimization. Using data on N = 2003 healthy individuals (aged 16–90 years) we trained support vector machines to (i) distinguish between young (<22 years) and old (>50 years) brains (classification) and (ii) predict chronological age (regression). We also evaluated generalisability of the age-regression model to an independent dataset (CamCAN, N = 648, aged 18–88 years). Bayesian optimization was used to identify optimal voxel size and smoothing kernel size for each task. This procedure adaptively samples the parameter space to evaluate accuracy across a range of possible parameters, using independent sub-samples to iteratively assess different parameter combinations to arrive at optimal values. When distinguishing between young and old brains a classification accuracy of 88.1% was achieved, (optimal voxel size = 11.5 mm3, smoothing kernel = 2.3 mm). For predicting chronological age, a mean absolute error (MAE) of 5.08 years was achieved, (optimal voxel size = 3.73 mm3, smoothing kernel = 3.68 mm). This was compared to performance using default values of 1.5 mm3 and 4mm respectively, resulting in MAE = 5.48 years, though this 7.3% improvement was not statistically significant. When assessing generalisability, best performance was achieved when applying the entire Bayesian

Correlates of willingness to engage in residential gardening: implications for health optimization in ibadan, Nigeria.

PubMed

Motunrayo Ibrahim, Fausat

2013-01-01

Gardening is a worthwhile adventure which engenders health op-timization. Yet, a dearth of evidences that highlights motivations to engage in gardening exists. This study examined willingness to engage in gardening and its correlates, including some socio-psychological, health related and socio-demographic variables. In this cross-sectional survey, 508 copies of a structured questionnaire were randomly self administered among a group of civil servants of Oyo State, Nigeria. Multi-item measures were used to assess variables. Step wise multiple regression analysis was used to identify predictors of willingness to engage in gar-dening Results: Simple percentile analysis shows that 71.1% of respondents do not own a garden. Results of step wise multiple regression analysis indicate that descriptive norm of gardening is a good predictor, social support for gardening is better while gardening self efficacy is the best predictor of willingness to engage in gardening (P< 0.001). Health consciousness, gardening response efficacy, education and age are not predictors of this willingness (P> 0.05). Results of t-test and ANOVA respectively shows that gender is not associated with this willingness (P> 0.05), but marital status is (P< 0.05).  Socio-psychological characteristics and being married are very rele-vant in motivations to engage in gardening. The nexus between gardening and health optimization appears to be highly obscured in this population.

Challenges in achieving patient participation: A review of how patient participation is addressed in empirical studies.

PubMed

Angel, Sanne; Frederiksen, Kirsten Norup

2015-09-01

For decades, it has been an ideal in western countries that individuals should participate in society as self-governing and autonomous subjects; however, this ideal does not always correspond to the actual experiences of individuals in their encounters with health professionals. This review identifies how empirical studies address challenges in achieving patient participation in clinical nursing. We conducted a literature search for studies of patient participation in PubMed, Cinahl, PsychInfo and Scopus. In a systematic review using Garrard's matrix method, we selected empirical studies that focused on patients' participation in health services. The empirical studies we investigated addressed the relationship between patient and nurse, knowledge, contact time with the patient, severity of illness and the effect of age on the degree of patient involvement. Every study thus investigated assessed patient participation as being achievable. None of the studies questioned the foundation for patient participation, which has been described in theoretical articles. The main explanation for difficulties in achieving patient participation was that expectations concerning the extent and quality of participation could be unrealistic and lead to dissatisfaction. Studies on patient participation identify challenges due to the nature of the relationship between laypersons and professionals, and the embedded difference in situation and knowledge. This difference may be reduced by time and a mutually positive attitude. But participation in its ideal form cannot be achieved because of this fundamental difference. Therefore, the optimal level of patient participation can only be achieved within a framework which provides both patients and health professionals with adequate time to build relationships and shared knowledge. Copyright © 2015 Elsevier Ltd. All rights reserved.

Hitting the Optimal Vaccination Percentage and the Risks of Error: Why to Miss Right.

PubMed

Harvey, Michael J; Prosser, Lisa A; Messonnier, Mark L; Hutton, David W

2016-01-01

To determine the optimal level of vaccination coverage defined as the level that minimizes total costs and explore how economic results change with marginal changes to this level of coverage. A susceptible-infected-recovered-vaccinated model designed to represent theoretical infectious diseases was created to simulate disease spread. Parameter inputs were defined to include ranges that could represent a variety of possible vaccine-preventable conditions. Costs included vaccine costs and disease costs. Health benefits were quantified as monetized quality adjusted life years lost from disease. Primary outcomes were the number of infected people and the total costs of vaccination. Optimization methods were used to determine population vaccination coverage that achieved a minimum cost given disease and vaccine characteristics. Sensitivity analyses explored the effects of changes in reproductive rates, costs and vaccine efficacies on primary outcomes. Further analysis examined the additional cost incurred if the optimal coverage levels were not achieved. Results indicate that the relationship between vaccine and disease cost is the main driver of the optimal vaccination level. Under a wide range of assumptions, vaccination beyond the optimal level is less expensive compared to vaccination below the optimal level. This observation did not hold when the cost of the vaccine cost becomes approximately equal to the cost of disease. These results suggest that vaccination below the optimal level of coverage is more costly than vaccinating beyond the optimal level. This work helps provide information for assessing the impact of changes in vaccination coverage at a societal level.

Supply-Chain Optimization Template

NASA Technical Reports Server (NTRS)

Quiett, William F.; Sealing, Scott L.

2009-01-01

The Supply-Chain Optimization Template (SCOT) is an instructional guide for identifying, evaluating, and optimizing (including re-engineering) aerospace- oriented supply chains. The SCOT was derived from the Supply Chain Council s Supply-Chain Operations Reference (SCC SCOR) Model, which is more generic and more oriented toward achieving a competitive advantage in business.

Correlates of Achieving the Guidelines of Four Forms of Physical Activity, and the Relationship between Guidelines Achievement and Academic Performance: Undergraduate Students in Finland.

PubMed

El Ansari, Walid; Suominen, Sakari; Draper, Steve

2017-06-01

We surveyed and compared, by gender, the levels and correlates of achieving the international guidelines of four forms of physical activity (PA): moderate PA (MPA), vigorous PA (VPA), moderate or vigorous PA (MVPA), and muscle strengthening PA (MSPA). The study assessed the associations between achieving the guidelines of the four PA forms and a range of socio-demographic, health and academic performance variables. Data was collected across the seven faculties of the University of Turku (2013-2014 from a representative sample of 1,189 undergraduates). An English language online self-administered questionnaire assessed frequency and duration of PA/week for each form of PA. We employed cut-offs for the guidelines in accordance with the American Heart Association. Chi-square statistic tested the differences in PA, socio-demographic variables and academic performance between males and females. Binary logistic regression examined the factors associated with achieving the four PA guidelines and linear regression examined the association between the frequency of PA and academic performance. Achievement of PA guidelines was relatively low across the sample. Female students were less likely to achieve the VPA or MSPA guidelines, but were more health conscious and in generally exhibited better academic performace than males. High health awareness and excellent/very good self-rated health were the strongest predictors of achieving all forms of PA. Parents' education level was positively related to likelihood of achieving the VPA, MVPA and MSPA guidelines. Achieving the MPA guidelines (but not VPA or MSPA) was positively associated with subjective perceptions of better academic performance. Achievement of PA guidelines was generally low for this sample of Finnish students, and was associated with positive health status and high health awareness. Universities need a holistic approach to improve awareness of health and promote PA in students' lifestyles. Copyright© by the

Schistosomiasis elimination strategies and potential role of a vaccine in achieving global health goals.

PubMed

Mo, Annie X; Agosti, Jan M; Walson, Judd L; Hall, B Fenton; Gordon, Lance

2014-01-01

In March 2013, the National Institute of Allergy and Infectious Diseases and the Bill and Melinda Gates Foundation co-sponsored a meeting entitled "Schistosomiasis Elimination Strategy and Potential Role of a Vaccine in Achieving Global Health Goals" to discuss the potential role of schistosomiasis vaccines and other tools in the context of schistosomiasis control and elimination strategies. It was concluded that although schistosomiasis elimination in some focal areas may be achievable through current mass drug administration programs, global control and elimination will face several significant scientific and operational challenges, and will require an integrated approach with other, additional interventions. These challenges include vector (snail) control; environmental modification; water, sanitation, and hygiene; and other future innovative tools such as vaccines. Defining a clear product development plan that reflects a vaccine strategy as complementary to the existing control programs to combat different forms of schistosomiasis will be important to develop a vaccine effectively.

Organizational health and the achievement level of students in science at the secondary-level schools in Sri Lanka

NASA Astrophysics Data System (ADS)

Pakkeer-Jaufar, Pakkeer Cadermohideen

This study sought to identify those organizational health factors that might have overriding influence on the achievement level of students in science in Sri Lankan secondary schools. This study involved 752 students, 33 science teachers, and 10 principals from two different districts, Ampara and Colombo, in Sri Lanka. Ten Tamil medium, secondary level, public schools were selected to participate in this study. Data were collected using four types of instruments: a questionnaire for pupils; interview schedules for science teachers and principals; checklists for classroom/school facilities, science laboratory facilities, and science practicals; and a science achievement test. The analysis focused on the collective perceptions of students, science teachers, and principals. Regression and path analyses were used as major analysis techniques, and the qualitative data provided by science teachers and principals were considered for a crosschecking of the quantitative inferences. The researcher found teacher affiliation, academic emphasis, and instructional leadership of the principal, in descending order, were the overriding influential factors on the achievement level of students in science in Sri Lankan secondary schools. At the same time a similar descending order was found in their mean values and qualities. The researcher concluded that increasing the quality of the organizational health factors in Sri Lankan secondary schools would result in improved better achievement in science. The findings further indicate that instructional leadership of the principal had both direct and indirect effects on students' achievement in science when academic emphasis and teacher affiliation were taken into account. In addition, the resource support of the principal did not make any difference in students' science achievement and the findings stress the availability of the resources for individual students instead of assuming the general facilities of the school are available to all

Eradication of Yaws: Historical Efforts and Achieving WHO's 2020 Target

PubMed Central

Asiedu, Kingsley; Fitzpatrick, Christopher; Jannin, Jean

2014-01-01

Background Yaws, one of the 17 neglected tropical diseases (NTDs), is targeted for eradication by 2020 in resolution WHA66.12 of the World Health Assembly (2013) and the WHO roadmap on NTDs (2012). The disease frequently affects children who live in poor socioeconomic conditions. Between 1952 and 1964, WHO and the United Nations Children's Fund (UNICEF) led a global eradication campaign using injectable benzathine penicillin. Recent developments using a single dose of oral azithromycin have renewed optimism that eradication can be achieved through a comprehensive large-scale treatment strategy. We review historical efforts to eradicate yaws and argue that this goal is now technically feasible using new tools and with the favorable environment for control of NTDs. We also summarize the work of WHO's Department of Control of Neglected Tropical Diseases in leading the renewed eradication initiative and call on the international community to support efforts to achieve the 2020 eradication goal. The critical factor remains access to azithromycin. Excluding medicines, the financial cost of yaws eradication could be as little as US$ 100 million. Conclusions The development of new tools has renewed interest in eradication of yaws; with modest support, the WHO eradication target of 2020 can be achieved. PMID:25254372

Glycaemic control of diabetic patients in an urban primary health care setting in Sarawak: the Tanah Puteh Health Centre experience.

PubMed

Wong, J S; Rahimah, N

2004-08-01

Achieving glycaemic goals in diabetics has always been a problem, especially in a developing country with inadequate facilities such as in Sarawak in Malaysia. There are no reported studies on the control of diabetes mellitus in a diabetic clinic in the primary health care setting in Sarawak. This paper describes the profile of 1031 patients treated in Klinik Kesihatan Tanah Puteh Health Centre. The mean age was 59 years, the mean BMI 27 kg/m2. There was a female preponderance and mainly type-2 diabetes. Mean HbA1c was 7.4%. Glycaemic control was optimal in 28% (HbA1c <6.5%), fair in 34% (HbA1c 6.5-7.5%) and poor in 38% (HbA1c >7.5%). Reasonable glycaemic control can be achieved in the primary health care setting in Sarawak.

Seeking consensus on universal health coverage indicators in the sustainable development goals.

PubMed

Reddock, Jennifer

2017-01-01

There is optimism that the inclusion of universal health coverage in the Sustainable Development Goals advances its prominence in global and national health policy. However, formulating indicators for Target 3.8 through the Inter-Agency Expert Group on Sustainable Development Indicators has been challenging. Achieving consensus on the conceptual and methodological aspects of universal health coverage is likely to take some time in multi-stakeholder fora compared with national efforts to select indicators.

Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery.

PubMed

Adamina, Michel; Kehlet, Henrik; Tomlinson, George A; Senagore, Anthony J; Delaney, Conor P

2011-06-01

Health care systems provide care to increasingly complex and elderly patients. Colorectal surgery is a prime example, with high volumes of major procedures, significant morbidity, prolonged hospital stays, and unplanned readmissions. This situation is exacerbated by an exponential rise in costs that threatens the stability of health care systems. Enhanced recovery pathways (ERP) have been proposed as a means to reduce morbidity and improve effectiveness of care. We have reviewed the evidence supporting the implementation of ERP in clinical practice. Medline, Embase, and the Cochrane library were searched for randomized, controlled trials comparing ERP with traditional care in colorectal surgery. Systematic reviews and papers on ERP based on data published in major surgical and anesthesiology journals were critically reviewed by international contributors, experienced in the development and implementation of ERP. A random-effect Bayesian meta-analysis was performed, including 6 randomized, controlled trials totalizing 452 patients. For patients adhering to ERP, length of stay decreased by 2.5 days (95% credible interval [CrI] -3.92 to -1.11), whereas 30-day morbidity was halved (relative risk, 0.52; 95% CrI, 0.36-0.73) and readmission was not increased (relative risk, 0.59; 95% CrI, 0.14-1.43) when compared with patients undergoing traditional care. Adherence to ERP achieves a reproducible improvement in the quality of care by enabling standardization of health care processes. Thus, while accelerating recovery and safely reducing hospital stay, ERPs optimize utilization of health care resources. ERPs can and should be routinely used in care after colorectal and other major gastrointestinal procedures. Copyright © 2011 Mosby, Inc. All rights reserved.

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons.

PubMed

Ajeani, Judith; Mangwi Ayiasi, Richard; Tetui, Moses; Ekirapa-Kiracho, Elizabeth; Namazzi, Gertrude; Muhumuza Kananura, Ronald; Namusoke Kiwanuka, Suzanne; Beyeza-Kashesya, Jolly

2017-08-01

There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers. This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model. The cascade model started with initial training of health workers from three districts of Pallisa, Kibuku and Kamuli from where potential local mentors were selected for further training and mentorship by central mentors. These local mentors then went on to conduct mentorship visits supported by the external mentors. The mentorship process concentrated on partograph use, newborn resuscitation, prevention and management of Post-Partum Haemorrhage (PPH), including active management of third stage of labour, preeclampsia management and management of the sick newborn. Data for this paper was obtained from key informant interviews with district-level managers and local mentors. Mentorship improved several aspects of health-care delivery, ranging from improved competencies and responsiveness to emergencies and health-worker professionalism. In addition, due to better district leadership for Maternal and Newborn Health (MNH), there were improved supplies/medicine availability, team work and innovative local problem-solving approaches. Health workers were ultimately empowered to perform better. The study demonstrated that it is possible to improve the competencies of frontline health workers through performance enhancement for MNH services using locally built capacity in clinical mentorship for Emergency Obstetric and Newborn Care (EmONC). The cascade mentoring process needed strong external mentorship support at the start to ensure improved

Strain sensors optimal placement for vibration-based structural health monitoring. The effect of damage on the initially optimal configuration

NASA Astrophysics Data System (ADS)

Loutas, T. H.; Bourikas, A.

2017-12-01

We revisit the optimal sensor placement of engineering structures problem with an emphasis on in-plane dynamic strain measurements and to the direction of modal identification as well as vibration-based damage detection for structural health monitoring purposes. The approach utilized is based on the maximization of a norm of the Fisher Information Matrix built with numerically obtained mode shapes of the structure and at the same time prohibit the sensorization of neighbor degrees of freedom as well as those carrying similar information, in order to obtain a satisfactory coverage. A new convergence criterion of the Fisher Information Matrix (FIM) norm is proposed in order to deal with the issue of choosing an appropriate sensor redundancy threshold, a concept recently introduced but not further investigated concerning its choice. The sensor configurations obtained via a forward sequential placement algorithm are sub-optimal in terms of FIM norm values but the selected sensors are not allowed to be placed in neighbor degrees of freedom providing thus a better coverage of the structure and a subsequent better identification of the experimental mode shapes. The issue of how service induced damage affects the initially nominated as optimal sensor configuration is also investigated and reported. The numerical model of a composite sandwich panel serves as a representative aerospace structure upon which our investigations are based.

Optimization of PZT ceramic IDT sensors for health monitoring of structures.

PubMed

Takpara, Rafatou; Duquennoy, Marc; Ouaftouh, Mohammadi; Courtois, Christian; Jenot, Frédéric; Rguiti, Mohamed

2017-08-01

Surface acoustic waves (SAW) are particularly suited to effectively monitoring and characterizing structural surfaces (condition of the surface, coating, thin layer, micro-cracks…) as their energy is localized on the surface, within approximately one wavelength. Conventionally, in non-destructive testing, wedge sensors are used to the generation guided waves but they are especially suited to flat surfaces and sized for a given type material (angle of refraction). Additionally, these sensors are quite expensive so it is quite difficult to leave the sensors permanently on the structure for its health monitoring. Therefore we are considering in this study, another type of ultrasonic sensors, able to generate SAW. These sensors are interdigital sensors or IDT sensors for InterDigital Transducer. This paper focuses on optimization of IDT sensors for non-destructive structural testing by using PZT ceramics. The challenge was to optimize the dimensional parameters of the IDT sensors in order to efficiently generate surface waves. Acoustic tests then confirmed these parameters. Copyright © 2017 Elsevier B.V. All rights reserved.

The expanded invasive weed optimization metaheuristic for solving continuous and discrete optimization problems.

PubMed

Josiński, Henryk; Kostrzewa, Daniel; Michalczuk, Agnieszka; Switoński, Adam

2014-01-01

This paper introduces an expanded version of the Invasive Weed Optimization algorithm (exIWO) distinguished by the hybrid strategy of the search space exploration proposed by the authors. The algorithm is evaluated by solving three well-known optimization problems: minimization of numerical functions, feature selection, and the Mona Lisa TSP Challenge as one of the instances of the traveling salesman problem. The achieved results are compared with analogous outcomes produced by other optimization methods reported in the literature.

Perceived Enablers and Barriers to Optimal Health among Music Students: A Qualitative Study in the Music Conservatoire Setting

PubMed Central

Perkins, Rosie; Reid, Helen; Araújo, Liliana S.; Clark, Terry; Williamon, Aaron

2017-01-01

Student health and wellbeing within higher education has been documented as poor in relation to the general population. This is a particular problem among students at music conservatoires, who are studying within a unique educational context that is known to generate both physical and psychological challenges. This article examines how conservatoire students experience health and wellbeing within their institutional context, using a framework from health promotion to focus attention on perceived enablers and barriers to optimal health in relation to three levels: lifestyle, support services, and conservatoire environment. In order to respond to the individuality of students’ experiences, a qualitative approach was taken based on semi-structured interviews with 20 current or recent conservatoire students in the United Kingdom. Thematic analysis revealed a complex set of enablers and barriers: (i) lifestyle enablers included value placed on the importance of optimal health and wellbeing for musicians and daily practices to enable this; lifestyle barriers included struggling to maintain healthy lifestyles within the context of musical practice and learning; (ii) support enablers included accessible support sources within and beyond the conservatoire; support barriers included a perceived lack of availability or awareness of appropriate support; (iii) environmental enablers included positive and enjoyable experiences of performance as well as strong relationships and communities; environmental barriers included experiences of comparison and competition, pressure and stress, challenges with negative performance feedback, psychological distress, and perceived overwork. The findings reveal a need for health promotion to focus not only on individuals but also on the daily practices and routines of conservatoires. Additionally, they suggest that continued work is required to embed health and wellbeing support as an integral component of conservatoire education, raising

Perceived Enablers and Barriers to Optimal Health among Music Students: A Qualitative Study in the Music Conservatoire Setting.

PubMed

Perkins, Rosie; Reid, Helen; Araújo, Liliana S; Clark, Terry; Williamon, Aaron

2017-01-01

Student health and wellbeing within higher education has been documented as poor in relation to the general population. This is a particular problem among students at music conservatoires, who are studying within a unique educational context that is known to generate both physical and psychological challenges. This article examines how conservatoire students experience health and wellbeing within their institutional context, using a framework from health promotion to focus attention on perceived enablers and barriers to optimal health in relation to three levels: lifestyle, support services, and conservatoire environment. In order to respond to the individuality of students' experiences, a qualitative approach was taken based on semi-structured interviews with 20 current or recent conservatoire students in the United Kingdom. Thematic analysis revealed a complex set of enablers and barriers: (i) lifestyle enablers included value placed on the importance of optimal health and wellbeing for musicians and daily practices to enable this; lifestyle barriers included struggling to maintain healthy lifestyles within the context of musical practice and learning; (ii) support enablers included accessible support sources within and beyond the conservatoire; support barriers included a perceived lack of availability or awareness of appropriate support; (iii) environmental enablers included positive and enjoyable experiences of performance as well as strong relationships and communities; environmental barriers included experiences of comparison and competition, pressure and stress, challenges with negative performance feedback, psychological distress, and perceived overwork. The findings reveal a need for health promotion to focus not only on individuals but also on the daily practices and routines of conservatoires. Additionally, they suggest that continued work is required to embed health and wellbeing support as an integral component of conservatoire education, raising

Healthier students are better learners: high-quality, strategically planned, and effectively coordinated school health programs must be a fundamental mission of schools to help close the achievement gap.

PubMed

Basch, Charles E

2011-10-01

To discuss implications for educational policy and practice relevant to closing the achievement gap based on the literature review and synthesis presented in 7 articles of the October 2011 special issue of the Journal of School Health. Implications for closing the achievement gap are drawn from analyses of current literature. During the past several decades, school reform efforts to close the achievement gap have focused on various strategies, yielding very limited progress. Educationally relevant health disparities influence students' motivation and ability to learn, but reducing these disparities has been largely overlooked as an element of an overall strategy for closing the achievement gap. If these health problems are not addressed, the educational benefits of other school reform efforts will be jeopardized. Healthier students are better learners. School health programs and services that are evidence based, strategically planned to influence academic achievement, and effectively coordinated warrant validation as a cohesive school improvement initiative for closing the achievement gap. National, state, and local responsibilities for supporting school health are outlined, including shared strategies; leadership from the U.S. Department of Education; policy development; guidance, technical assistance, and professional development; accountability and data and software systems; and a research agenda. To date, the U.S. Department of Education has not provided leadership for integrating evidence-based, strategically planned, and effectively coordinated school health programs and services into the fundamental mission of schools. Now is an opportune time for change. © 2011, American School Health Association.

E-health: how to make the right choice.

PubMed

Perez, Elizabeth

2009-01-01

TOPIC. The online health promotion phenomenon is a pivotal movement toward consumer empowerment. The challenges for the 21st century are to create meaningful, accurate online health communication interventions that successfully change behavior and improve health. PURPOSE. The Internet is a valuable tool for health promotion, self-care tools, and decision aids components for a high-quality care. The nurse educator ensures e-health sites used meet the criteria for achieving optimal wellness for the consumer. SOURCES. Published literature. CONCLUSIONS. It is crucial for nurses to use reputable e-health sites for consumer engagement and education. Researchers and practitioners are exploring the phenomenon of e-health to gain a better understanding of how to engage these consumers in health behavioral change programs.

Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

PubMed Central

Johannessen, Anne-Kari; Ådnanes, Marian; Paulsen, Bård; Mannion, Russell

2016-01-01

Introduction: This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles. Methods: The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work. Results: Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients. Conclusion: Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients. PMID:28435416

Assisting Pupils in Mathematics Achievement (The Common Core Standards)

ERIC Educational Resources Information Center

Ediger, Marlow

2011-01-01

Mathematics teachers must expect reasonably high standards of achievement from pupils. Too frequently, pupils attain at a substandard level and more optimal achievement is necessary. Thus, pupils should have self esteem needs met in the school and classroom setting. Thus, learners feel that mathematics is worthwhile and effort must be put forth to…

Optimal and safe standard doses of midazolam and propofol to achieve patient and doctor satisfaction with dental treatment: A prospective cohort study

PubMed Central

Nonaka, Mutsumi; Nishimura, Akiko; Gotoh, Kinuko; Oka, Shuichirou; Iijima, Takehiko

2017-01-01

Background The incidences of morbidity and mortality caused by pharmacosedation for dental treatment have not yet reached zero. Adverse events are related to inappropriate respiratory management, mostly originating from an overdose of sedatives. Since sedation is utilized for the satisfaction of both the dentist and the patient, the optimal dose should be minimized to prevent adverse events. We attempted to define the optimal doses of midazolam and propofol required to achieve high levels of patient and dentist satisfaction. Methods One thousand dental patients, including those undergoing third molar extractions, were enrolled in this study. A dose of 1 mg of midazolam was administered at 1-minute intervals until adequate sedation was achieved. Propofol was then infused continuously to maintain the sedation level. Both the patients and the dentists were subsequently interviewed and asked to complete a questionnaire. A multivariate logistic regression analysis was used to examine the factors that contributed to patient and dentist satisfaction. Results The peak midazolam dose resulting in the highest percentage of patient satisfaction was 3 mg. Both a lower dose and a higher dose reduced patient satisfaction. Patient satisfaction increased with an increasing dosage of propofol up until 4 mg/kg/hr, reaching a peak of 78.6%. The peak midazolam dose resulting in the highest percentage of dentist satisfaction (78.8%) was 2 mg. Incremental propofol doses reduced dentist satisfaction, in contrast to their effect on patient satisfaction. The strongest independent predictors of patient satisfaction and dentist satisfaction were no intraoperative memory (OR, 5.073; 95% CI, 3.532–7.287; P<0.001) and unintentional movements by the patient (OR, 0.035; 95% CI, 0.012–0.104; P<0.001), respectively. No serious adverse events were reported. Conclusion We found that 3 mg of midazolam and 3 mg/kg/hr of propofol may be the optimal doses for maximizing both patient and dentist

Use of response surface methodology in a fed-batch process for optimization of tricarboxylic acid cycle intermediates to achieve high levels of canthaxanthin from Dietzia natronolimnaea HS-1.

PubMed

Nasri Nasrabadi, Mohammad Reza; Razavi, Seyed Hadi

2010-04-01

In this work, we applied statistical experimental design to a fed-batch process for optimization of tricarboxylic acid cycle (TCA) intermediates in order to achieve high-level production of canthaxanthin from Dietzia natronolimnaea HS-1 cultured in beet molasses. A fractional factorial design (screening test) was first conducted on five TCA cycle intermediates. Out of the five TCA cycle intermediates investigated via screening tests, alfaketoglutarate, oxaloacetate and succinate were selected based on their statistically significant (P<0.05) and positive effects on canthaxanthin production. These significant factors were optimized by means of response surface methodology (RSM) in order to achieve high-level production of canthaxanthin. The experimental results of the RSM were fitted with a second-order polynomial equation by means of a multiple regression technique to identify the relationship between canthaxanthin production and the three TCA cycle intermediates. By means of this statistical design under a fed-batch process, the optimum conditions required to achieve the highest level of canthaxanthin (13172 + or - 25 microg l(-1)) were determined as follows: alfaketoglutarate, 9.69 mM; oxaloacetate, 8.68 mM; succinate, 8.51 mM. Copyright 2009 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

Need for optimizing catalyst loading for achieving affordable microbial fuel cells.

PubMed

Singh, Inderjeet; Chandra, Amreesh

2013-08-01

Microbial fuel cell (MFC) technology is a promising technology for electricity production together with simultaneous water treatment. Catalysts play an important role in deciding the MFC performance. In most reports, effect of catalyst - both type and quantity is not optimized. In this paper, synthesis of nanorods of MnO2-catalyst particles for application in Pt-free MFCs is reported. The effect of catalyst loading i.e., weight ratio, with respect to conducting element and binder has been optimized by employing large number of combinations. Using simple theoretical model, it is shown that too high (or low) concentration of catalysts result in loss of MFC performance. The operation of MFC has been investigated using domestic wastewater as source of bio-waste for obtaining real world situation. Maximum power density of ∼61 mW/m(2) was obtained when weight ratio of catalyst and conducting species was 1:1. Suitable reasons are given to explain the outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

From Headline to Hard Grind: The Importance of Understanding Public Administration in Achieving Health Outcomes

PubMed Central

O’Flynn, Janine

2016-01-01

Many public policy programs fail to translate ambitious headlines to on-the-ground action. The reasons for this are many and varied, but for public administration and management scholars a large part of the gap between ambition and achievement is the challenge associated with the operation of the machinery of government itself, and how it relates to the other parties that it relies on to fulfill these outcomes. In their article, Carey and Friel set out key reasons why public health scholars should seek to better understand important ideas in public administration. In commenting on their contribution, I draw out two critical questions that are raised by this discussion: (i) what are boundaries and what forms do they take? and (ii) why work across boundaries? Expanding on these key questions extends the points made by Carey and Friel on the importance of understanding public administration and will better place public health scholars and practitioners to realise health outcomes. PMID:27694672

Defining an integrative approach for health promotion and disease prevention: A population health equity framework

PubMed Central

Trinh-Shevrin, Chau; Nadkarni, Smiti; Park, Rebecca; Islam, Nadia; Kwon, Simona C.

2015-01-01

Background Eliminating health disparities in racial ethnic minority and underserved populations requires a paradigm shift from disease-focused biomedical approaches to a health equity framework that aims to achieve optimal health for all by targeting social and structural determinants of health. Methods We describe the concepts and parallel approaches that underpin an integrative population health equity framework. Using a case study approach we present the experience of the NYU Center for the Study of Asian American Health (CSAAH) in applying the framework to guide its work. Results This framework is central to CSAAH’s efforts moving towards a population health equity vision for Asian Americans. Discussion Advancing the health of underserved populations requires community engagement and an understanding of the multilevel contextual factors that influence health. Applying an integrative framework has allowed us to advance health equity for Asian American communities and may serve as a useful framework for other underserved populations. PMID:25981095

Schistosomiasis Elimination Strategies and Potential Role of a Vaccine in Achieving Global Health Goals

PubMed Central

Mo, Annie X.; Agosti, Jan M.; Walson, Judd L.; Hall, B. Fenton; Gordon, Lance

2014-01-01

In March 2013, the National Institute of Allergy and Infectious Diseases and the Bill and Melinda Gates Foundation co-sponsored a meeting entitled “Schistosomiasis Elimination Strategy and Potential Role of a Vaccine in Achieving Global Health Goals” to discuss the potential role of schistosomiasis vaccines and other tools in the context of schistosomiasis control and elimination strategies. It was concluded that although schistosomiasis elimination in some focal areas may be achievable through current mass drug administration programs, global control and elimination will face several significant scientific and operational challenges, and will require an integrated approach with other, additional interventions. These challenges include vector (snail) control; environmental modification; water, sanitation, and hygiene; and other future innovative tools such as vaccines. Defining a clear product development plan that reflects a vaccine strategy as complementary to the existing control programs to combat different forms of schistosomiasis will be important to develop a vaccine effectively. PMID:24402703

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

Countdown to 2015: comparing progress towards the achievement of the health Millennium Development Goals in Ethiopia and other sub-Saharan African countries.

PubMed

Accorsi, Sandro; Bilal, Nejmudin Kedir; Farese, Pasquale; Racalbuto, Vincenzo

2010-05-01

Mid-way 2007 reports indicate that many low-income countries, at current rates of progress, are unlikely to reach the Millennium Development Goals (MDG) by 2015. In Ethiopia, a decline was observed in under-five mortality rates from 204 to 123 per 1000 live births between 1990 and 2005, showing good progress towards the achievement of MDG4. A downward trend was observed in the maternal mortality ratio; however, because of the high degree of sampling variability, it is not possible to reach any firm conclusion about the possibility of achieving MDG5. Regarding MDG6, good progress was observed in controlling HIV/AIDS and malaria, whereas MDG indicators related to tuberculosis are still below international standards. Therefore, performance was not uniform across programmes. In general, interventions that can be routinely scheduled, such as immunisation, had much higher coverage than those that rely on functional health systems and clinical services proximate to households with 24h availability, such as skilled care at birth. These mixed results highlight that, although MDGs focus on specific diseases and conditions, targets cannot be achieved without strengthening health systems. It is for this reason that the strategic health plan in Ethiopia is focusing on high-impact and cost-effective health interventions and on health systems strengthening. Copyright 2009 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Specialty Task Force: A Strategic Component to Electronic Health Record (EHR) Optimization.

PubMed

Romero, Mary Rachel; Staub, Allison

2016-01-01

Post-implementation stage comes after an electronic health record (EHR) deployment. Analyst and end users deal with the reality that some of the concepts and designs initially planned and created may not be complementary to the workflow; creating anxiety, dissatisfaction, and failure with early adoption of system. Problems encountered during deployment are numerous and can vary from simple to complex. Redundant ticket submission creates backlog for Information Technology personnel resulting in delays in resolving concerns with EHR system. The process of optimization allows for evaluation of system and reassessment of users' needs. A solid and well executed optimization infrastructure can help minimize unexpected end-user disruptions and help tailor the system to meet regulatory agency goals and practice standards. A well device plan to resolve problems during post implementation is necessary for cost containment and to streamline communication efforts. Creating a specialty specific collaborative task force is efficacious and expedites resolution of users' concerns through a more structured process.

Achieving Consistent Near-Optimal Pattern Recognition Accuracy Using Particle Swarm Optimization to Pre-Train Artificial Neural Networks

ERIC Educational Resources Information Center

Nikelshpur, Dmitry O.

2014-01-01

Similar to mammalian brains, Artificial Neural Networks (ANN) are universal approximators, capable of yielding near-optimal solutions to a wide assortment of problems. ANNs are used in many fields including medicine, internet security, engineering, retail, robotics, warfare, intelligence control, and finance. "ANNs have a tendency to get…

Changes in Optimal Childcare Practices in Kenya: Insights from the 2003, 2008-9 and 2014 Demographic and Health Surveys

PubMed Central

Matanda, Dennis Juma; Urke, Helga Bjørnøy; Mittelmark, Maurice B.

2016-01-01

Objective(s) Using nationally representative surveys conducted in Kenya, this study examined optimal health promoting childcare practices in 2003, 2008–9 and 2014. This was undertaken in the context of continuous child health promotion activities conducted by government and non-government organizations throughout Kenya. It was the aim of such activities to increase the prevalence of health promoting childcare practices; to what extent have there been changes in optimal childcare practices in Kenya during the 11-year period under study? Methods Cross-sectional data were obtained from the Kenya Demographic and Health Surveys conducted in 2003, 2008–9 and 2014. Women 15–49 years old with children 0–59 months were interviewed about a range of childcare practices. Logistic regression analysis was used to examine changes in, and correlates of, optimal childcare practices using the 2003, 2008–9 and 2014 data. Samples of 5949, 6079 and 20964 women interviewed in 2003, 2008–9 and 2014 respectively were used in the analysis. Results Between 2003 and 2014, there were increases in all health facility-based childcare practices with major increases observed in seeking medical treatment for diarrhoea and complete child vaccination. Mixed results were observed in home-based care where increases were noted in the use of insecticide treated bed nets, sanitary stool disposal and use of oral rehydration solutions, while decreases were observed in the prevalence of urging more fluid/food during diarrhoea and consumption of a minimum acceptable diet. Logit models showed that area of residence (region), household wealth, maternal education, parity, mother's age, child’s age and pregnancy history were significant determinants of optimal childcare practices across the three surveys. Conclusions The study observed variation in the uptake of the recommended optimal childcare practices in Kenya. National, regional and local child health promotion activities, coupled with changes

Changes in Optimal Childcare Practices in Kenya: Insights from the 2003, 2008-9 and 2014 Demographic and Health Surveys.

PubMed

Matanda, Dennis Juma; Urke, Helga Bjørnøy; Mittelmark, Maurice B

2016-01-01

Using nationally representative surveys conducted in Kenya, this study examined optimal health promoting childcare practices in 2003, 2008-9 and 2014. This was undertaken in the context of continuous child health promotion activities conducted by government and non-government organizations throughout Kenya. It was the aim of such activities to increase the prevalence of health promoting childcare practices; to what extent have there been changes in optimal childcare practices in Kenya during the 11-year period under study? Cross-sectional data were obtained from the Kenya Demographic and Health Surveys conducted in 2003, 2008-9 and 2014. Women 15-49 years old with children 0-59 months were interviewed about a range of childcare practices. Logistic regression analysis was used to examine changes in, and correlates of, optimal childcare practices using the 2003, 2008-9 and 2014 data. Samples of 5949, 6079 and 20964 women interviewed in 2003, 2008-9 and 2014 respectively were used in the analysis. Between 2003 and 2014, there were increases in all health facility-based childcare practices with major increases observed in seeking medical treatment for diarrhoea and complete child vaccination. Mixed results were observed in home-based care where increases were noted in the use of insecticide treated bed nets, sanitary stool disposal and use of oral rehydration solutions, while decreases were observed in the prevalence of urging more fluid/food during diarrhoea and consumption of a minimum acceptable diet. Logit models showed that area of residence (region), household wealth, maternal education, parity, mother's age, child's age and pregnancy history were significant determinants of optimal childcare practices across the three surveys. The study observed variation in the uptake of the recommended optimal childcare practices in Kenya. National, regional and local child health promotion activities, coupled with changes in society and in living conditions between 2003 and

Spatio-temporal optimization of agricultural practices to achieve a sustainable development at basin level; framework of a case study in Colombia

NASA Astrophysics Data System (ADS)

Uribe, Natalia; corzo, Gerald; Solomatine, Dimitri

2016-04-01

The flood events present during the last years in different basins of the Colombian territory have raised questions on the sensitivity of the regions and if this regions have common features. From previous studies it seems important features in the sensitivity of the flood process were: land cover change, precipitation anomalies and these related to impacts of agriculture management and water management deficiencies, among others. A significant government investment in the outreach activities for adopting and promoting the Colombia National Action Plan on Climate Change (NAPCC) is being carried out in different sectors and regions, having as a priority the agriculture sector. However, more information is still needed in the local environment in order to assess were the regions have this sensitivity. Also the continuous change in one region with seasonal agricultural practices have been pointed out as a critical information for optimal sustainable development. This combined spatio-temporal dynamics of crops cycle in relation to climate change (or variations) has an important impact on flooding events at basin areas. This research will develop on the assessment and optimization of the aggregated impact of flood events due to determinate the spatio-temporal dynamic of changes in agricultural management practices. A number of common best agricultural practices have been identified to explore their effect in a spatial hydrological model that will evaluate overall changes. The optimization process consists on the evaluation of best performance in the agricultural production, without having to change crops activities or move to other regions. To achieve this objectives a deep analysis of different models combined with current and future climate scenarios have been planned. An algorithm have been formulated to cover the parametric updates such that the optimal temporal identification will be evaluated in different region on the case study area. Different hydroinformatics