Library outreach: overcoming health literacy challenges*

PubMed Central

Parker, Ruth; Kreps, Gary L.

2005-01-01

Objective: This paper examines the powerful influences of consumer health literacy on access to and use of relevant health information. Method: The paper describes how widespread problems with health literacy significantly limit effective dissemination of relevant health information in society, especially to many vulnerable populations where health literacy challenges are especially pervasive. Results: The paper examines strengths and weaknesses of different programs for addressing health literacy problems, including educational programs, message design programs, and strategic communication training and intervention programs. Implications: The paper evaluates strategies that can be implemented throughout the modern health care system to address problems of health literacy by improving health information access, processing, and understanding. It concludes by examining several strategies that libraries can adopt to overcome many health literacy challenges. PMID:16239962

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa.

PubMed

Mburu, Grace; George, Gavin

2017-07-31

Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

Efficacy of a training program designed to help address challenges faced by health promotion volunteers.

PubMed

Taguchi, Atsuko; Murayama, Hiroshi; Arakawa, Mihoko; Terao, Atsushi

2017-01-01

Objective　To evaluate the effectiveness of a training program designed to address the following three challenges facing health promotion volunteers: lack of new volunteers, short tenure of volunteering, and failure to build a collaborative relationship with other civic organizations.Methods　Thirty-eight volunteer leaders representing 36 school districts (one from each district and two additional leaders) from southern parts of Shiga Prefecture participated in the training program. Four training sessions were conducted between July 2012 and January 2013. Each session lasted for 2 hours. The program included a lecture, group work, and role playing, all of which centered on the challenges experienced by the volunteers and possible solutions. Those who participated constituted the "training group," and other volunteers in the same area of Shiga, who did not take part in the program, made up the "non-training group." A third, control group consisted of health promotion volunteers based in City A, located outside the areas where the training occurred. To compare the three groups, we collected data before and after the training. The main evaluation index comprised the following three survey items: having confidence in recruiting new volunteers, having confidence in overcoming the difficulties or discouragement to continue to volunteer, and having confidence in explaining their activities to other local organizations to earn their cooperation. These questions were asked in a self-administered questionnaire using a 6-point Likert scale (1: strongly disagree, 6: strongly agree).Results　The data were compared among the training group (28 out of the 38 participants completed the survey), non-training group (n=293), and control group (n=107). On the question about recruiting new volunteers, the training group's mean score increased from 2.9 (standard deviation (SD)=1.3) to 3.3 (SD=1.0) following the training, and the improvement relative to the other two groups was

Emerging Infections Program Efforts to Address Health Equity

PubMed Central

Vugia, Duc J.; Bennett, Nancy M.; Moore, Matthew R.

2015-01-01

The Emerging Infections Program (EIP), a collaboration between (currently) 10 state health departments, their academic center partners, and the Centers for Disease Control and Prevention, was established in 1995. The EIP performs active, population-based surveillance for important infectious diseases, addresses new problems as they arise, emphasizes projects that lead to prevention, and develops and evaluates public health practices. The EIP has increasingly addressed the health equity challenges posed by Healthy People 2020. These challenges include objectives to increase the proportion of Healthy People–specified conditions for which national data are available by race/ethnicity and socioeconomic status as a step toward first recognizing and subsequently eliminating health inequities. EIP has made substantial progress in moving from an initial focus on monitoring social determinants exclusively through collecting and analyzing data by race/ethnicity to identifying and piloting ways to conduct population-based surveillance by using area-based socioeconomic status measures. PMID:26291875

Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa

PubMed Central

2017-01-01

Background Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. Aim This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. Setting The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. Methods The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Results Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. Conclusion South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be

Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century

PubMed Central

Zhang, Xinzhi; Pérez-Stable, Eliseo J.; Bourne, Philip E.; Peprah, Emmanuel; Duru, O. Kenrik; Breen, Nancy; Berrigan, David; Wood, Fred; Jackson, James S.; Wong, David W.S.; Denny, Joshua

2017-01-01

Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them. PMID:28439179

Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century.

PubMed

Zhang, Xinzhi; Pérez-Stable, Eliseo J; Bourne, Philip E; Peprah, Emmanuel; Duru, O Kenrik; Breen, Nancy; Berrigan, David; Wood, Fred; Jackson, James S; Wong, David W S; Denny, Joshua

2017-01-01

Addressing minority health and health disparities has been a missing piece of the puzzle in Big Data science. This article focuses on three priority opportunities that Big Data science may offer to the reduction of health and health care disparities. One opportunity is to incorporate standardized information on demographic and social determinants in electronic health records in order to target ways to improve quality of care for the most disadvantaged populations over time. A second opportunity is to enhance public health surveillance by linking geographical variables and social determinants of health for geographically defined populations to clinical data and health outcomes. Third and most importantly, Big Data science may lead to a better understanding of the etiology of health disparities and understanding of minority health in order to guide intervention development. However, the promise of Big Data needs to be considered in light of significant challenges that threaten to widen health disparities. Care must be taken to incorporate diverse populations to realize the potential benefits. Specific recommendations include investing in data collection on small sample populations, building a diverse workforce pipeline for data science, actively seeking to reduce digital divides, developing novel ways to assure digital data privacy for small populations, and promoting widespread data sharing to benefit under-resourced minority-serving institutions and minority researchers. With deliberate efforts, Big Data presents a dramatic opportunity for reducing health disparities but without active engagement, it risks further widening them.

How Can eHealth Technology Address Challenges Related to Multimorbidity? Perspectives from Patients with Multiple Chronic Conditions.

PubMed

Zulman, Donna M; Jenchura, Emily C; Cohen, Danielle M; Lewis, Eleanor T; Houston, Thomas K; Asch, Steven M

2015-08-01

Patient eHealth technology offers potential support for disease self-management, but the value of existing applications for patients with multiple chronic conditions (MCCs) is unclear. To understand self-management and health care navigation challenges that patients face due to MCCs and to identify opportunities to support these patients through new and enhanced eHealth technology. After administering a screening survey, we conducted 10 focus groups of 3-8 patients grouped by age, sex, and common chronic conditions. Patients discussed challenges associated with having MCCs and their use of (and desires from) technology to support self-management. Three investigators used standard content analysis methods to code the focus group transcripts. Emergent themes were reviewed with all collaborators, and final themes and representative quotes were validated with a sample of participants. Fifty-three individuals with ≥3 chronic conditions and experience using technology for health-related purposes. Focus group participants had an average of five chronic conditions. Participants reported using technology most frequently to search for health information (96%), communicate with health care providers (92%), track medical information (83%), track medications (77%), and support decision-making about treatment (55%). Three themes emerged to guide eHealth technology development: (1) Patients with MCCs manage a high volume of information, visits, and self-care tasks; (2) they need to coordinate, synthesize, and reconcile health information from multiple providers and about different conditions; (3) their unique position at the hub of multiple health issues requires self-advocacy and expertise. Focus groups identified desirable eHealth resources and tools that reflect these themes. Although patients with multiple health issues use eHealth technology to support self-care for specific conditions, they also desire tools that transcend disease boundaries. By addressing the holistic

Implementing a Public Health Approach to Addressing Mental Health Needs in a University Setting: Lessons and Challenges

ERIC Educational Resources Information Center

Parcover, Jason; Mays, Sally; McCarthy, Amy

2015-01-01

The mental health needs of college students are placing increasing demands on counseling center resources, and traditional outreach efforts may be outdated or incomplete. The public health model provides an approach for reaching more students, decreasing stigma, and addressing mental health concerns before they reach crisis levels. Implementing a…

Challenges created by data dissemination and access restrictions when attempting to address community concerns: individual privacy versus public wellbeing.

PubMed

Colquhoun, Amy; Aplin, Laura; Geary, Janis; Goodman, Karen J; Hatcher, Juanita

2012-05-08

Population health data are vital for the identification of public health problems and the development of public health strategies. Challenges arise when attempts are made to disseminate or access anonymised data that are deemed to be potentially identifiable. In these situations, there is debate about whether the protection of an individual's privacy outweighs potentially beneficial public health initiatives developed using potentially identifiable information. While these issues have an impact at planning and policy levels, they pose a particular dilemma when attempting to examine and address community concerns about a specific health problem. Research currently underway in northern Canadian communities on the frequency of Helicobacter pylori infection and associated diseases, such as stomach cancer, is used in this article to illustrate the challenges that data controls create on the ability of researchers and health officials to address community concerns. Barriers are faced by public health professionals and researchers when endeavouring to address community concerns; specifically, provincial cancer surveillance departments and community-driven participatory research groups face challenges related to data release or access that inhibit their ability to effectively address community enquiries. The resulting consequences include a limited ability to address misinformation or to alleviate concerns when dealing with health problems in small communities. The development of communication tools and building of trusting relationships are essential components of a successful investigation into community health concerns. It may also be important to consider that public wellbeing may outweigh the value of individual privacy in these situations. As such, a re-evaluation of data disclosure policies that are applicable in these circumstances should be considered.

National health inequality monitoring: current challenges and opportunities.

PubMed

Hosseinpoor, Ahmad Reza; Bergen, Nicole; Schlotheuber, Anne; Boerma, Ties

National health inequality monitoring needs considerably more investment to realize equity-oriented health improvements in countries, including advancement towards the Sustainable Development Goals. Following an overview of national health inequality monitoring and the associated resource requirements, we highlight challenges that countries may encounter when setting up, expanding or strengthening national health inequality monitoring systems, and discuss opportunities and key initiatives that aim to address these challenges. We provide specific proposals on what is needed to ensure that national health inequality monitoring systems are harnessed to guide the reduction of health inequalities.

Four Challenges That Global Health Networks Face

PubMed Central

Shiffman, Jeremy

2017-01-01

Global health networks, webs of individuals and organizations with a shared concern for a particular condition, have proliferated over the past quarter century. They differ in their effectiveness, a factor that may help explain why resource allocations vary across health conditions and do not correspond closely with disease burden. Drawing on findings from recently concluded studies of eight global health networks—addressing alcohol harm, early childhood development (ECD), maternal mortality, neonatal mortality, pneumonia, surgically-treatable conditions, tobacco use, and tuberculosis—I identify four challenges that networks face in generating attention and resources for the conditions that concern them. The first is problem definition: generating consensus on what the problem is and how it should be addressed. The second is positioning: portraying the issue in ways that inspire external audiences to act. The third is coalition-building: forging alliances with these external actors, particularly ones outside the health sector. The fourth is governance: establishing institutions to facilitate collective action. Research indicates that global health networks that effectively tackle these challenges are more likely to garner support to address the conditions that concern them. In addition to the effectiveness of networks, I also consider their legitimacy, identifying reasons both to affirm and to question their right to exert power. PMID:28812801

Local Health Departments’ Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction?

PubMed Central

Shah, Gulzar H.; Sheahan, John P.

2015-01-01

Context: Health disparities are among the critical public health challenges. Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement. Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities. Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four activities. LHD characteristics significantly associated (p≤0.05) with the increased likelihood of performing activities to address health disparities were: recent completion of community health assessment, community health improvement plan and agency wide strategic plan. Other significant positive impacts on such activities included per capita expenditures, local governance, having one or more local boards of health, larger population size and metropolitan status of the LHD jurisdiction. Conclusions: Reduced infrastructural capacity of LHDs has resulted in fewer LHDs addressing health disparities in their jurisdictions. LHD characteristics associated with higher performance of activities for health disparity reduction identified by this research have important policy implications. PMID:26703693

Addressing refugee health through evidence-based policies: a case study

PubMed Central

de Bocanegra, Heike Thiel; Carter-Pokras, Olivia; Ingleby, J. David; Pottie, Kevin; Tchangalova, Nedelina; Allen, Sophia I.; Smith-Gagen, Julie; Hidalgo, Bertha

2017-01-01

The cumulative total of persons forced to leave their country for fear of persecution or organized violence reached an unprecedented 24.5 million by the end of 2015. Providing equitable access to appropriate health services for these highly diverse newcomers poses challenges for receiving countries. In this case study, we illustrate the importance of translating epidemiology into policy to address the health needs of refugees by highlighting examples of what works as well as identifying important policy-relevant gaps in knowledge. First, we formed an international working group of epidemiologists and health services researchers to identify available literature on the intersection of epidemiology, policy, and refugee health. Second, we created a synopsis of findings to inform a recommendation for integration of policy and epidemiology to support refugee health in the US and other high-income receiving countries. Third, we identified eight key areas to guide the involvement of epidemiologists in addressing refugee health concerns. The complexity and uniqueness of refugee health issues, and the need to develop sustainable management information systems, require epidemiologists to expand their repertoire of skills to identify health patterns among arriving refugees, monitor access to appropriately designed health services, address inequities, and communicate with policy makers and multidisciplinary teams. PMID:28554498

Addressing childhood obesity at school entry: Qualitative experiences of school health professionals.

PubMed

Turner, Gillian L; Owen, Stephanie; Watson, Paula M

2016-09-01

School entry provides an opportune moment for health professionals to intervene with children who are overweight, yet identification and management of childhood obesity presents challenges in practice. This multi-method qualitative study explored the experiences of 26 school health professionals in addressing childhood obesity at school entry. Methods included semi-structured interviews with service managers (n = 3); focus groups with school nurses (n = 12) and child health practitioners (n = 6); and open-ended questionnaires with school nurses (n = 4) and child health practitioners (n = 1) who were unable to attend the focus groups. A thematic analysis revealed agreement between service managers, school nurses and child health practitioners. Whilst it was felt school health professionals have an important role to play in managing childhood obesity, efforts to address child weight were limited by a lack of capacity, lack of clear protocols, challenges of engaging parents and insufficient training in childhood obesity and related lifestyle issues. School health policymakers need to recognize childhood obesity as a serious public health issue, allocate appropriate resources to nurse training and development and ensure clear pathways are established to ensure consistency of care. © The Author(s) 2015.

The next organizational challenge: finding and addressing diagnostic error.

PubMed

Graber, Mark L; Trowbridge, Robert; Myers, Jennifer S; Umscheid, Craig A; Strull, William; Kanter, Michael H

2014-03-01

Although health care organizations (HCOs) are intensely focused on improving the safety of health care, efforts to date have almost exclusively targeted treatment-related issues. The literature confirms that the approaches HCOs use to identify adverse medical events are not effective in finding diagnostic errors, so the initial challenge is to identify cases of diagnostic error. WHY HEALTH CARE ORGANIZATIONS NEED TO GET INVOLVED: HCOs are preoccupied with many quality- and safety-related operational and clinical issues, including performance measures. The case for paying attention to diagnostic errors, however, is based on the following four points: (1) diagnostic errors are common and harmful, (2) high-quality health care requires high-quality diagnosis, (3) diagnostic errors are costly, and (4) HCOs are well positioned to lead the way in reducing diagnostic error. FINDING DIAGNOSTIC ERRORS: Current approaches to identifying diagnostic errors, such as occurrence screens, incident reports, autopsy, and peer review, were not designed to detect diagnostic issues (or problems of omission in general) and/or rely on voluntary reporting. The realization that the existing tools are inadequate has spurred efforts to identify novel tools that could be used to discover diagnostic errors or breakdowns in the diagnostic process that are associated with errors. New approaches--Maine Medical Center's case-finding of diagnostic errors by facilitating direct reports from physicians and Kaiser Permanente's electronic health record--based reports that detect process breakdowns in the followup of abnormal findings--are described in case studies. By raising awareness and implementing targeted programs that address diagnostic error, HCOs may begin to play an important role in addressing the problem of diagnostic error.

A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities.

PubMed

Weinstein, Lara Carson; Lanoue, Marianna D; Plumb, James D; King, Hannah; Stein, Brianna; Tsemberis, Sam

2013-01-01

People with histories of homelessness and serious mental illness experience profound health disparities. Housing First is an evidenced-based practice that is working to end homelessness for these individuals through a combination of permanent housing and community-based supports. The Jefferson Department of Family and Community Medicine and a Housing First agency, Pathways to Housing-PA, has formed a partnership to address multiple levels of health care needs for this group. We present a preliminary program evaluation of this partnership using the framework of the patient-centered medical home and the "10 Essential Public Health Services." Preliminary program evaluation results suggest that this partnership is evolving to function as an integrated person-centered health home and an effective local public health monitoring system. The Pathways to Housing-PA/Jefferson Department of Family and Community Medicine partnership represents a community of solution, and multiple measures provide preliminary evidence that this model is feasible and can address the "grand challenges" of integrated community health services.

Addressing risks to advance mental health research.

PubMed

Iltis, Ana S; Misra, Sahana; Dunn, Laura B; Brown, Gregory K; Campbell, Amy; Earll, Sarah A; Glowinski, Anne; Hadley, Whitney B; Pies, Ronald; Dubois, James M

2013-12-01

Risk communication and management are essential to the ethical conduct of research, yet addressing risks may be time consuming for investigators and institutional review boards may reject study designs that seem too risky. This can discourage needed research, particularly in higher-risk protocols or those enrolling potentially vulnerable individuals, such as those with some level of suicidality. Improved mechanisms for addressing research risks may facilitate much needed psychiatric research. To provide mental health researchers with practical approaches to (1) identify and define various intrinsic research risks, (2) communicate these risks to others (eg, potential participants, regulatory bodies, and society), (3) manage these risks during the course of a study, and (4) justify the risks. As part of a National Institute of Mental Health-funded scientific meeting series, a public conference and a closed-session expert panel meeting were held on managing and disclosing risks in mental health clinical trials. The expert panel reviewed the literature with a focus on empirical studies and developed recommendations for best practices and further research on managing and disclosing risks in mental health clinical trials. No institutional review board-review was required because there were no human subjects. Challenges, current data, practical strategies, and topics for future research are addressed for each of 4 key areas pertaining to management and disclosure of risks in clinical trials: identifying and defining risks, communicating risks, managing risks during studies, and justifying research risks. Empirical data on risk communication, managing risks, and the benefits of research can support the ethical conduct of mental health research and may help investigators better conceptualize and confront risks and to gain institutional review board-approval.

Mental health challenges among adolescents living with HIV.

PubMed

Vreeman, Rachel C; McCoy, Brittany M; Lee, Sonia

2017-05-16

Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions. For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English. Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health. Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental health support is integrated into the care management for HIV

Health information exchange: persistent challenges and new strategies

PubMed Central

Gamm, Larry D

2010-01-01

Recent federal policies and actions support the adoption of health information exchange (HIE) in order to improve healthcare by addressing fragmented personal health information. However, concerted efforts at facilitating HIE have existed for over two decades in this country. The lessons of these experiences include a recurrence of barriers and challenges beyond those associated with technology. Without new strategies, the current support and methods of facilitating HIE may not address these barriers. PMID:20442146

Estimating the Health Effects of Greenhouse Gas Mitigation Strategies: Addressing Parametric, Model, and Valuation Challenges

PubMed Central

Hess, Jeremy J.; Ebi, Kristie L.; Markandya, Anil; Balbus, John M.; Wilkinson, Paul; Haines, Andy; Chalabi, Zaid

2014-01-01

simultaneously improving health. Citation: Remais JV, Hess JJ, Ebi KL, Markandya A, Balbus JM, Wilkinson P, Haines A, Chalabi Z. 2014. Estimating the health effects of greenhouse gas mitigation strategies: addressing parametric, model, and valuation challenges. Environ Health Perspect 122:447–455; http://dx.doi.org/10.1289/ehp.1306744 PMID:24583270

CIRM Alpha Stem Cell Clinics: Collaboratively Addressing Regenerative Medicine Challenges.

PubMed

Jamieson, Catriona H M; Millan, Maria T; Creasey, Abla A; Lomax, Geoff; Donohoe, Mary E; Walters, Mark C; Abedi, Mehrdad; Bota, Daniela A; Zaia, John A; Adams, John S

2018-06-01

The California Institute for Regenerative Medicine (CIRM) Alpha Stem Cell Clinic (ASCC) Network was launched in 2015 to address a compelling unmet medical need for rigorous, FDA-regulated, stem cell-related clinical trials for patients with challenging, incurable diseases. Here, we describe our multi-center experiences addressing current and future challenges. Copyright © 2018 Elsevier Inc. All rights reserved.

Developing effective interuniversity partnerships and community-based research to address health disparities.

PubMed

Carey, Timothy S; Howard, Daniel L; Goldmon, Moses; Roberson, James T; Godley, Paul A; Ammerman, Alice

2005-11-01

Health disparities are an enormous challenge to American society. Addressing these disparities is a priority for U.S. society and especially for institutions of higher learning, with their threefold mission of education, service, and research. Collaboration across multiple intellectual disciplines will be critical as universities address health disparities. In addition, universities must collaborate with communities, with state partners, and with each other. Development of these collaborations must be sensitive to the history and unique characteristics of each academic institution and population. The authors describe the challenges of all three types of collaboration, but primarily focus on collaboration between research-intensive universities and historically black colleges and universities. The authors describe a four-year collaboration between Shaw University and the University of North Carolina at Chapel Hill (UNC-CH). These universities strategically developed multiple research initiatives to address health disparities, building on modest early success and personal relationships. These activities included participation by Shaw faculty in faculty development activities, multiple collaborative pilot studies, and joint participation in securing grants from the Agency for Health care Research and Quality of the federal Department of Health and Human Services and the National Institutes of Health, including a P-60 Project EXPORT center grant. These multiple activities were sometimes led by UNC-CH, sometimes by Shaw University. Open discussion of problems as they arose, realistic expectations, and mutual recognition of the strengths of each institution and its faculty have been critical in achieving successful collaboration to date.

Developing Effective Interuniversity Partnerships and Community-Based Research to Address Health Disparities

PubMed Central

Carey, Timothy S.; Howard, Daniel L.; Goldmon, Moses; Roberson, James T.; Godley, Paul A.; Ammerman, Alice

2009-01-01

Health disparities are an enormous challenge to American society. Addressing these disparities is a priority for U.S. society and especially for institutions of higher learning, with their threefold mission of education, service, and research. Collaboration across multiple intellectual disciplines will be critical as universities address health disparities. In addition, universities must collaborate with communities, with state partners, and with each other. Development of these collaborations must be sensitive to the history and unique characteristics of each academic institution and population. The authors describe the challenges of all three types of collaboration, but primarily focus on collaboration between research-intensive universities and historically black colleges and universities. The authors describe a four-year collaboration between Shaw University and the University of North Carolina at Chapel Hill (UNC-CH). These universities strategically developed multiple research initiatives to address health disparities, building on modest early success and personal relationships. These activities included participation by Shaw faculty in faculty development activities, multiple collaborative pilot studies, and joint participation in securing grants from the Agency for Health care Research and Quality of the federal Department of Health and Human Services and the National Institutes of Health, including a P-60 Project EXPORT center grant. These multiple activities were sometimes led by UNC-CH, sometimes by Shaw University. Open discussion of problems as they arose, realistic expectations, and mutual recognition of the strengths of each institution and its faculty have been critical in achieving successful collaboration to date. PMID:16249303

The changing global landscape of health and disease: addressing challenges and opportunities for sustaining progress towards control and elimination of neglected tropical diseases (NTDs).

PubMed

Molyneux, David H; Dean, Laura; Adekeye, Oluwatosin; Stothard, J Russell; Theobald, Sally

2018-03-16

The drive to control neglected tropical diseases (NTDs) has had many successes but to reach defined targets new approaches are required. Over the last decade, NTD control programmes have benefitted from increased resources, and from effective partnerships and long-term pharmaceutical donations. Although the NTD agenda is broader than those diseases of parasitic aetiology there has been a massive up-scaling of the delivery of medicines to some billion people annually. Recipients are often the poorest, with the aspiration that NTD programmes are key to universal health coverage as reflected within the 2030 United Nations sustainable development goals (SDGs). To reach elimination targets, the community will need to adapt global events and changing policy environments to ensure programmes are responsive and can sustain progress towards NTD targets. Innovative thinking embedded within regional and national health systems is needed. Policy makers, managers and frontline health workers are the mediators between challenge and change at global and local levels. This paper attempts to address the challenges to end the chronic pandemic of NTDs and achieve the SDG targets. It concludes with a conceptual framework that illustrates the interactions between these key challenges and opportunities and emphasizes the health system as a critical mediator.

Multi-Sectoral Action for Addressing Social Determinants of Noncommunicable Diseases and Mainstreaming Health Promotion in National Health Programmes in India

PubMed Central

Arora, Monika; Chauhan, Kavita; John, Shoba; Mukhopadhyay, Alok

2011-01-01

Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's “Action Plan for a Global Strategy for Prevention and Control of NCDs” calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs. PMID:22628911

Addressing data access challenges in seismology

NASA Astrophysics Data System (ADS)

Trabant, C. M.; Ahern, T.; Weertman, B.; Benson, R. B.; Van Fossen, M.; Weekly, R. T.; Casey, R. E.; Suleiman, Y. Y.; Stults, M.

2016-12-01

The development of web services at the IRIS Data Management Center (DMC) over the last 6 years represents the most significant enhancement of data access ever introduced at the DMC. These web services have allowed the us to focus our internal operations around a single, consistent data access layer while facilitating development of a new generation of tools and methods for researchers to conduct their work. This effort led the DMC to propose standardized web service interfaces within the International Federation of Digital Seismograph Networks (FDSN), enabling other seismological data centers to offer data using compatible interfaces. With this new foundation, we now turn our attention to more advanced data access challenges. In particular, we will present the status of two developments intending to address 1) access to data of consistent quality for science and 2) discovery and access of data from multiple data centers. To address the challenge of requesting high or consistent quality data we will introduce our Research-Ready Data Sets (RRDS) initiative. The purpose of the RRDS project is to reduce the time a researcher spends culling and otherwise identifying data appropriate for given study. RRDS will provide users with additional criteria related to data quality that can be specified when requesting data. Leveraging the data quality measurements provided by our MUSTANG system, these criteria will include ambient noise, completeness, dead channel identification and more. To address the challenge of seismological data discovery and access, we have built and continue to improve the IRIS Federator. The Federator takes advantage of the FDSN-standard web services at various data centers to help a user locate specific channels, wherever they may be offered globally. The search interface provides results that are pre-formatted requests, ready for submission to each data center that serves that data. These two developments are aimed squarely at reducing the time

Mental health challenges among adolescents living with HIV

PubMed Central

Vreeman, Rachel C.; McCoy, Brittany M.; Lee, Sonia

2017-01-01

Abstract Introduction: Mental health is a critical and neglected global health challenge for adolescents infected with HIV. The prevalence of mental and behavioural health issues among HIV-infected adolescents may not be well understood or addressed as the world scales up HIV prevention and treatment for adolescents. The objective of this narrative review is to assess the current literature related to mental health challenges faced by adolescents living with HIV, including access to mental health services, the role of mental health challenges during transition from paediatric to adult care services and responsibilities, and the impact of mental health interventions. Methods: For each of the topics included in this review, individual searches were run using Medline and PubMed, accompanied by scans of bibliographies of relevant articles. The topics on which searches were conducted for HIV-infected adolescents include depression and anxiety, transition from paediatric to adult HIV care and its impact on adherence and mental health, HIV-related, mental health services and interventions, and the measurement of mental health problems. Articles were included if the focus was consistent with one of the identified topics, involved HIV-infected adolescents, and was published in English. Results and Discussion: Mental and behavioural health challenges are prevalent in HIV-infected adolescents, including in resource-limited settings where most of them live, and they impact all aspects of HIV prevention and treatment. Too little has been done to measure the impact of mental health challenges for adolescents living with HIV, to evaluate interventions to best sustain or improve the mental health of this population, or to create healthcare systems with personnel or resources to promote mental health. Conclusions: Mental health issues should be addressed proactively during adolescence for all HIV-infected youth. In addition, care systems need to pay greater attention to how mental

Using Local Data to Address Abandoned Property: Lessons Learned From a Community Health Partnership.

PubMed

Teixeira, Samantha; Kolke, Demi

A growing body of research highlights the role of the built environment in promoting or impeding health. This research suggests that environmental issues like abandoned properties exact a toll on physical and mental health. We describe a community partnership aimed at improving community health through equitable land use policies and blight remediation. A collaboration between the University of Pittsburgh and Operation Better Block, Inc. (OBB), a community development corporation in Pittsburgh, was formed. We implemented an intervention to address property abandonment using data-driven techniques. In addition to successful advocacy for city-wide policies addressing abandonment, 80% of the properties that were part of our intervention were improved or addressed by the city. Balancing the needs of community and academic partners can be challenging, but our experiences suggest that community health partnerships to address built environmental issues may be an important conduit to health promotion.

Addressing the determinants of child mental health: intersectionality as a guide to primary health care renewal.

PubMed

McPherson, Charmaine M; McGibbon, Elizabeth A

2010-09-01

Primary health care (PHC) renewal was designed explicitly to attend to the multidimensional factors impacting on health, including the social determinants of health. These determinants are central considerations in the development of integrated, cross-sectoral, and multi-jurisdictional policies such as those that inform models of shared mental health care for children. However, there are complex theoretical challenges in translating these multidimensional issues into policy. One of these is the rarely discussed interrelationships among the social determinants of health and identities such as race, gender, age, sexuality, and social class within the added confluence of geographic contexts. An intersectionality lens is used to examine the complex interrelationships among the factors affecting child mental health and the associated policy challenges surrounding PHC renewal. The authors argue that an understanding of the intersections of social determinants of health, identity, and geography is pivotal in guiding policy-makers as they address child mental health inequities using a PHC renewal agenda.

ORD-State Cooperation is Essential to Help States Address Contemporary Environmental Public Health Challenges

EPA Science Inventory

Dr. Cascio’s presentation “ORD-State Cooperation is Essential to Help States Address Contemporary Environmental Public Health Challenges” at ORD’s State Coordination Team Meeting will highlight the role that ORD science and technical expertise in helping t...

On the road to a stronger public health workforce: visual tools to address complex challenges.

PubMed

Drehobl, Patricia; Stover, Beth H; Koo, Denise

2014-11-01

The public health workforce is vital to protecting the health and safety of the public, yet for years, state and local governmental public health agencies have reported substantial workforce losses and other challenges to the workforce that threaten the public's health. These challenges are complex, often involve multiple influencing or related causal factors, and demand comprehensive solutions. However, proposed solutions often focus on selected factors and might be fragmented rather than comprehensive. This paper describes approaches to characterizing the situation more comprehensively and includes two visual tools: (1) a fishbone, or Ishikawa, diagram that depicts multiple factors affecting the public health workforce; and (2) a roadmap that displays key elements-goals and strategies-to strengthen the public health workforce, thus moving from the problems depicted in the fishbone toward solutions. The visual tools aid thinking about ways to strengthen the public health workforce through collective solutions and to help leverage resources and build on each other's work. The strategic roadmap is intended to serve as a dynamic tool for partnership, prioritization, and gap assessment. These tools reflect and support CDC's commitment to working with partners on the highest priorities for strengthening the workforce to improve the public's health. Published by Elsevier Inc.

[The Brazilian National Health Conference: challenges for the country].

PubMed

Gadelha, Paulo

2015-10-01

This article was published in the context of the upcoming 15th Brazilian National Health Conference and addresses the country's health challenges based on the history of previous conferences. The authors analyze the evolution of health as a public policy agenda, highlighting the role of such institutions as the Brazilian Center for Health Studies (CEBES), the Brazilian Association of Collective Health (Abrasco), and the National Health Council in advocating and establishing the Brazilian Unified National Health System (SUS). The article also focuses on expectations concerning the 15th National Health Conference within a political and economic scenario that raises questions and challenges both for the future of health policy, exemplified by SUS, and the current capacity to mobilize stakeholders.

Scoping review of health promotion and disease prevention interventions addressed to elderly people.

PubMed

Duplaga, Mariusz; Grysztar, Marcin; Rodzinka, Marcin; Kopec, Agnieszka

2016-09-05

The ageing of modern societies remains one of the greatest challenges for health and social systems. To respond to this challenge, we need effective strategies assuring healthy active life for elderly people. Health promotion and related activities are perceived as a key intervention, which can improve wellbeing in later life. The main aim of this study is the identification and classification of such interventions addressed to older adults and elderly. Therefore, the strategy based on the scoping review as a feasible tool for exploring this domain, summarizing research findings and identifying gaps of evidence, was applied. The scoping review relies on the analysis of previous reviews of interventions aimed at older adults (55-64 years old) and elderly persons (65 years and above) assessed for their effectiveness in the framework of a systematic review and/or meta-analysis. The search strategy was based on the identification of interventions reported as health promotion, primary disease prevention, screening or social support. In the analysis, the reviews published from January 2000 to April 2015 were included. The search strategy yielded 334 systematic reviews and/or meta-analyses addressed to target groups of interest, 182 of them assessed interventions belonging to health promotion, 219 to primary prevention, 34 to screening and 35 to social support. The studies focused on elderly (65 years and above) made up 40.4 % of all retrieved reviews and those addressing population of 55 years and above accounted for 24.0 %. Interventions focused on health maintenance and improvement in elderly and older adults represent frequently combined health promotion and disease prevention actions. Many interventions of this type are not addressed exclusively to elderly populations and/or older adults but are designed for the general population. The most common types of interventions addressed to elderly and older adults in the area of health promotion include health

National Institutes of Health addresses the science of diversity.

PubMed

Valantine, Hannah A; Collins, Francis S

2015-10-06

The US biomedical research workforce does not currently mirror the nation's population demographically, despite numerous attempts to increase diversity. This imbalance is limiting the promise of our biomedical enterprise for building knowledge and improving the nation's health. Beyond ensuring fairness in scientific workforce representation, recruiting and retaining a diverse set of minds and approaches is vital to harnessing the complete intellectual capital of the nation. The complexity inherent in diversifying the research workforce underscores the need for a rigorous scientific approach, consistent with the ways we address the challenges of science discovery and translation to human health. Herein, we identify four cross-cutting diversity challenges ripe for scientific exploration and opportunity: research evidence for diversity's impact on the quality and outputs of science; evidence-based approaches to recruitment and training; individual and institutional barriers to workforce diversity; and a national strategy for eliminating barriers to career transition, with scientifically based approaches for scaling and dissemination. Evidence-based data for each of these challenges should provide an integrated, stepwise approach to programs that enhance diversity rapidly within the biomedical research workforce.

Commentary: Pediatric eHealth Interventions: Common Challenges During Development, Implementation, and Dissemination

PubMed Central

Steele, Ric G.; Connelly, Mark A.; Palermo, Tonya M.; Ritterband, Lee M.

2014-01-01

Objective To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. Methods The article draws on the existing eHealth literature and the authors’ collective experience in pediatric eHealth research. Results and conclusions The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. PMID:24816766

Addressing Environmental Health Inequalities.

PubMed

Gouveia, Nelson

2016-08-27

Environmental health inequalities refer to health hazards disproportionately or unfairly distributed among the most vulnerable social groups, which are generally the most discriminated, poor populations and minorities affected by environmental risks. Although it has been known for a long time that health and disease are socially determined, only recently has this idea been incorporated into the conceptual and practical framework for the formulation of policies and strategies regarding health. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), "Addressing Environmental Health Inequalities-Proceedings from the ISEE Conference 2015", we incorporate nine papers that were presented at the 27th Conference of the International Society for Environmental Epidemiology (ISEE), held in Sao Paulo, Brazil, in 2015. This small collection of articles provides a brief overview of the different aspects of this topic. Addressing environmental health inequalities is important for the transformation of our reality and for changing the actual development model towards more just, democratic, and sustainable societies driven by another form of relationship between nature, economy, science, and politics.

MO-FG-BRB-01: Investing to Address the Global Cancer Challenge

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

Atun, R.

2015-06-15

The global burden of cancer is growing rapidly with an estimated 15 million new cases per year worldwide in 2015, growing to 19 million by 2025 and 24 million by 2035. The largest component of this growth will occur in low-to-middle income countries (LMICs). About half of these cases will require radiation treatment. The gap for available cancer treatment, including radiation therapy, between high-income countries (HICs) and LMICs is enormous. Accurate data and quantitative models to project the needs and the benefits of cancer treatment are a critical first step in closing the large cancer divide between LMICs and HICs.more » In this context, the Union for International Cancer Control (UICC) has developed a Global Task Force on Radiotherapy for Cancer Control (GTFRCC) with a charge to answer the question as to what it will take to close the gap between what exists today and reasonable access to radiation therapy globally by 2035 and what the potential clinical and economic benefits are for doing this. The Task Force has determined the projections of cancer incidence and the infrastructure required to provide access to radiation therapy globally. Furthermore it has shown that appropriate investment not only yields improved clinical outcomes for millions of patients but that it also provides an overall economic gain throughout all the income settings where this investment is made. This symposium will summarize the facets associated with this global cancer challenge by reviewing the cancer burden, looking at the requirements for radiation therapy, reviewing the benefits of providing such therapy both from a clinical and economic perspective and finally by looking at what approaches can be used to aid in the alleviation of this global cancer challenge. The speakers are world renowned experts in global public health issues (R. Atun), medical physics (D. Jaffray) and radiation oncology (N. Coleman). Learning Objectives: To describe the global cancer challenge and the

Teaching undergraduate nursing students about environmental health: addressing public health issues through simulation.

PubMed

Stanley, Mary Jo; Rojas, Deb

2014-01-01

Schools of nursing are challenged to find clinical placements in public health settings. Use of simulation can address situations unique to public health, with attention to specific concerns, such as environmental health. Environmental health is an integral part of public health nursing and is a standard of professional practice. Current simulations focus on acute care situations, offering limited scenarios with a public health perspective and excluding environmental health. This study's simulation scenario was created to enhance nursing students' understanding of public health concepts within an environmental health context. Outcomes from the simulation include the need for integration of environmental issues in public health teaching. Students stated that this scenario provided a broader understanding of the environmental influences that can affect the client's and family's health. This scenario fills a void in simulation content, while providing an interactive teaching and learning strategy to help students to apply knowledge to practice. Copyright 2014, SLACK Incorporated.

ADDRESSING ENVIRONMENTAL ENGINEERING CHALLENGES WITH COMPUTATIONAL FLUID DYNAMICS

EPA Science Inventory

This paper discusses the status and application of Computational Fluid Dynamics )CFD) models to address environmental engineering challenges for more detailed understanding of air pollutant source emissions, atmospheric dispersion and resulting human exposure. CFD simulations ...

Lessons Learned and Challenges in Building a Filipino Health Coalition

PubMed Central

Aguilar, David E.; Abesamis-Mendoza, Noilyn; Ursua, Rhodora; Divino, Lily Ann M.; Cadag, Kara; Gavin, Nicholas P.

2010-01-01

In recent years, community-based coalitions have become an effective channel to addressing various health problems within specific ethnic communities. The purpose of this article is twofold: (a) to describe the process involved in building the Kalusugan Coalition (KC), a Filipino American health coalition based in New York City, and (b) to highlight the lessons learned and the challenges from this collaborative venture. The challenges described also offer insights on how the coalition development process can be greatly affected by the partnership with an academic institution on a community-based research project. Because each cultural group has unique issues and concerns, the theoretical framework used by KC offers creative alternatives to address some of the challenges regarding coalition infrastructures, leadership development, unexpected change of coalition dynamics, and cultural nuances. PMID:19098260

Profile of men's health in Malaysia: problems and challenges

PubMed Central

Tong, Seng Fah; Low, Wah Yun; Ng, Chirk Jenn

2011-01-01

Men's health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men compared to their female counterparts is well documented. A review of the epidemiological data from Malaysia noted a similar trend in which men die at higher rates in under 1 and above 15 years old groups and most disease categories compared to women. In Malaysia, the main causes of death in men are non-communicable diseases and injuries. Risk factors, such as risk-taking behaviour, smoking and hypertension, are prevalent and amenable to early interventions. Erectile dysfunction, premature ejaculation and prostate disorders are also prevalent. However, many of these morbidities go unreported and are not diagnosed early; therefore, opportunities for early intervention are missed. This reflects poor health knowledge and inadequate health-care utilisation among Malaysian men. Their health-seeking behaviour has been shown to be strongly influenced by family members and friends. However, more research is needed to identify men's unmet health-care needs and to develop optimal strategies for addressing them. Because the Malaysian population is aging and there is an increase in sedentary lifestyles, optimizing men's health will remain a challenge unless effective measures are implemented. The existing male-unfriendly health-care system and the negative influence of masculinity on men's health behaviour must be addressed. A national men's health policy based on a male-friendly approach to health-care delivery is urgently needed to provide a framework for addressing these challenges. PMID:21358664

Addressing maternal and child health in post-conflict Afghanistan: the way forward.

PubMed

Singh, P K; Rai, R K; Alagarajan, M

2013-09-01

Afghanistan's maternal and child mortality rates are among the highest in the world. The country faces challenges to meet the Millennium Development Goals set for 2015 which can be attributed to multiple causes related to accessibility, affordability and availability of health-care services. This report addresses the challenges in strengthening maternal and child health care in Afghanistan, as well discussing the areas to be prioritized. In order to ensure sound maternal and child health care in Afghanistan, policy-makers must prioritize monitoring and surveillance systems, integrating maternal and child health care with rights-based family planning methods, building human resources, offering incentives (such as the provision of a conditional cash transfer to women) and promoting action-oriented, community-based interventions. On a wider scale, the focus must be to improve the health infrastructure, organizing international collaboration and expanding sources of funding.

Practical Challenges of Systems Thinking and Modeling in Public Health

PubMed Central

Trochim, William M.; Cabrera, Derek A.; Milstein, Bobby; Gallagher, Richard S.; Leischow, Scott J.

2006-01-01

Objectives. Awareness of and support for systems thinking and modeling in the public health field are growing, yet there are many practical challenges to implementation. We sought to identify and describe these challenges from the perspectives of practicing public health professionals. Methods. A systems-based methodology, concept mapping, was used in a study of 133 participants from 2 systems-based public health initiatives (the Initiative for the Study and Implementation of Systems and the Syndemics Prevention Network). This method identified 100 key challenges to implementation of systems thinking and modeling in public health work. Results. The project resulted in a map identifying 8 categories of challenges and the dynamic interactions among them. Conclusions. Implementation by public health professionals of the 8 simple rules we derived from the clusters in the map identified here will help to address challenges and improve the organization of systems that protect the public’s health. PMID:16449581

Multiple-level stakeholder engagement in malaria clinical trials: addressing the challenges of conducting clinical research in resource-limited settings.

PubMed

Mtove, George; Kimani, Joshua; Kisinza, William; Makenga, Geofrey; Mangesho, Peter; Duparc, Stephan; Nakalembe, Miriam; Phiri, Kamija S; Orrico, Russell; Rojo, Ricardo; Vandenbroucke, Pol

2018-03-22

Multinational clinical trials are logistically complex and require close coordination between various stakeholders. They must comply with global clinical standards and are accountable to multiple regulatory and ethical bodies. In resource-limited settings, it is challenging to understand how to apply global clinical standards to international, national, and local factors in clinical trials, making multiple-level stakeholder engagement an important element in the successful conduct of these clinical trials. During the planning and implementation of a large multinational clinical trial for intermittent preventive treatment of malaria in pregnancy in resource-limited areas of sub-Saharan Africa, we encountered numerous challenges, which required implementation of a range of engagement measures to ensure compliance with global clinical and regulatory standards. These challenges included coordination with ongoing global malaria efforts, heterogeneity in national regulatory structures, sub-optimal healthcare infrastructure, local practices and beliefs, and perspectives that view healthcare providers with undue trust or suspicion. In addition to engagement with international bodies, such as the World Health Organization, the Malaria in Pregnancy Consortium, the Steve Biko Centre for Bioethics, and the London School of Hygiene and Tropical Medicine, in order to address the challenges just described, Pfizer Inc. and Medicines for Malaria Venture (the "Sponsoring Entities" for these studies) and investigators liaised with national- and district-level stakeholders such as health ministers and regional/local community health workers. Community engagement measures undertaken by investigators included local meetings with community leaders to explain the research aims and answer questions and concerns voiced by the community. The investigators also engaged with family members of prospective trial participants in order to be sensitive to local practices and beliefs. Engagement

Addressing refugee health through evidence-based policies: a case study.

PubMed

Thiel de Bocanegra, Heike; Carter-Pokras, Olivia; Ingleby, J David; Pottie, Kevin; Tchangalova, Nedelina; Allen, Sophia I; Smith-Gagen, Julie; Hidalgo, Bertha

2018-06-01

The cumulative total of persons forced to leave their country for fear of persecution or organized violence reached an unprecedented 24.5 million by the end of 2015. Providing equitable access to appropriate health services for these highly diverse newcomers poses challenges for receiving countries. In this case study, we illustrate the importance of translating epidemiology into policy to address the health needs of refugees by highlighting examples of what works as well as identifying important policy-relevant gaps in knowledge. First, we formed an international working group of epidemiologists and health services researchers to identify available literature on the intersection of epidemiology, policy, and refugee health. Second, we created a synopsis of findings to inform a recommendation for integration of policy and epidemiology to support refugee health in the United States and other high-income receiving countries. Third, we identified eight key areas to guide the involvement of epidemiologists in addressing refugee health concerns. The complexity and uniqueness of refugee health issues, and the need to develop sustainable management information systems, require epidemiologists to expand their repertoire of skills to identify health patterns among arriving refugees, monitor access to appropriately designed health services, address inequities, and communicate with policy makers and multidisciplinary teams. Copyright © 2017 Elsevier Inc. All rights reserved.

Addressing the “Global Health Tax” and “Wild Cards”: Practical Challenges to Building Academic Careers in Global Health

PubMed Central

Dhillon, Ranu

2016-01-01

Among many possible benefits, global health efforts can expand the skills and experience of U.S. clinicians, improve health for communities in need, and generate innovations in care delivery with relevance everywhere. Yet, despite high rates of interest among students and medical trainees to include global health opportunities in their training, there is still no clear understanding of how this interest will translate into viable and sustained global health careers after graduation. Building on a growing conversation about how to support careers in academic global health, this Perspective describes the practical challenges faced by physicians pursuing these careers after they complete training. Writing from their perspective as junior faculty at one U.S. academic health center with a dedicated focus on global health training, the authors describe a number of practical issues they have found to be critical both for their own career development and for the advice they provide their mentees. With a particular emphasis on the financial, personal, professional, and logistical challenges that young “expat” global health physicians in academic institutions face, they underscore the importance of finding ways to support these career paths, and propose possible solutions. Such investments would not only respond to the rational and moral imperatives of global health work and advance the mission of improving human health but also help to fully leverage the potential of what is already an unprecedented movement within academic medicine. PMID:26244256

Addressing the social determinants of health at the local level: Opportunities and challenges.

PubMed

Fosse, E; Helgesen, M K; Hagen, S; Torp, S

2018-02-01

The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

Barriers to Addressing Adolescent Substance Use: Perceptions of New York School-Based Health Center Providers.

PubMed

Harris, Brett; Shaw, Benjamin; Lawson, Hal; Sherman, Barry

2016-02-01

Adolescent substance use is associated with chronic health conditions, accidents, injury, and school-related problems, including dropping out. Schools have the potential to provide students with substance use prevention and intervention services, albeit with confidentiality challenges. School-based health centers (SBHCs) provide confidentiality, positioning them as ideal settings to provide substance use prevention and intervention. This study identified program directors' and clinicians' barriers to addressing adolescent substance use in SBHCs. Between May and June 2013, an electronic survey was distributed to all 162 New York State SBHC program directors and clinicians serving middle and high school students. The most prevalent perceived barriers to discussing substance use with students were time constraints (43%), the belief that students are not honest about their use (43%), and clinicians' lack of training (28%). Both directors and clinicians identified challenges in getting students to return for additional sessions to address their use, and they also indicated that confidentiality was a treatment referral barrier. This study identified timely opportunities that may be leveraged and unique challenges that may be overcome with targeted dissemination, training, and technical assistance efforts to enable directors and clinicians to routinely address substance use in SBHCs. © 2016, American School Health Association.

National Institutes of Health addresses the science of diversity

PubMed Central

Valantine, Hannah A.; Collins, Francis S.

2015-01-01

The US biomedical research workforce does not currently mirror the nation’s population demographically, despite numerous attempts to increase diversity. This imbalance is limiting the promise of our biomedical enterprise for building knowledge and improving the nation’s health. Beyond ensuring fairness in scientific workforce representation, recruiting and retaining a diverse set of minds and approaches is vital to harnessing the complete intellectual capital of the nation. The complexity inherent in diversifying the research workforce underscores the need for a rigorous scientific approach, consistent with the ways we address the challenges of science discovery and translation to human health. Herein, we identify four cross-cutting diversity challenges ripe for scientific exploration and opportunity: research evidence for diversity’s impact on the quality and outputs of science; evidence-based approaches to recruitment and training; individual and institutional barriers to workforce diversity; and a national strategy for eliminating barriers to career transition, with scientifically based approaches for scaling and dissemination. Evidence-based data for each of these challenges should provide an integrated, stepwise approach to programs that enhance diversity rapidly within the biomedical research workforce. PMID:26392553

Across the Atlantic cooperation to address international challenges in eHealth and health IT: managing toward a common goal.

PubMed

Friedman, Charles P; Iakovidis, Ilias; Debenedetti, Laurent; Lorenzi, Nancy M

2009-11-01

Countries on both sides of the Atlantic Ocean have invested in health information and communication technologies. Since eHealth challenges cross borders a European Union-United States of America conference on public policies relating to health IT and eHealth was held October 20-21, 2008 in Paris, France. The conference was organized around the four themes: (1) privacy and security, (2) health IT interoperability, (3) deployment and adoption of health IT, and (4) Public Private Collaborative Governance. The four key themes framed the discussion over the two days of plenary sessions and workshops. Key findings of the conference were organized along the four themes. (1) Privacy and security: Patients' access to their own data and key elements of a patient identification management framework were discussed. (2) Health IT interoperability: Three significant and common interoperability challenges emerged: (a) the need to establish common or compatible standards and clear guidelines for their implementation, (b) the desirability for shared certification criteria and (c) the need for greater awareness of the importance of interoperability. (3) Deployment and adoption of health IT: Three major areas of need emerged: (a) a shared knowledge base and assessment framework, (b) public-private collaboration and (c) and effective organizational change strategies. (4) Public Private Collaborative Governance: Sharing and communication are central to success in this area. Nations can learn from one another about ways to develop harmonious, effective partnerships. Three areas that were identified as highest priority for collaboration included: (1) health data security, (2) developing effective strategies to ensure healthcare professionals' acceptance of health IT tools, and (3) interoperability.

Megacities and Large Urban Complexes - WMO Role in Addressing Challenges and Opportunities

NASA Astrophysics Data System (ADS)

Terblanche, Deon; Jalkanen, Liisa

2013-04-01

Megacities and Large Urban Complexes - WMO Role in Addressing Challenges and Opportunities Deon E. Terblanche and Liisa Jalkanen dterblanche@wmo.int ljalkanen@wmo.int World Meteorological Organization, Geneva, Switzerland The 21st Century could amongst others, become known as the century in which our species has evolved from Homo sapiens to Homo urbanus. By now the urban population has surpassed the rural population and the rate of urbanization will continue at such a pace that by 2050 urban dwellers could outnumber their rural counterpart by more than two to one. Most of this growth in urban population will occur in developing countries and along coastal areas. Urbanization is to a large extent the outcome of humans seeking a better life through improved opportunities presented by high-density communities. Megacities and large urban complexes provide more job opportunities and social structures, better transport and communication links and a relative abundance of physical goods and services when compared to most rural areas. Unfortunately these urban complexes also present numerous social and environmental challenges. Urban areas differ from their surroundings by morphology, population density, and with high concentration of industrial activities, energy consumption and transport. They also pose unique challenges to atmospheric modelling and monitoring and create a multi-disciplinary spectrum of potential threats, including air pollution, which need to be addressed in an integrated way. These areas are also vulnerable to the changing climate and its implications to sea-level and extreme events, air quality and related health impacts. Many urban activities are significantly impacted by weather events that would not be considered to be of high impact in less densely populated areas. For instance, moderate precipitation events can cause flooding and landslides as modified urban catchments generally have higher run-off to rainfall ratios than their more pristine rural

New directions for public health care purchasers? Responses to looming challenges.

PubMed

McKethan, Aaron; Gitterman, Daniel; Feezor, Allen; Enthoven, Alain

2006-01-01

State public employee health plans (PEHPs) provide health benefits for millions of state and local workers, retirees, and their dependents nationwide. This paper explores major issues and challenges that PEHP leaders and state policymakers are addressing. These include the perennial challenge of funding benefits for a diverse and aging workforce; new accounting standards affecting public employers; and the changing relationship between states, retired public employees, and the Medicare program. Interviews with PEHP executives explored whether these are incremental challenges to which states can effectively adapt, or whether these challenges will catalyze broader and lasting change in the public employee and retiree health benefits arena.

The Untold Story: Examining Ontario's Community Health Centres' Initiatives to Address Upstream Determinants of Health

PubMed Central

Collins, Patricia A.; Resendes, Sarah J.; Dunn, James R.

2014-01-01

Background: Unlike traditional primary care centres, part of the Community Health Centre (CHC) mandate is to address upstream health determinants. In Ontario, CHCs refer to these activities as Community Initiatives (CIs); yet, little is known about how CIs operate. The objective of this study was to examine the scope, resource requirements, partnerships, successes and challenges among selected Ontario CIs. Methods: We conducted qualitative interviews with 10 CHC staff members representing 11 CIs across Ontario. CIs were identified through an online inventory, recruited by e-mail and interviewed between March and June 2011. Results: Most CIs aim to increase community participation, while addressing social isolation and poverty. They draw minimal financial resources from their CHC, and employ highly skilled staff to support implementation. Most enlist support from various partners, and use numerous methods for community engagement. Successes include improved community relations, increased opportunities for education and employment and rewarding partnerships, while insufficient funding was a commonly identified challenge. Conclusions: Despite minimal attention from researchers and funders, our findings suggest that CIs play key capacity-building roles in vulnerable communities across Ontario, and warrant further investigation. PMID:25410693

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.

Narratives and images used by public communication campaigns addressing social determinants of health and health disparities.

PubMed

Clarke, Christopher E; Niederdeppe, Jeff; Lundell, Helen C

2012-12-01

Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These efforts will need to overcome low public awareness and concern about SDH; few organized campaigns; and limited descriptions of existing message content. To begin addressing these challenges, we analyzed characteristics of 58 narratives and 135 visual images disseminated by two national SDH awareness initiatives: The Robert Wood Johnson Foundation's Commission to Build a Healthier America and the PBS-produced documentary film Unnatural Causes. Certain types of SDH, including income/wealth and one's home and workplace environment, were emphasized more heavily than others. Solutions for addressing SDH often involved combinations of self-driven motivation (such as changes in personal health behaviors) along with externally-driven factors such as government policy related to urban revitilization. Images, especially graphs and charts, drew connections among SDH, health outcomes, and other variables, such as the relationship between mother's education and infant mortality as well as the link between heart disease and education levels within communities. We discuss implications of these findings for raising awareness of SDH and health disparities in the US through narrative and visual means.

Community health clinical education in Canada: part 2--developing competencies to address social justice, equity, and the social determinants of health.

PubMed

Cohen, Benita E; Gregory, David

2009-01-01

Recently, several Canadian professional nursing associations have highlighted the expectations that community health nurses (CHNs) should address the social determinants of health and promote social justice and equity. These developments have important implications for (pre-licensure) CHN clinical education. This article reports the findings of a qualitative descriptive study that explored how baccalaureate nursing programs in Canada address the development of competencies related to social justice, equity, and the social determinants of health in their community health clinical courses. Focus group interviews were held with community health clinical course leaders in selected Canadian baccalaureate nursing programs. The findings foster understanding of key enablers and challenges when providing students with clinical opportunities to develop the CHN role related to social injustice, inequity, and the social determinants of health. The findings may also have implications for nursing programs internationally that are addressing these concepts in their community health clinical courses.

MO-FG-BRB-03: Addressing the Cancer Challenge: International Cancer Experts Corps

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

Coleman, N.

The global burden of cancer is growing rapidly with an estimated 15 million new cases per year worldwide in 2015, growing to 19 million by 2025 and 24 million by 2035. The largest component of this growth will occur in low-to-middle income countries (LMICs). About half of these cases will require radiation treatment. The gap for available cancer treatment, including radiation therapy, between high-income countries (HICs) and LMICs is enormous. Accurate data and quantitative models to project the needs and the benefits of cancer treatment are a critical first step in closing the large cancer divide between LMICs and HICs.more » In this context, the Union for International Cancer Control (UICC) has developed a Global Task Force on Radiotherapy for Cancer Control (GTFRCC) with a charge to answer the question as to what it will take to close the gap between what exists today and reasonable access to radiation therapy globally by 2035 and what the potential clinical and economic benefits are for doing this. The Task Force has determined the projections of cancer incidence and the infrastructure required to provide access to radiation therapy globally. Furthermore it has shown that appropriate investment not only yields improved clinical outcomes for millions of patients but that it also provides an overall economic gain throughout all the income settings where this investment is made. This symposium will summarize the facets associated with this global cancer challenge by reviewing the cancer burden, looking at the requirements for radiation therapy, reviewing the benefits of providing such therapy both from a clinical and economic perspective and finally by looking at what approaches can be used to aid in the alleviation of this global cancer challenge. The speakers are world renowned experts in global public health issues (R. Atun), medical physics (D. Jaffray) and radiation oncology (N. Coleman). Learning Objectives: To describe the global cancer challenge and the

Barriers and challenges affecting the contemporary church's engagement in health promotion.

PubMed

Ayton, Darshini; Manderson, Lenore; Smith, Ben J

2017-03-01

Issue addressed Christian churches have historically undertaken welfare and community service activities to practise faith and increase their relevance to communities. However, the church in Australia has received little attention from health promotion practitioners and researchers. The objective of this qualitative study was to explore the barriers and challenges that affect church engagement in health promotion to assist practitioners' understanding of the potential for these civil society organisations to play a role in health promotion programs and partnerships. Methods The research was based on interviews with five directors of church-affiliated organisations and with the church leaders (ministers, pastors, priests) of 30 churches in urban and rural Victoria. Analysis was iterative using open, axial and thematic coding. Results The challenges to church involvement in health promotion, as articulated by church leaders, fell under the themes of the social context of churches and the attributes of congregations. Major issues raised were perceived relevance, mistrust, contested agendas, discordant values within congregations, and risk management. Conclusion Although churches may take a different stance to health promotion agencies on a range of social and health issues, many have experience addressing social disadvantage and are prepared to commit resources to meet the needs of people outside their congregations. However, several factors inhibit the engagement of churches in health promotion including perceived irrelevance and community mistrust, agendas of conversion and values that conflict with health promotion. So what? Churches have a history of addressing social determinants of health such as housing, employment and food security. Deeper understanding of the challenges and barriers church leaders experience in undertaking health promotion work will facilitate more realistic and effective engagement by practitioners with these organisations.

Addressing tomorrow's DMO technical challenges today

NASA Astrophysics Data System (ADS)

Milligan, James R.

2009-05-01

Distributed Mission Operations (DMO) is essentially a type of networked training that pulls in participants from all the armed services and, increasingly, allies to permit them to "game" and rehearse highly complex campaigns, using a mix of local, distant, and virtual players. The United States Air Force Research Laboratory (AFRL) is pursuing Science and Technology (S&T) solutions to address technical challenges associated with distributed communications and information management as DMO continues to progressively scale up the number, diversity, and geographic dispersal of participants in training and rehearsal exercises.

Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination.

PubMed

Wu, Yelena P; Steele, Ric G; Connelly, Mark A; Palermo, Tonya M; Ritterband, Lee M

2014-07-01

To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Quantitative Outcomes of a One Health approach to Study Global Health Challenges.

PubMed

Falzon, Laura C; Lechner, Isabel; Chantziaras, Ilias; Collineau, Lucie; Courcoul, Aurélie; Filippitzi, Maria-Eleni; Laukkanen-Ninios, Riikka; Peroz, Carole; Pinto Ferreira, Jorge; Postma, Merel; Prestmo, Pia G; Phythian, Clare J; Sarno, Eleonora; Vanantwerpen, Gerty; Vergne, Timothée; Grindlay, Douglas J C; Brennan, Marnie L

2018-03-01

Having gained momentum in the last decade, the One Health initiative promotes a holistic approach to address complex global health issues. Before recommending its adoption to stakeholders, however, it is paramount to first compile quantitative evidence of the benefit of such an approach. The aim of this scoping review was to identify and summarize primary research that describes monetary and non-monetary outcomes following adoption of a One Health approach. An extensive literature search yielded a total of 42,167 references, of which 85 were included in the final analysis. The top two biotic health issues addressed in these studies were rabies and malaria; the top abiotic health issue was air pollution. Most studies described collaborations between human and animal (n = 42), or human and environmental disciplines (n = 41); commonly reported interventions included vector control and animal vaccination. Monetary outcomes were commonly expressed as cost-benefit or cost-utility ratios; non-monetary outcomes were described using disease frequency or disease burden measurements. The majority of the studies reported positive or partially positive outcomes. This paper illustrates the variety of health challenges that can be addressed using a One Health approach, and provides tangible quantitative measures that can be used to evaluate future implementations of the One Health approach.

Road-traffic injuries: confronting disparities to address a global-health problem.

PubMed

Ameratunga, Shanthi; Hijar, Martha; Norton, Robyn

2006-05-06

Evidence suggests that the present and projected global burden of road-traffic injuries is disproportionately borne by countries that can least afford to meet the health service, economic, and societal challenges posed. Although the evidence base on which these estimates are made remains somewhat precarious in view of the limited data systems in most low-income and middle-income countries (as per the classification on the World Bank website), these projections highlight the essential need to address road-traffic injuries as a public-health priority. Most well-evaluated effective interventions do not directly focus on efforts to protect vulnerable road users, such as motorcyclists and pedestrians. Yet, these groups comprise the majority of road-traffic victims in low-income and middle-income countries, and consequently, the majority of the road-traffic victims globally. Appropriately responding to these disparities in available evidence and prevention efforts is necessary if we are to comprehensively address this global-health dilemma.

NREL, SolarCity Addressing Challenges of High Penetrations of Distributed

Science.gov Websites

Companies NREL, SolarCity Addressing Challenges of High Penetrations of Distributed Photovoltaics NREL is , reliability, and stability challenges of interconnecting high penetrations of distributed photovoltaics (PV country that distributed solar is not a liability for reliability-and can even be an asset. Project Impact

Progress and challenges of disaster health management in China: a scoping review

PubMed Central

Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard

2014-01-01

Background Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. Objective This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. Design A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. Results The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. Conclusions One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level). PMID:25215910

Progress and challenges of disaster health management in China: a scoping review.

PubMed

Zhong, Shuang; Clark, Michele; Hou, Xiang-Yu; Zang, Yuli; FitzGerald, Gerard

2014-01-01

Despite the importance of an effective health system response to various disasters, relevant research is still in its infancy, especially in middle- and low-income countries. This paper provides an overview of the status of disaster health management in China, with its aim to promote the effectiveness of the health response for reducing disaster-related mortality and morbidity. A scoping review method was used to address the recent progress of and challenges to disaster health management in China. Major health electronic databases were searched to identify English and Chinese literature that were relevant to the research aims. The review found that since 2003 considerable progress has been achieved in the health disaster response system in China. However, there remain challenges that hinder effective health disaster responses, including low standards of disaster-resistant infrastructure safety, the lack of specific disaster plans, poor emergency coordination between hospitals, lack of portable diagnostic equipment and underdeveloped triage skills, surge capacity, and psychological interventions. Additional challenges include the fragmentation of the emergency health service system, a lack of specific legislation for emergencies, disparities in the distribution of funding, and inadequate cost-effective considerations for disaster rescue. One solution identified to address these challenges appears to be through corresponding policy strategies at multiple levels (e.g. community, hospital, and healthcare system level).

Adequately Addressing Pediatric Obesity: Challenges Faced by Primary Care Providers.

PubMed

Shreve, Marilou; Scott, Allison; Vowell Johnson, Kelly

2017-07-01

To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity. All providers reported lack of time as a barrier to providing the care needed for obese children. Cultural barriers of both the provider and client were identified as factors, which negatively affect the care and treatment of obese children. Primary care providers continue to experience challenges when addressing pediatric obesity. In this study, a lack of adequate time to address obesity was identified as the most significant current barrier and may likely be tied to physician resources. Although reimbursement for obesity is increasing, the level of reimbursement does not support the time or the resources needed to treat patients. Many providers reported their patients' cultural view of obesity influenced how they counsel their patients. Increasing providers' knowledge concerning differences in how weight is viewed or valued may assist them in the assessment and care of obese pediatric patients. The challenges identified in previous research continue to limit providers when addressing obesity. Although progress has been made regarding knowledge of guidelines, continuing effort is needed to tackle the remaining challenges. This will allow for earlier identification and intervention, resulting in improved outcomes in pediatric obesity.

Linking Obesity Prevention and Mental Health Promotion to Address Health Disparities.

PubMed

Claydon, Elizabeth; Austin, Anna; Smith, Megan V

2016-05-01

Considerable racial health disparities exist, especially in mental health and obesity. However, few approaches exist to address obesity and mental health simultaneously in minority groups. An intervention to address mental health in a low-income, minority group of urban mothers was designed using results from a needs assessment. Participating women were asked to rank their top health concerns and personal goals. Along with mental health concerns and basic needs, the majority of mothers desired assistance with improving their physical well-being. These results are surprising, but lend credence to creating interventions that aim to address both mental health and obesity concerns simultaneously.

Teaching lesbian, gay, bisexual and transgender health in a South African health sciences faculty: addressing the gap.

PubMed

Müller, Alexandra

2013-12-27

People who identity as lesbian, gay, bisexual and transgender (LGBT) have specific health needs. Sexual orientation and gender identity are social determinants of health, as homophobia and heteronormativity persist as prejudices in society. LGBT patients often experience discrimination and prejudice in health care settings. While recent South African policies recognise the need for providing LGBT specific health care, no curricula for teaching about LGBT health related issues exist in South African health sciences faculties. This study aimed to determine the extent to which LGBT health related content is taught in the University of Cape Town's medical curriculum. A curriculum mapping exercise was conducted through an online survey of all academic staff at the UCT health sciences faculty, determining LGBT health related content, pedagogical methodology and assessment. 127 academics, across 31 divisions and research units in the Faculty of Health Sciences, responded to the survey, of which 93 completed the questionnaire. Ten taught some content related to LGBT health in the MBChB curriculum. No LGBT health related content was taught in the allied health sciences curricula. The MBChB curriculum provided no opportunity for students to challenge their own attitudes towards LGBT patients, and key LGBT health topics such as safer sex, mental health, substance abuse and adolescent health were not addressed. At present, UCTs health sciences curricula do not adequately address LGBT specific health issues. Where LGBT health related content is taught in the MBChB curriculum, it is largely discretionary, unsystematic and not incorporated into the overarching structure. Coordinated initiatives to integrate LGBT health related content into all health sciences curricula should be supported, and follow an approach that challenges students to develop professional attitudes and behaviour concerning care for patients from LGBT backgrounds, as well as providing them with specific LGBT

Teaching lesbian, gay, bisexual and transgender health in a South African health sciences faculty: addressing the gap

PubMed Central

2013-01-01

Background People who identity as lesbian, gay, bisexual and transgender (LGBT) have specific health needs. Sexual orientation and gender identity are social determinants of health, as homophobia and heteronormativity persist as prejudices in society. LGBT patients often experience discrimination and prejudice in health care settings. While recent South African policies recognise the need for providing LGBT specific health care, no curricula for teaching about LGBT health related issues exist in South African health sciences faculties. This study aimed to determine the extent to which LGBT health related content is taught in the University of Cape Town’s medical curriculum. Methods A curriculum mapping exercise was conducted through an online survey of all academic staff at the UCT health sciences faculty, determining LGBT health related content, pedagogical methodology and assessment. Results 127 academics, across 31 divisions and research units in the Faculty of Health Sciences, responded to the survey, of which 93 completed the questionnaire. Ten taught some content related to LGBT health in the MBChB curriculum. No LGBT health related content was taught in the allied health sciences curricula. The MBChB curriculum provided no opportunity for students to challenge their own attitudes towards LGBT patients, and key LGBT health topics such as safer sex, mental health, substance abuse and adolescent health were not addressed. Conclusion At present, UCTs health sciences curricula do not adequately address LGBT specific health issues. Where LGBT health related content is taught in the MBChB curriculum, it is largely discretionary, unsystematic and not incorporated into the overarching structure. Coordinated initiatives to integrate LGBT health related content into all health sciences curricula should be supported, and follow an approach that challenges students to develop professional attitudes and behaviour concerning care for patients from LGBT backgrounds, as

Narratives and Images Used by Public Communication Campaigns Addressing Social Determinants of Health and Health Disparities

PubMed Central

Clarke, Christopher E.; Niederdeppe, Jeff; Lundell, Helen C.

2012-01-01

Researchers have increasingly focused on how social determinants of health (SDH) influence health outcomes and disparities. They have also explored strategies for raising public awareness and mobilizing support for policies to address SDH, with particular attention to narrative and image-based information. These efforts will need to overcome low public awareness and concern about SDH; few organized campaigns; and limited descriptions of existing message content. To begin addressing these challenges, we analyzed characteristics of 58 narratives and 135 visual images disseminated by two national SDH awareness initiatives: The Robert Wood Johnson Foundation’s Commission to Build a Healthier America and the PBS-produced documentary film Unnatural Causes. Certain types of SDH, including income/wealth and one’s home and workplace environment, were emphasized more heavily than others. Solutions for addressing SDH often involved combinations of self-driven motivation (such as changes in personal health behaviors) along with externally-driven factors such as government policy related to urban revitilization. Images, especially graphs and charts, drew connections among SDH, health outcomes, and other variables, such as the relationship between mother’s education and infant mortality as well as the link between heart disease and education levels within communities. We discuss implications of these findings for raising awareness of SDH and health disparities in the US through narrative and visual means. PMID:23330220

Designing Groups to Meet Evolving Challenges in Health Care Settings

ERIC Educational Resources Information Center

McCarthy, Christopher J.; Hart, Sonia

2011-01-01

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

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

PubMed Central

Kaplan, Sue A.; Ruddock, Charmaine; Golub, Maxine; Davis, Joyce; Foley, Robert; Devia, Carlos; Rosen, Rosa; Berry, Carolyn; Barretto, Brenda; Carter, Toni; Irish-Spencer, Evalina; Marchena, Maria; Purcaro, Ellenrita; Calman, Neil

2011-01-01

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institution-alization and sustainability. PMID:20168022

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

PubMed Central

Beers, Lee; Southammakosane, Cathy; Lewin, Amy

2014-01-01

Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents’ engagement in mental health treatment. PMID:24298010

The Challenges Encountered by Immigrant-Serving Agencies in Addressing the Health of Temporary Foreign Workers.

PubMed

Salami, Bukola; Kirova, Anna; Hegadoren, Kathleen; Meherali, Salima; Chiu, Yvonne; Nsaliwa, Christina

2016-01-01

This study sought to examine the challenges encountered by immigrant-serving agencies in meeting the health needs of temporary foreign workers and their families in one Canadian province. The authors interviewed 11 representatives of immigrant-serving agencies and two policy makers. Some of the challenges that agencies face in delivering programs and services for temporary foreign workers and their families include the time required to build trust with this population, temporary foreign workers' reluctance to use services due to fear that it will affect their immigration status, and the emotional labor associated with working with temporary foreign workers.

Do textbooks address known learning challenges in area measurement? A comparative analysis

NASA Astrophysics Data System (ADS)

Hong, Dae S.; Choi, Kyong Mi; Runnalls, Cristina; Hwang, Jihyun

2018-02-01

This study compared area lessons from Korean textbooks and US standard-based textbooks to understand differences and similarities among these textbooks, as well as how these textbooks address known learning challenges in area measurement. Several well-known challenges have been identified in previous studies, such as covering, array structure, and linking array structure to area formula. We were interested in knowing if textbooks addressed these issues in their treatments of area measurement and, in doing so, provided students with opportunities to overcome or become familiar with known challenges. The results show that both countries' textbooks demonstrated similar limitations; only few area and area-related lessons are covered and three important learning challenges in area measurement are not covered well, which need to be informed to practicing teachers.

Addressing the Grand Challenge of atmospheric carbon dioxide: geologic sequestration vs. biological recycling

PubMed Central

2011-01-01

On February 15, 2008, the National Academy of Engineering unveiled their list of 14 Grand Challenges for Engineering. Building off of tremendous advancements in the past century, these challenges were selected for their role in assuring a sustainable existence for the rapidly increasing global community. It is no accident that the first five Challenges on the list involve the development of sustainable energy sources and management of environmental resources. While the focus of this review is to address the single Grand Challenge of "develop carbon sequestration methods", is will soon be clear that several other Challenges are intrinsically tied to it through the principles of sustainability. How does the realm of biological engineering play a role in addressing these Grand Challenges? PMID:22047501

EPA Leadership on Science, Innovation, and Decision Support Tools for Addressing Current and Future Challenges.

PubMed

Hecht, Alan D; Ferster, Aaron; Summers, Kevin

2017-10-16

When the U.S. Environmental Protection Agency (EPA) was established nearly 50 years ago, the nation faced serious threats to its air, land, and water, which in turn impacted human health. These threats were effectively addressed by the creation of EPA (in 1970) and many subsequent landmark environmental legislations which in turn significantly reduced threats to the Nation's environment and public health. A key element of historic legislation is research aimed at dealing with current and future problems. Today we face national and global challenges that go beyond classic media-specific (air, land, water) environmental legislation and require an integrated paradigm of action and engagement based on (1) innovation based on science and technology, (2) stakeholder engagement and collaboration, and (3) public education and support. This three-pronged approach recognizes that current environmental problems, include social as well as physical and environmental factors, are best addressed through collaborative problem solving, the application of innovation in science and technology, and multiple stakeholder engagement. To achieve that goal, EPA's Office of Research and Development (ORD) is working directly with states and local communities to develop and apply a suite of accessible decision support tools (DST) that aim to improve environmental conditions, protect human health, enhance economic opportunity, and advance a resilient and sustainability society. This paper showcases joint EPA and state actions to develop tools and approaches that not only meet current environmental and public health challenges, but do so in a way that advances sustainable, healthy, and resilient communities well into the future. EPA's future plans should build on current work but aim to effectively respond to growing external pressures. Growing pressures from megatrends are a major challenge for the new Administration and for cities and states across the country. The recent hurricanes hitting

Addressing challenges to human health in the Anthropocene epoch-an overview of the findings of the Rockefeller/Lancet Commission on Planetary Health.

PubMed

Haines, Andy

The report of the Rockefeller Foundation/Lancet Commission on Planetary Health described how human health directly depends upon the environment. It takes a broad perspective not only acknowledging climate change as the most important global environmental threat to health but also recognizing other impacts, including dramatic loss of tropical forests, land degradation, loss of biodiversity, declining freshwater resources, ocean acidification, and over-exploitation of fisheries. All pose challenges to human health gains, leading to the concept of planetary health-that the human condition is tied to natural systems. The Planetary Health Commission report highlights several major concerns arising from environmental change including impacts on food availability and quality, increases in natural disasters and population displacement, and newly emerging diseases, e.g. from zoonotic infections. Three challenges emerge from the report: the first is imagination, or conceptual challenges-better metrics are needed to assess human progress within the context of environmental change; the second is a lack of relevant knowledge, requiring more research on the inter-linkages between environmental change and health and on the effectiveness of potential solutions; and the third is implementation of solutions, ensuring that the science is translated into policy and practice. There are many opportunities to promote planetary health including developing sustainable and healthy cities, encouraging more resilient health systems and disaster preparedness, reducing food waste, preserving ecosystems, and redirecting harmful subsidies in food, agriculture, fishery and energy sectors. Many current trends are driven by inequitable, inefficient, and unsustainable patterns of resource consumption and technological development, coupled with population growth, but solutions lie within reach. Prosperity must be redefined as an enhancement of the quality of life and the delivery of improved health

Aviation Security: Efforts to Measure Effectiveness and Address Challenges

DTIC Science & Technology

2003-11-05

AND SUBTITLE AVIATION SECURITY Efforts to Meassure Effectiveness and Address Challenges 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT...screeners in becoming more adept at detecting hard -to-spot threat objects. However, TIP was shut down immediately following the September 11

Strategies for Addressing the Challenges of Patient-Centered Medical Home Implementation: Lessons from Oregon.

PubMed

Gelmon, Sherril; Bouranis, Nicole; Sandberg, Billie; Petchel, Shauna

2018-01-01

Patient-centered medical homes (PCMHs) are at the forefront of the transformation of primary care as part of health systems reform. Despite robust literature describing implementation challenges, few studies describe strategies being used to overcome these challenges. This article addresses this gap through observations of exemplary PCMHs in Oregon, where the Oregon Health Authority supports and recognizes Patient-Centered Primary Care Homes (PCPCH). Twenty exemplary PCPCHs were selected using program scores, with considerations for diversity in clinic characteristics. Between 2015 and 2016, semistructured interviews and focus groups were completed with 85 key informants. Clinics reported similar challenges implementing the PCPCH model, including shifting patterns of care use, fidelity to the PCPCH model, and refining care processes. The following ten implementation strategies emerged: expanding access through care teams, preventing unnecessary emergency department visits through patient outreach, improved communication and referral tracking with outside providers, prioritization of selected program metrics, implementing patient-centered practices, developing continuous improvement capacity through committees and "champions," incorporating preventive services and chronic disease management, standardization of workflows, customizing electronic health records, and integration of mental health. Clinic leaders benefited from understanding the local context in which they were operating. Despite differences in size, ownership, geography, and population, all clinic leaders were observed to be proponents of strategies commonly associated with a "learning organization": systems thinking, personal mastery, mental models, shared vision, and team. Clinics can draw on their own characteristics, use state resources, and look to established PCMHs to build the evidence base for implementation in primary care. © Copyright 2018 by the American Board of Family Medicine.

Women Connect! Strengthening communications to meet sexual and reproductive health challenges.

PubMed

Pillsbury, Barbara; Mayer, Doe

2005-06-01

Women's nongovernmental organizations (NGOs) have significant comparative advantage for addressing sexual and reproductive health challenges facing women and families. This article describes an initiative to assist women's NGOs in developing greater skills using media and information communication technology for communicating women's health messages. Participating women's groups in Africa undertook innovative media projects--radio broadcasts on human immunodeficiency virus (HIV) and family planning, an antiviolence campaign, media campaigns on avoiding teen pregnancy--and designed websites, established Internet cafés, and downloaded health information from the Internet. Lessons learned offer guidance for collaboration with women's NGOs everywhere to strengthen communication for addressing critical sexual and reproductive health issues.

Practice Facilitator Strategies for Addressing Electronic Health Record Data Challenges for Quality Improvement: EvidenceNOW.

PubMed

Hemler, Jennifer R; Hall, Jennifer D; Cholan, Raja A; Crabtree, Benjamin F; Damschroder, Laura J; Solberg, Leif I; Ono, Sarah S; Cohen, Deborah J

2018-01-01

Practice facilitators ("facilitators") can play an important role in supporting primary care practices in performing quality improvement (QI), but they need complete and accurate clinical performance data from practices' electronic health records (EHR) to help them set improvement priorities, guide clinical change, and monitor progress. Here, we describe the strategies facilitators use to help practices perform QI when complete or accurate performance data are not available. Seven regional cooperatives enrolled approximately 1500 small-to-medium-sized primary care practices and 136 facilitators in EvidenceNOW, the Agency for Healthcare Research and Quality's initiative to improve cardiovascular preventive services. The national evaluation team analyzed qualitative data from online diaries, site visit field notes, and interviews to discover how facilitators worked with practices on EHR data challenges to obtain and use data for QI. We found facilitators faced practice-level EHR data challenges, such as a lack of clinical performance data, partial or incomplete clinical performance data, and inaccurate clinical performance data. We found that facilitators responded to these challenges, respectively, by using other data sources or tools to fill in for missing data, approximating performance reports and generating patient lists, and teaching practices how to document care and confirm performance measures. In addition, facilitators helped practices communicate with EHR vendors or health systems in requesting data they needed. Overall, facilitators tailored strategies to fit the individual practice and helped build data skills and trust. Facilitators can use a range of strategies to help practices perform data-driven QI when performance data are inaccurate, incomplete, or missing. Support is necessary to help practices, particularly those with EHR data challenges, build their capacity for conducting data-driven QI that is required of them for participating in practice

Challenges to Health During Deep Space Exploration Missions

NASA Technical Reports Server (NTRS)

Watkins, S.; Leveton, L.; Norsk, P.; Huff, J.; Shah, R.

2014-01-01

Long duration missions outside of low Earth orbit will present unique challenges to the maintenance of human health. Stressors with physiologic and psychological impacts are inherent in exploration missions, including reduced gravity, increased radiation, isolation, limited habitable volume, circadian disruptions, and cabin atmospheric changes. Operational stressors such as mission timeline and extravehicular activities must also be considered, and these varied stressors may act in additive or synergistic fashions. Should changes to physiology or behavior manifest as a health condition, the rendering of care in an exploration environment must also be considered. Factors such as the clinical background of the crew, inability to evacuate to Earth in a timely manner, communication delay, and limitations in available medical resources will have an impact on the assessment and treatment of these conditions. The presentations associated with this panel will address these unique challenges from the perspective of several elements of the NASA Human Research Program, including Behavioral Health and Performance, Human Health Countermeasures, Space Radiation, and Exploration Medical Capability.

Addressing strategy execution challenges to lead sustainable change.

PubMed

Shirey, Maria R

2011-01-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses strategy execution challenges that must be addressed to lead sustainable change.

Moving beyond regression techniques in cardiovascular risk prediction: applying machine learning to address analytic challenges

PubMed Central

Goldstein, Benjamin A.; Navar, Ann Marie; Carter, Rickey E.

2017-01-01

Abstract Risk prediction plays an important role in clinical cardiology research. Traditionally, most risk models have been based on regression models. While useful and robust, these statistical methods are limited to using a small number of predictors which operate in the same way on everyone, and uniformly throughout their range. The purpose of this review is to illustrate the use of machine-learning methods for development of risk prediction models. Typically presented as black box approaches, most machine-learning methods are aimed at solving particular challenges that arise in data analysis that are not well addressed by typical regression approaches. To illustrate these challenges, as well as how different methods can address them, we consider trying to predicting mortality after diagnosis of acute myocardial infarction. We use data derived from our institution's electronic health record and abstract data on 13 regularly measured laboratory markers. We walk through different challenges that arise in modelling these data and then introduce different machine-learning approaches. Finally, we discuss general issues in the application of machine-learning methods including tuning parameters, loss functions, variable importance, and missing data. Overall, this review serves as an introduction for those working on risk modelling to approach the diffuse field of machine learning. PMID:27436868

Addressing Health Disparities through Multi-institutional, Multidisciplinary Collaboratories

PubMed Central

Fleming, Erik S.; Perkins, James; Easa, David; Conde, José G.; Baker, Richard S.; Southerland, William M.; Dottin, Robert; Benabe, Julio E.; Ofili, Elizabeth O.; Bond, Vincent C.; McClure, Shelia A.; Sayre, Michael H.; Beanan, Maureen J.; Norris, Keith C.

2009-01-01

The national research leadership has recently become aware of the tremendous potential of translational research as an approach to address health disparities. The Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) is a research network that supports multi-institutional, multidisciplinary collaboration with a focus on key diseases and conditions for which disproportionately adverse racial and ethnic health disparities exist. The RTRN is designed to facilitate the movement of scientific advances across the translational research spectrum by providing researchers at different institutions with the infrastructure and tools necessary to collaborate on interdisciplinary and transdisciplinary research projects relating to specific health outcomes for which major racial/ethnic disparities exist. In the past, the difficulty of overcoming the restrictions imposed by time and space have made it difficult to carry out this type of large-scale, multilevel collaboration efficiently. To address this formidable challenge, the RTRN will deploy a translational research cluster system that uses “cyber workspaces” to bring researchers with similar interests together by using online collaboratory technology. These virtual meeting environments will provide a number of tools, including videoconferences (seminars, works in progress, meetings); project management tools (WebCT, Microsoft Share Point); and posting areas for projects, concepts, and other research and educational activities. This technology will help enhance access to resources across institutions with a common mission, minimize many of the logistical hurdles that impede intellectual exchange, streamline the planning and implementation of innovative interdisciplinary research, and assess the use of protocols and practices to assist researchers in interacting across and within cyber workspaces. PMID:18646341

Addressing health disparities through multi-institutional, multidisciplinary collaboratories.

PubMed

Fleming, Erik S; Perkins, James; Easa, David; Conde, José G; Baker, Richard S; Southerland, William M; Dottin, Robert; Benabe, Julio E; Ofili, Elizabeth O; Bond, Vincent C; McClure, Shelia A; Sayre, Michael H; Beanan, Maureen J; Norris, Keith C

2008-01-01

The national research leadership has recently become aware of the tremendous potential of translational research as an approach to address health disparities. The Research Centers in Minority Institutions (RCMI) Translational Research Network (RTRN) is a research network that supports multi-institutional, multidisciplinary collaboration with a focus on key diseases and conditions for which disproportionately adverse racial and ethnic health disparities exist. The RTRN is designed to facilitate the movement of scientific advances across the translational research spectrum by providing researchers at different institutions with the infrastructure and tools necessary to collaborate on interdisciplinary and transdisciplinary research projects relating to specific health outcomes for which major racial/ethnic disparities exist. In the past, the difficulty of overcoming the restrictions imposed by time and space have made it difficult to carry out this type of large-scale, multilevel collaboration efficiently. To address this formidable challenge, the RTRN will deploy a translational research cluster system that uses "cyber workspaces" to bring researchers with similar interests together by using online collaboratory technology. These virtual meeting environments will provide a number of tools, including videoconferences (seminars, works in progress, meetings); project management tools (WebCT, Microsoft Share Point); and posting areas for projects, concepts, and other research and educational activities. This technology will help enhance access to resources across institutions with a common mission, minimize many of the logistical hurdles that impede intellectual exchange, streamline the planning and implementation of innovative interdisciplinary research, and assess the use of protocols and practices to assist researchers in interacting across and within cyber workspaces.

Analysing implementer narratives on addressing health inequity through convergent action on the social determinants of health in India.

PubMed

Nambiar, Devaki; Muralidharan, Arundati; Garg, Samir; Daruwalla, Nayreen; Ganesan, Prathibha

2015-11-17

Understanding health inequity in India is a challenge, given the complexity that characterise the lives of its residents. Interpreting constructive action to address health inequity in the country is rare, though much exhorted by the global research community. We critically analysed operational understandings of inequity embedded in convergent actions to address health-related inequalities by stakeholders in varying contexts within the country. Two implementer groups were purposively chosen to reflect on their experiences addressing inequalities in health (and its determinants) in the public sector working in rural areas and in the private non-profit sector working in urban areas. A representing co-author from each group developed narratives around how they operationally defined, monitored, and addressed health inequality in their work. These narratives were content analysed by two other co-authors to draw out common and disparate themes characterising each action context, operational definitions, shifts and changes in strategies and definitions, and outcomes (both intended and unintended). Findings were reviewed by all authors to develop case studies. We theorised that action to address health inequality converges around a unifying theme or pivot, and developed a heuristic that describes the features of this convergence. In one case, the convergence was a single decision-making platform for deliberation around myriad village development issues, while in the other, convergence brought together communities, legal, police, and health system action around one salient health issue. One case emphasized demand generation, the other was focussed on improving quality and supply of services. In both cases, the operationalization of equity broke beyond a biomedical or clinical focus. Dearth of data meant that implementers exercised various strategies to gather it, and to develop interventions - always around a core issue or population. This exercise demonstrated the

Plain language: a strategic response to the health literacy challenge.

PubMed

Stableford, Sue; Mettger, Wendy

2007-01-01

Low health literacy is a major challenge confronting American and international health organizations. Research in the past decade has documented the prevalence of limited literacy and limited health literacy skills among adults worldwide. This creates a major policy challenge: how to create text-based health information - a common method of health communication - that is accessible to the public. Plain language is a logical, flexible response. While touted by American, Canadian, and European health policy makers, adoption and promotion of plain language standards and skills in health-focused organizations have lagged. Most text-based health information continues to be too hard for most adults to read. Barriers to more rapid diffusion of plain language are reflected in a set of myths perpetuated by critics. These myths are identified and refuted. While plain language is only one of many broad-based solutions needed to address low health literacy, the benefits to everyone demand increased use by health organizations.

Challenges to Mental Health Counselors in a Dynamic Society: Macrostrategies in the Profession.

ERIC Educational Resources Information Center

Herr, Edwin L.

1991-01-01

Addresses major challenges facing mental health counselors in decade ahead and twenty-first century, including effects of advanced technology on occupational structure, changing family structures, cultural diversity and pluralism, and enlarging populations at risk. Advocates challenges be considered within profession's planning of macrostrategies,…

Mobile mental health: a challenging research agenda.

PubMed

Olff, Miranda

2015-01-01

The field of mobile health ("m-Health") is evolving rapidly and there is an explosive growth of psychological tools on the market. Exciting high-tech developments may identify symptoms, help individuals manage their own mental health, encourage help seeking, and provide both preventive and therapeutic interventions. This development has the potential to be an efficient cost-effective approach reducing waiting lists and serving a considerable portion of people globally ("g-Health"). However, few of the mobile applications (apps) have been rigorously evaluated. There is little information on how valid screening and assessment tools are, which of the mobile intervention apps are effective, or how well mobile apps compare to face-to-face treatments. But how feasible is rigorous scientific evaluation with the rising demands from policy makers, business partners, and users for their quick release? In this paper, developments in m-Health tools-targeting screening, assessment, prevention, and treatment-are reviewed with examples from the field of trauma and posttraumatic stress disorder. The academic challenges in developing and evaluating m-Health tools are being addressed. Evidence-based guidance is needed on appropriate research designs that may overcome some of the public and ethical challenges (e.g., equity, availability) and the market-driven wish to have mobile apps in the "App Store" yesterday rather than tomorrow.

Biological approaches for addressing the grand challenge of providing access to clean drinking water.

PubMed

Riley, Mark R; Gerba, Charles P; Elimelech, Menachem

2011-03-31

The U.S. National Academy of Engineering (NAE) recently published a document presenting "Grand Challenges for Engineering". This list was proposed by leading engineers and scientists from around the world at the request of the U.S. National Science Foundation (NSF). Fourteen topics were selected for these grand challenges, and at least seven can be addressed using the tools and methods of biological engineering. Here we describe how biological engineers can address the challenge of providing access to clean drinking water. This issue must be addressed in part by removing or inactivating microbial and chemical contaminants in order to properly deliver water safe for human consumption. Despite many advances in technologies this challenge is expanding due to increased pressure on fresh water supplies and to new opportunities for growth of potentially pathogenic organisms.

Biological approaches for addressing the grand challenge of providing access to clean drinking water

PubMed Central

2011-01-01

The U.S. National Academy of Engineering (NAE) recently published a document presenting "Grand Challenges for Engineering". This list was proposed by leading engineers and scientists from around the world at the request of the U.S. National Science Foundation (NSF). Fourteen topics were selected for these grand challenges, and at least seven can be addressed using the tools and methods of biological engineering. Here we describe how biological engineers can address the challenge of providing access to clean drinking water. This issue must be addressed in part by removing or inactivating microbial and chemical contaminants in order to properly deliver water safe for human consumption. Despite many advances in technologies this challenge is expanding due to increased pressure on fresh water supplies and to new opportunities for growth of potentially pathogenic organisms. PMID:21453515

Addressing the challenges of diagnostics demand and supply: insights from an online global health discussion platform.

PubMed

Engel, Nora; Wachter, Keri; Pai, Madhukar; Gallarda, Jim; Boehme, Catharina; Celentano, Isabelle; Weintraub, Rebecca

2016-01-01

Several barriers challenge development, adoption and scale-up of diagnostics in low and middle income countries. An innovative global health discussion platform allows capturing insights from the global health community on factors driving demand and supply for diagnostics. We conducted a qualitative content analysis of the online discussion 'Advancing Care Delivery: Driving Demand and Supply of Diagnostics' organised by the Global Health Delivery Project (GHD) (http://www.ghdonline.org/) at Harvard University. The discussion, driven by 12 expert panellists, explored what must be done to develop delivery systems, business models, new technologies, interoperability standards, and governance mechanisms to ensure that patients receive the right diagnostic at the right time. The GHD Online (GHDonline) platform reaches over 19 000 members from 185 countries. Participants (N=99) in the diagnostics discussion included academics, non-governmental organisations, manufacturers, policymakers, and physicians. Data was coded and overarching categories analysed using qualitative data analysis software. Participants considered technical characteristics of diagnostics as smaller barriers to effective use of diagnostics compared with operational and health system challenges, such as logistics, poor fit with user needs, cost, workforce, infrastructure, access, weak regulation and political commitment. Suggested solutions included: health system strengthening with patient-centred delivery; strengthened innovation processes; improved knowledge base; harmonised guidelines and evaluation; supply chain innovations; and mechanisms for ensuring quality and capacity. Engaging and connecting different actors involved with diagnostic development and use is paramount for improving diagnostics. While the discussion participants were not representative of all actors involved, the platform enabled a discussion between globally acknowledged experts and physicians working in different countries.

Electronic health systems: challenges faced by hospital-based providers.

PubMed

Agno, Christina Farala; Guo, Kristina L

2013-01-01

The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

The Asian American Hepatitis B Program: Building a Coalition to Address Hepatitis B Health Disparities

PubMed Central

Trinh-Shevrin, Chau; Pollack, Henry J.; Tsang, Thomas; Park, Jihyun; Ramos, Mary Ruchel; Islam, Nadia; Wang, Su; Chun, Kay; Sim, Shao-Chee; Pong, Perry; Rey, Mariano Jose; Kwon, Simona C.

2012-01-01

Background Community coalitions are increasingly recognized as important strategies for addressing health disparities. By providing the opportunity to pool resources, they provide a means to develop and sustain innovative approaches to affect community health. Objectives This article describes the challenges and lessons learned in building the Asian American Hepatitis B Program (AAHBP) coalition to conduct a community-based participatory research (CBPR) initiative to address hepatitis B (HBV) among New York City Asian-American communities. Methods Using the stages of coalition development as a framework, a comprehensive assessment of the process of developing and implementing the AAHBP coalition is presented. Lessons Learned Findings highlight the importance of developing a sound infrastructure and set of processes to foster a greater sense of ownership, shared vision, and investment in the program. Conclusion Grassroots community organizing and campus–community partnerships can be successfully leveraged to address and prevent a significant health disparity in an underserved and diverse community. PMID:22080774

Towards addressing transient learning challenges in undergraduate physics: an example from electrostatics

NASA Astrophysics Data System (ADS)

Fredlund, T.; Linder, C.; Airey, J.

2015-09-01

In this article we characterize transient learning challenges as learning challenges that arise out of teaching situations rather than conflicts with prior knowledge. We propose that these learning challenges can be identified by paying careful attention to the representations that students produce. Once a transient learning challenge has been identified, teachers can create interventions to address it. By illustration, we argue that an appropriate way to design such interventions is to create variation around the disciplinary-relevant aspects associated with the transient learning challenge.

The health and health system of South Africa: historical roots of current public health challenges.

PubMed

Coovadia, Hoosen; Jewkes, Rachel; Barron, Peter; Sanders, David; McIntyre, Diane

2009-09-05

The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.

Moving beyond regression techniques in cardiovascular risk prediction: applying machine learning to address analytic challenges.

PubMed

Goldstein, Benjamin A; Navar, Ann Marie; Carter, Rickey E

2017-06-14

Risk prediction plays an important role in clinical cardiology research. Traditionally, most risk models have been based on regression models. While useful and robust, these statistical methods are limited to using a small number of predictors which operate in the same way on everyone, and uniformly throughout their range. The purpose of this review is to illustrate the use of machine-learning methods for development of risk prediction models. Typically presented as black box approaches, most machine-learning methods are aimed at solving particular challenges that arise in data analysis that are not well addressed by typical regression approaches. To illustrate these challenges, as well as how different methods can address them, we consider trying to predicting mortality after diagnosis of acute myocardial infarction. We use data derived from our institution's electronic health record and abstract data on 13 regularly measured laboratory markers. We walk through different challenges that arise in modelling these data and then introduce different machine-learning approaches. Finally, we discuss general issues in the application of machine-learning methods including tuning parameters, loss functions, variable importance, and missing data. Overall, this review serves as an introduction for those working on risk modelling to approach the diffuse field of machine learning. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

Addressing overuse of health services in health systems: a critical interpretive synthesis.

PubMed

Ellen, Moriah E; Wilson, Michael G; Vélez, Marcela; Shach, Ruth; Lavis, John N; Grimshaw, Jeremy M; Moat, Kaelan A

2018-06-15

Health systems are increasingly focusing on the issue of 'overuse' of health services and how to address it. We developed a framework focused on (1) the rationale and context for health systems prioritising addressing overuse, (2) elements of a comprehensive process and approach to reduce overuse and (3) implementation considerations for addressing overuse. We conducted a critical interpretive synthesis informed by a stakeholder-engagement process. The synthesis identified relevant empirical and non-empirical articles about system-level overuse. Two reviewers independently screened records, assessed for inclusion and conceptually mapped included articles. From these, we selected a purposive sample, created structured summaries of key findings and thematically synthesised the results. Our search identified 3545 references, from which we included 251. Most articles (76%; n = 192) were published within 5 years of conducting the review and addressed processes for addressing overuse (63%; n = 158) or political and health system context (60%; n = 151). Besides negative outcomes at the patient, system and global level, there were various contextual factors to addressing service overuse that seem to be key issue drivers. Processes for addressing overuse can be grouped into three elements comprising a comprehensive approach, including (1) approaches to identify overused health services, (2) stakeholder- or patient-led approaches and (3) government-led initiatives. Key implementation considerations include the need to develop 'buy in' from stakeholders and citizens. Health systems want to ensure the use of high-value services to keep citizens healthy and avoid harm. Our synthesis can be used by policy-makers, stakeholders and researchers to understand how the issue has been prioritised, what approaches have been used to address it and implementation considerations. PROSPERO CRD42014013204 .

Medical mycology and fungal immunology: new research perspectives addressing a major world health challenge

PubMed Central

Gow, Neil A. R.; Netea, Mihai G.

2016-01-01

Fungi cause more than a billion skin infections, more than 100 million mucosal infections, 10 million serious allergies and more than a million deaths each year. Global mortality owing to fungal infections is greater than for malaria and breast cancer and is equivalent to that owing to tuberculosis (TB) and HIV. These statistics evidence fungal infections as a major threat to human health and a major burden to healthcare budgets worldwide. Those patients who are at greatest risk of life-threatening fungal infections include those who have weakened immunity or have suffered trauma or other predisposing infections such as HIV. To address these global threats to human health, more research is urgently needed to understand the immunopathology of fungal disease and human disease susceptibility in order to augment the advances being made in fungal diagnostics and drug development. Here, we highlight some recent advances in basic research in medical mycology and fungal immunology that are beginning to inform clinical decisions and options for personalized medicine, vaccine development and adjunct immunotherapies. This article is part of the themed issue ‘Tackling emerging fungal threats to animal health, food security and ecosystem resilience’. PMID:28080988

Medical mycology and fungal immunology: new research perspectives addressing a major world health challenge.

PubMed

Gow, Neil A R; Netea, Mihai G

2016-12-05

Fungi cause more than a billion skin infections, more than 100 million mucosal infections, 10 million serious allergies and more than a million deaths each year. Global mortality owing to fungal infections is greater than for malaria and breast cancer and is equivalent to that owing to tuberculosis (TB) and HIV. These statistics evidence fungal infections as a major threat to human health and a major burden to healthcare budgets worldwide. Those patients who are at greatest risk of life-threatening fungal infections include those who have weakened immunity or have suffered trauma or other predisposing infections such as HIV. To address these global threats to human health, more research is urgently needed to understand the immunopathology of fungal disease and human disease susceptibility in order to augment the advances being made in fungal diagnostics and drug development. Here, we highlight some recent advances in basic research in medical mycology and fungal immunology that are beginning to inform clinical decisions and options for personalized medicine, vaccine development and adjunct immunotherapies.This article is part of the themed issue 'Tackling emerging fungal threats to animal health, food security and ecosystem resilience'. © 2016 The Authors.

The Evolution of an Innovative Community-Engaged Health Navigator Program to Address Social Determinants of Health.

PubMed

Page-Reeves, Janet; Moffett, Maurice L; Steimel, Leah; Smith, Daryl T

Health navigators and other types of community health workers (CHWs) have become recognized as essential components of quality care, and key for addressing health disparities owing to the complex health care services landscape presents almost insurmountable challenges for vulnerable individuals. Bernalillo County, New Mexico, has high rates of uninsurance, poverty, and food insecurity. The design of the Pathways to a Healthy Bernalillo County Program (BP) has evolved innovations that are unique in terms of program stability and security, expansive reach, and community capacity across six domains: sustainable public mechanism for program funding, involvement of community organizations in designing the program, expanded focus to address the broader social determinants of health with targeted outreach, an integrated, community-based implementation structure, an outcomes-based payment structure, and using an adaptive program design that actively incorporates navigators in the process. In 2008, the Pathways to a Healthy Bernalillo County Program (BP), located in the Albuquerque metropolitan area in central New Mexico, was established to provide navigation and support for the most vulnerable county residents. BP is funded through a 1% carve out of county mill levy funds. The pathways model is an outcome-based approach for health and social services coordination that uses culturally competent CHW as "navigators" trained to connect at-risk individuals to needed health and social services. One of the important innovations of the pathways approach is a shift in focus from merely providing discrete services to confirming healthy outcomes for the individual patient.

What can Pakistan do to address maternal and child health over the next decade?

PubMed

Bhutta, Zulfiqar A; Hafeez, Assad

2015-11-25

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents a range of actions needed for change within the health and social sectors, including primary care, social determinants, strategies to reach the unreached, and accountability.

Agriculture and Health Sectors Collaborate in Addressing Population Health

PubMed Central

Kaufman, Arthur; Boren, Jon; Koukel, Sonja; Ronquillo, Francisco; Davies, Cindy; Nkouaga, Carolina

2017-01-01

PURPOSE Population health is of growing importance in the changing health care environment. The Cooperative Extension Service, housed in each state’s land grant university, has a major impact on population health through its many community-based efforts, including the Supplemental Nutrition Assistance Program – Education (SNAP-Ed) nutrition programs, 4-H youth engagement, health and wellness education, and community development. Can the agricultural and health sectors, which usually operate in parallel, mostly unknown to each other, collaborate to address population health? We set out to provide an overview of the collaboration between the Cooperative Extension Service and the health sector in various states and describe a case study of 1 model as it developed in New Mexico. METHODS We conducted a literature review and personally contacted states in which the Cooperative Extension Service is collaborating on a “Health Extension” model with academic health centers or their health systems. We surveyed 6 states in which Health Extension models are being piloted as to their different approaches. For a case study of collaboration in New Mexico, we drew on interviews with the leadership of New Mexico State University’s Cooperative Extension Service in the College of Agricultural, Consumer and Environmental Sciences; the University of New Mexico (UNM) Health Science Center’s Office for Community Health; and the personal experiences of frontline Cooperative Extension agents and UNM Health Extension officers who collaborated on community projects. RESULTS A growing number of states are linking the agricultural Cooperative Extension Service with academic health centers and with the health care system. In New Mexico, the UNM academic health center has created “Health Extension Rural Offices” based on principles of the Cooperative Extension model. Today, these 2 systems are working collaboratively to address unmet population health needs in their communities

Addressing the Challenges in Tonsillectomy Research to Inform Health Care Policy: A Review.

PubMed

Mandavia, Rishi; Schilder, Anne G M; Dimitriadis, Panagiotis A; Mossialos, Elias

2017-09-01

Eighty-five percent of investment in medical research has been wasted, with lack of effect on clinical practice and policy. There is increasing effort to improve the likelihood of research being used to influence clinical practice and policy. Tonsillectomy is one of the most common otorhinolaryngologic surgical procedures, and its frequency, cost, and morbidity create a clear need for evidence-based guidelines and policy. The first systematic review on tonsillectomy was conducted 40 years ago and highlighted the lack of definitive evidence for the procedure. Since that study, the body of evidence has still not been able to sufficiently inform policy. This review provides an overview of the key challenges in research to inform tonsillectomy policy and recommendations to help bridge the evidence-policy gap. The challenges in using research to inform policy can be summarized as 4 main themes: (1) non-policy-focused evidence and lack of available evidence, (2) quality of evidence, (3) communication of research findings, and (4) coordinating time frames. Researchers and decision makers should be aware of the limitations of research designs and conflicts of interest that can undermine policy decisions. Researchers must work with decision makers and patients throughout the research process to identify areas of unmet need and political priority, align research and policy time frames, and disseminate research findings. Incentives for researchers should be reorganized to promote dissemination of findings. It is important to consider why evidence gaps in tonsillectomy research have not been addressed during the past 40 years despite considerable investment in time and resources. These findings and recommendations will help produce research that is more responsive to policy gaps and more likely to result in policy changes.

A Lifetime of Trauma: Mental Health Challenges for Higher Education in a Conflict Environment in Afghanistan

ERIC Educational Resources Information Center

Babury, Mohammed Osman; Hayward, Fred Manwarren

2013-01-01

More than 30 years of war in Afghanistan have resulted in immense policy challenges to address the resulting mental health issues. The purpose of this policy analysis is to examine the potential role of higher education in addressing the pressing mental health problems in Afghanistan's public universities and higher education institutions as a…

Challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia.

PubMed

Walubita, Mulima; Sikateyo, Bornwell; Zulu, Joseph M

2018-05-02

Zambia is experiencing high prevalence of childhood cancer. However, very few children access and complete treatment for cancer. This study aimed to document the challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia, and their coping strategies. This was an exploratory health facility-based qualitative study that was conducted at a Paediatric oncology ward at referral hospital in Zambia. In-depth individual interviews conducted with fifteen (15) caregivers and seven (7) key informants were analysed using thematic analysis. Several challenges related to managing the childhood cancer diagnosis were recorded. Individual and family challenges were inadequate knowledge on childhood cancer, lack of finances to meet treatment and transport costs as well as long period of hospitalisation that affected women's ability to perform multiple responsibilities. Whereas challenges at community level were inadequate support to address emotional and physical distress and social stigmatisation experienced by caregivers. Health systems issues included inadequate specialised health workers, poor communication among health workers, limited space and beds as well as insufficient supplies such as blood. Cultural related factors were the belief that cancer is a product of witchcraft as well as religious beliefs regarding the role of faith healing in childhood cancer treatment. Coping strategies used by parents/ caregivers included praying to God, material support from organisations and church as well as delaying having another child. Addressing the challenges for health care providers, parents and patients who face a childhood cancer diagnosis may require adopting a systems or an ecological approach that allows developing strategies that simultaneously address challenges related to the individual, family, community, health system and cultural aspects.

Internet and mobile technologies: addressing the mental health of trauma survivors in less resourced communities.

PubMed

Ruzek, J I; Yeager, C M

2017-01-01

Internet and mobile technologies offer potentially critical ways of delivering mental health support in low-resource settings. Much evidence indicates an enormous negative impact of mental health problems in low- and middle-income countries (LMICs), and many of these problems are caused, or worsened, by exposure to wars, conflicts, natural and human-caused disasters, and other traumatic events. Though specific mental health treatments have been found to be efficacious and cost-effective for low-resource settings, most individuals living in these areas do not have access to them. Low-intensity task-sharing interventions will help, but there is a limit to the scalability and sustainability of human resources in these settings. To address the needs of trauma survivors, it will be important to develop and implement Internet and mobile technology resources to help reduce the scarcity, inequity, and inefficiency of current mental health services in LMICs. Mobile and Internet resources are experiencing a rapid growth in LMICs and can help address time, stigma, and cost barriers and connect those who have been socially isolated by traumatic events. This review discusses current research in technological interventions in low-resource settings and outlines key issues and future challenges and opportunities. Though formidable challenges exist for large-scale deployment of mobile and Internet mental health technologies, work to date indicates that these technologies are indeed feasible to develop, evaluate, and deliver to those in need of mental health services, and that they can be effective.

Challenges for Policy Makers and Organizational Leaders: Addressing Trends in Mental Health Inequalities

PubMed Central

Rentmeester, Christy A.

2013-01-01

We typically think of acutely and chronically mentally ill patients as those who belong in psychiatric hospitals and the latter category of patients belonging in “regular” hospitals, but the intersection of physical and mental illness draws attention to important challenges for policy makers and organizational leaders. This article illuminates some broad trends in the health status of people with mental illnesses, canvasses important features of inequalities suffered by people with mental illnesses, and suggests strategies for systemic reform. Most reform recommendations I offer are in the area of healthcare organization leadership and management. Other key reforms will likely be legislative, regulatory, and insurance-related. Social and cultural reforms in organizational practices and structures will also be critical. PMID:24596844

Using the Electronic Health Record in Nursing Research: Challenges and Opportunities.

PubMed

Samuels, Joanne G; McGrath, Robert J; Fetzer, Susan J; Mittal, Prashant; Bourgoine, Derek

2015-10-01

Changes in the patient record from the paper to the electronic health record format present challenges and opportunities for the nurse researcher. Current use of data from the electronic health record is in a state of flux. Novel data analytic techniques and massive data sets provide new opportunities for nursing science. Realization of a strong electronic data output future relies on meeting challenges of system use and operability, data presentation, and privacy. Nurse researchers need to rethink aspects of proposal development. Joining ongoing national efforts aimed at creating usable data output is encouraged as a means to affect system design. Working to address challenges and embrace opportunities will help grow the science in a way that answers important patient care questions. © The Author(s) 2015.

Exploring the benefits and challenges of health professionals' participation in online health communities: Emergence of (dis)empowerment processes and outcomes.

PubMed

Atanasova, Sara; Kamin, Tanja; Petrič, Gregor

2017-02-01

Various online applications and service has led to the development of online health communities (OHCs), which in addition to the peer-to-peer communication offer patients and other users also interaction with health professionals. While the benefits and challenges of patients and other users' participation in OHCs have been extensively studied, a thorough examination of how health professionals as moderators (i.e., those who provide clinical expertise to patients and other users in OHCs) experience participation in OHCs is lacking. The aim of this study is to explore the main benefits and challenges of health professional moderators' participation in the OHCs. The study undertakes an exploratory qualitative study, with in-depth semi-structured interviews with health professional moderators (n=7) participating in the largest OHC in Slovenia, Med.Over.Net. The data was analysed using inductive thematic analysis approach and principles of grounded theory. Four themes of health professional moderators' experiences were identified: (a) benefits of addressing OHC users' health-related needs, (b) challenges of addressing OHC users' health-related needs, (c) health professional moderators' benefits, and (d) health professional moderators' challenges. This small study demonstrates that health professional participating in OHCs as moderators perceive themselves as facilitators of patients and other OHC's users empowering processes and outcomes, in which OHC's users improve their health literacy, develop skills, expand their social support, and gain other important resources necessary when dealing with health-related issues. Health professional moderator's role, however, also involves several duties, responsibilities and limitations that are often experienced as difficulties in providing patients and other users with adequate counselling and online medical service. OHCs also represent an important terrain for personal and professional empowerment of health professional

Addressing governance challenges in the provision of animal health services: A review of the literature and empirical application transaction cost theory.

PubMed

Ilukor, John; Birner, Regina; Nielsen, Thea

2015-11-01

Providing adequate animal health services to smallholder farmers in developing countries has remained a challenge, in spite of various reform efforts during the past decades. The focuses of the past reforms were on market failures to decide what the public sector, the private sector, and the "third sector" (the community-based sector) should do with regard to providing animal health services. However, such frameworks have paid limited attention to the governance challenges inherent in the provision of animal health services. This paper presents a framework for analyzing institutional arrangements for providing animal health services that focus not only on market failures, but also on governance challenges, such as elite capture, and absenteeism of staff. As an analytical basis, Williamson's discriminating alignment hypothesis is applied to assess the cost-effectiveness of different institutional arrangements for animal health services in view of both market failures and governance challenges. This framework is used to generate testable hypotheses on the appropriateness of different institutional arrangements for providing animal health services, depending on context-specific circumstances. Data from Uganda and Kenya on clinical veterinary services is used to provide an empirical test of these hypotheses and to demonstrate application of Williamson's transaction cost theory to veterinary service delivery. The paper concludes that strong public sector involvement, especially in building and strengthening a synergistic relation-based referral arrangement between paraprofessionals and veterinarians is imperative in improving animal health service delivery in developing countries. Copyright © 2015 Elsevier B.V. All rights reserved.

Bridging the Communication Gap: Successes and Challenges of Mobile Phone Technology in a Health and Demographic Surveillance System in Northern Nigeria

PubMed Central

Doctor, Henry V.; Olatunji, Alabi; Jumare, Abdul’Azeez

2012-01-01

Maternal and child health indicators are generally poor in Nigeria with the northern part of the country having the worst indicators than the southern part. Efforts to address maternal and health challenges in Nigeria include, among others, improvement in health and management information systems. We report on the experience of mobile phone technology in supporting the activities of a health and demographic surveillance system in northern Nigeria. Our experience calls for the need for the Nigerian Government, the mobile network companies, and the international community at large to consolidate their efforts in addressing the mobile network coverage and power supply challenges in order to create an enabling environment for socio-economic development particularly in rural and disadvantaged areas. Unless power and mobile network challenges are addressed, health interventions that rely on mobile phone technology will not have a significant impact in improving maternal and child health. PMID:23569650

Bridging the communication gap: successes and challenges of mobile phone technology in a health and demographic surveillance system in northern Nigeria.

PubMed

Doctor, Henry V; Olatunji, Alabi; Jumare, Abdul'azeez

2012-01-01

Maternal and child health indicators are generally poor in Nigeria with the northern part of the country having the worst indicators than the southern part. Efforts to address maternal and health challenges in Nigeria include, among others, improvement in health and management information systems. We report on the experience of mobile phone technology in supporting the activities of a health and demographic surveillance system in northern Nigeria. Our experience calls for the need for the Nigerian Government, the mobile network companies, and the international community at large to consolidate their efforts in addressing the mobile network coverage and power supply challenges in order to create an enabling environment for socio-economic development particularly in rural and disadvantaged areas. Unless power and mobile network challenges are addressed, health interventions that rely on mobile phone technology will not have a significant impact in improving maternal and child health.

SHAPING A NEW GENERATION OF HISPANIC CLINICAL AND TRANSLATIONAL RESEARCHERS ADDRESSING MINORITY HEALTH AND HEALTH DISPARITIES

PubMed Central

Estape, Estela S.; Segarra, Barbara; Baez, Adriana; Huertas, Aracelis; Diaz, Clemente; Frontera, Walter

2012-01-01

In 2011, research educators face significant challenges. Training programs in Clinical and Translational Research need to develop or enhance their curriculum to comply with new scientific trends and government policies. Curricula must impart the skills and competencies needed to help facilitate the dissemination and transfer of scientific advances at a faster pace than current health policy and practice. Clinical and translational researchers are facing also the need of new paradigms for effective collaboration, and resource sharing while using the best educational models. Both government and public policy makers emphasize addressing the goals of improving health quality and elimination of health disparities. To help achieve this goal, our academic institution is taking an active role and striving to develop an environment that fosters the career development of clinical and translational researchers. Consonant with this vision, in 2002 the University of Puerto Rico, Medical Sciences Campus School of Health Professions and School of Medicine initiated a multidisciplinary post-doctoral Master of Science in Clinical Research focused in training Hispanics who will address minority health and health disparities research. Recently, we proposed a curriculum revision to enhance this commitment in promoting competency-based curricula for clinician-scientists in clinical and translational sciences. The revised program will be a post-doctoral Master of Science in Clinical and Translational Research (MCTR), expanding its outreach by actively engaging in establishing new collaborations and partnerships that will increase our capability to diversify our educational efforts and make significant contributions to help reduce and eliminate the gap in health disparities. PMID:22263296

Addressing public health risks for cyanobacteria in recreational freshwaters: the Oregon and Vermont framework.

PubMed

Stone, David; Bress, William

2007-01-01

Toxigenic cyanobacteria, commonly known as blue green algae, are an emerging public health issue. The toxins produced by cyanobacteria have been detected across the United States in marine, freshwater and estuarine systems and associated with adverse health outcomes. The intent of this paper is to focus on how to address risk in a recreational freshwater scenario when toxigenic cyanobacteria are present. Several challenges exist for monitoring, assessing and posting water bodies and advising the public when toxigenic cyanobacteria are present. These include addressing different recreational activities that are associated with varying levels of risk, the dynamic temporal and spatial aspects of blooms, data gaps in toxicological information and the lack of training and resources for adequate surveillance. Without uniform federal guidance, numerous states have taken public health action for cyanobacteria with different criteria. Vermont and Oregon independently developed a tiered decision-making framework to reduce risk to recreational users when toxigenic cyanobacteria are present. This framework is based on a combination of qualitative and quantitative information.

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.

Group Health Coaching: Strengths, Challenges, and Next Steps

PubMed Central

Wolever, Ruth Q.; Manning, Linda; Elam, Roy; Moore, Margaret; Frates, Elizabeth Pegg; Duskey, Heidi; Anderson, Chelsea; Curtis, Rebecca L.; Masemer, Susan; Lawson, Karen

2013-01-01

There is great need for cost effective approaches to increase patient engagement and improve health and well-being. Health and wellness coaching has recently demonstrated great promise, but the majority of studies to date have focused on individual coaching (ie, one coach with one client). Newer initiatives are bringing a group coaching model from corporate leadership development and educational settings into the healthcare arena. A group approach potentially increases cost-effective access to a larger number of clients and brings the possible additional benefit of group support. This article highlights some of the group coaching approaches currently being conducted across the United States. The group coaching interventions included in this overview are offered by a variety of academic and private sector institutions, use both telephonic and in-person coaching, and are facilitated by professionally trained health and wellness coaches as well as trained peer coaches. Strengths and challenges experienced in these efforts are summarized, as are recommendations to address those challenges. A working definition of “Group Health and Wellness Coaching” is proposed, and important next steps for research and for the training of group coaches are presented. PMID:24416678

Group health coaching: strengths, challenges, and next steps.

PubMed

Armstrong, Colin; Wolever, Ruth Q; Manning, Linda; Elam, Roy; Moore, Margaret; Frates, Elizabeth Pegg; Duskey, Heidi; Anderson, Chelsea; Curtis, Rebecca L; Masemer, Susan; Lawson, Karen

2013-05-01

There is great need for cost effective approaches to increase patient engagement and improve health and well-being. Health and wellness coaching has recently demonstrated great promise, but the majority of studies to date have focused on individual coaching (ie, one coach with one client). Newer initiatives are bringing a group coaching model from corporate leadership development and educational settings into the healthcare arena. A group approach potentially increases cost-effective access to a larger number of clients and brings the possible additional benefit of group support. This article highlights some of the group coaching approaches currently being conducted across the United States. The group coaching interventions included in this overview are offered by a variety of academic and private sector institutions, use both telephonic and in-person coaching, and are facilitated by professionally trained health and wellness coaches as well as trained peer coaches. Strengths and challenges experienced in these efforts are summarized, as are recommendations to address those challenges. A working definition of "Group Health and Wellness Coaching" is proposed, and important next steps for research and for the training of group coaches are presented.

Scaling up to address data science challenges

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

Wendelberger, Joanne R.

Statistics and Data Science provide a variety of perspectives and technical approaches for exploring and understanding Big Data. Partnerships between scientists from different fields such as statistics, machine learning, computer science, and applied mathematics can lead to innovative approaches for addressing problems involving increasingly large amounts of data in a rigorous and effective manner that takes advantage of advances in computing. Here, this article will explore various challenges in Data Science and will highlight statistical approaches that can facilitate analysis of large-scale data including sampling and data reduction methods, techniques for effective analysis and visualization of large-scale simulations, and algorithmsmore » and procedures for efficient processing.« less

Scaling up to address data science challenges

DOE PAGES

Wendelberger, Joanne R.

2017-04-27

Statistics and Data Science provide a variety of perspectives and technical approaches for exploring and understanding Big Data. Partnerships between scientists from different fields such as statistics, machine learning, computer science, and applied mathematics can lead to innovative approaches for addressing problems involving increasingly large amounts of data in a rigorous and effective manner that takes advantage of advances in computing. Here, this article will explore various challenges in Data Science and will highlight statistical approaches that can facilitate analysis of large-scale data including sampling and data reduction methods, techniques for effective analysis and visualization of large-scale simulations, and algorithmsmore » and procedures for efficient processing.« less

Building Interdisciplinary Research Capacity: a Key Challenge for Ecological Approaches in Public Health.

PubMed

Galway, Lindsay P; Parkes, Margot W; Allen, Diana; Takaro, Tim K

2016-01-01

The shortcomings of public health research informed by reductionist and fragmented biomedical approaches and the emergence of wicked problems are fueling a renewed interest in ecological approaches in public health. Despite the central role of interdisciplinarity in the context of ecological approaches in public health research, inadequate attention has been given to the specific challenge of doing interdisciplinary research in practice. As a result, important knowledge gaps exist with regards to the practice of interdisciplinary research. We argue that explicit attention towards the challenge of doing interdisciplinary research is critical in order to effectively apply ecological approaches to public health issues. This paper draws on our experiences developing and conducting an interdisciplinary research project exploring the links among climate change, water, and health to highlight five specific insights which we see as relevant to building capacity for interdisciplinary research specifically, and which have particular relevance to addressing the integrative challenges demanded by ecological approaches to address public health issues. These lessons include: (i) the need for frameworks that facilitate integration; (ii) emphasize learning-by-doing; (iii) the benefits of examining issues at multiple scales; (iv) make the implicit, explicit; and (v) the need for reflective practice. By synthesizing and sharing experiences gained by engaging in interdisciplinary inquiries using an ecological approach, this paper responds to a growing need to build interdisciplinary research capacity as a means for advancing the ecological public health agenda more broadly.

Building Interdisciplinary Research Capacity: a Key Challenge for Ecological Approaches in Public Health

PubMed Central

Galway, Lindsay P.; Parkes, Margot W.; Allen, Diana; Takaro, Tim K.

2016-01-01

The shortcomings of public health research informed by reductionist and fragmented biomedical approaches and the emergence of wicked problems are fueling a renewed interest in ecological approaches in public health. Despite the central role of interdisciplinarity in the context of ecological approaches in public health research, inadequate attention has been given to the specific challenge of doing interdisciplinary research in practice. As a result, important knowledge gaps exist with regards to the practice of interdisciplinary research. We argue that explicit attention towards the challenge of doing interdisciplinary research is critical in order to effectively apply ecological approaches to public health issues. This paper draws on our experiences developing and conducting an interdisciplinary research project exploring the links among climate change, water, and health to highlight five specific insights which we see as relevant to building capacity for interdisciplinary research specifically, and which have particular relevance to addressing the integrative challenges demanded by ecological approaches to address public health issues. These lessons include: (i) the need for frameworks that facilitate integration; (ii) emphasize learning-by-doing; (iii) the benefits of examining issues at multiple scales; (iv) make the implicit, explicit; and (v) the need for reflective practice. By synthesizing and sharing experiences gained by engaging in interdisciplinary inquiries using an ecological approach, this paper responds to a growing need to build interdisciplinary research capacity as a means for advancing the ecological public health agenda more broadly. PMID:29546171

Team science and the physician-scientist in the age of grand health challenges.

PubMed

Steer, Clifford J; Jackson, Peter R; Hornbeak, Hortencia; McKay, Catherine K; Sriramarao, P; Murtaugh, Michael P

2017-09-01

Despite remarkable advances in medical research, clinicians face daunting challenges from new diseases, variations in patient responses to interventions, and increasing numbers of people with chronic health problems. The gap between biomedical research and unmet clinical needs can be addressed by highly talented interdisciplinary investigators focused on translational bench-to-bedside medicine. The training of talented physician-scientists comfortable with forming and participating in multidisciplinary teams that address complex health problems is a top national priority. Challenges, methods, and experiences associated with physician-scientist training and team building were explored at a workshop held at the Second International Conference on One Medicine One Science (iCOMOS 2016), April 24-27, 2016, in Minneapolis, Minnesota. A broad range of scientists, regulatory authorities, and health care experts determined that critical investments in interdisciplinary training are essential for the future of medicine and healthcare delivery. Physician-scientists trained in a broad, nonlinear, cross-disciplinary manner are and will be essential members of science teams in the new age of grand health challenges and the birth of precision medicine. Team science approaches have accomplished biomedical breakthroughs once considered impossible, and dedicated physician-scientists have been critical to these achievements. Together, they translate into the pillars of academic growth and success. © 2017 New York Academy of Sciences.

Hospital management autonomy in Chile: the challenges for human resources in health.

PubMed

Méndez, Claudio A; Torres A, M Cristina

2010-04-01

In Latin America, some health sector reforms have included steps to the implementation of autonomous hospitals. In Chile, the health system is implementing a reform that introduces a network of self-managed institutions. These organizations will be high complexity centers that involve greater technical diversity, cost centers and mechanisms to evaluate users' satisfaction. For human resources in health, the implementation of these centers creates challenges in the planning of service provision and a change from the traditional management style of the teams to one based on networks. These challenges include the estimation of gaps in medical specialists and in other professions in the health sector. In order to be successful with self-management, Chile needs to establish universal and local policies that address training and the organization of health service provisioning in these institutions.

Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries.

PubMed

Watkins, David A; Nugent, Rachel A

2017-01-01

Over the past decade, universal health coverage (UHC) has emerged as a major policy goal for many low- and middle-income country governments. Yet, despite the high burden of cardiovascular diseases (CVD), relatively little is known about how to address CVD through UHC. This review covers three major topics. First, we define UHC and provide some context for its importance, and then we illustrate its relevance to CVD prevention and treatment. Second, we discuss how countries might select high-priority CVD interventions for a UHC health benefits package drawing on economic evaluation methods. Third, we explore some implementation challenges and identify research gaps that, if addressed, could improve the inclusion of CVD into UHC.

Strategies to Address Common Challenges When Teaching in an Active Learning Classroom

ERIC Educational Resources Information Center

Petersen, Christina I.; Gorman, Kristen S.

2014-01-01

This chapter provides practical strategies for addressing common challenges that arise for teachers in active learning classrooms. Our strategies come from instructors with experience teaching in these environments.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-23

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Request for Measures of Health Plan Efforts To Address Health Plan Members' Health Literacy Needs AGENCY: Agency for... well health plans and health providers address health plan enrollees' health literacy needs and how...

Challenges to promoting health for amateur athletes through anti-doping policy.

PubMed

Henning, April

2017-01-01

Anti-doping regulations are intended, at least in part, to promote the health of athletes. While most anti-doping efforts target elite and professional competitors, there have been recent moves by sport governing bodies to expand anti-doping testing to include amateur athletes. Drawing on previous critiques of anti-doping policies and illustrating cases, this article outlines five of the challenges to health promotion of applying the current detect and ban model to the amateur level of sport. I argue that the current approach is not effective and, in some ways, may undermine the goal of health promotion at the amateur level. In order to address these challenges, I propose alternative, health-centred strategies that focus on athlete empowerment and choice through critical awareness of a variety of substances, associated risks and rewards, and the role of expertise in decision-making.

Challenges to promoting health for amateur athletes through anti-doping policy

PubMed Central

Henning, April

2017-01-01

Anti-doping regulations are intended, at least in part, to promote the health of athletes. While most anti-doping efforts target elite and professional competitors, there have been recent moves by sport governing bodies to expand anti-doping testing to include amateur athletes. Drawing on previous critiques of anti-doping policies and illustrating cases, this article outlines five of the challenges to health promotion of applying the current detect and ban model to the amateur level of sport. I argue that the current approach is not effective and, in some ways, may undermine the goal of health promotion at the amateur level. In order to address these challenges, I propose alternative, health-centred strategies that focus on athlete empowerment and choice through critical awareness of a variety of substances, associated risks and rewards, and the role of expertise in decision-making. PMID:28736489

A decade of research on health content in the media: the focus on health challenges and sociocultural context and attendant informational and ideological problems.

PubMed

Kline, Kimberly N

2006-01-01

There is a burgeoning interest in the health and illness content of popular media in the domains of advertising, journalism, and entertainment. This article reviews the past 10 years of this research, describing the relationship between the health topics addressed in the research, the shifting focus of concerns about the media, and, ultimately, the variation in problems for health promotion. I suggest that research attending to topics related to bodily health challenges focused on whether popular media accurately or appropriately represented health challenges. The implication was that there is some consensus about more right or wrong, complete or incomplete ways of representing an issue; the problem was that the media are generally wrong. Alternatively, research addressing topics related to sociocultural context issues focused on how certain interests are privileged in the media. The implication was that competing groups are making claims on the system, but the problem was that popular media marginalizes certain interests. In short, popular media is not likely to facilitate understandings helpful to individuals coping with health challenges and is likely to perpetuate social and political power differentials with regard to health-related issues. I conclude by offering some possibilities for future health media content research.

Remote Sensing of Ecosystem Health: Opportunities, Challenges, and Future Perspectives

PubMed Central

Li, Zhaoqin; Xu, Dandan; Guo, Xulin

2014-01-01

Maintaining a healthy ecosystem is essential for maximizing sustainable ecological services of the best quality to human beings. Ecological and conservation research has provided a strong scientific background on identifying ecological health indicators and correspondingly making effective conservation plans. At the same time, ecologists have asserted a strong need for spatially explicit and temporally effective ecosystem health assessments based on remote sensing data. Currently, remote sensing of ecosystem health is only based on one ecosystem attribute: vigor, organization, or resilience. However, an effective ecosystem health assessment should be a comprehensive and dynamic measurement of the three attributes. This paper reviews opportunities of remote sensing, including optical, radar, and LiDAR, for directly estimating indicators of the three ecosystem attributes, discusses the main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system, and provides some future perspectives. The main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system are: (1) scale issue; (2) transportability issue; (3) data availability; and (4) uncertainties in health indicators estimated from remote sensing data. However, the Radarsat-2 constellation, upcoming new optical sensors on Worldview-3 and Sentinel-2 satellites, and improved technologies for the acquisition and processing of hyperspectral, multi-angle optical, radar, and LiDAR data and multi-sensoral data fusion may partly address the current challenges. PMID:25386759

Remote sensing of ecosystem health: opportunities, challenges, and future perspectives.

PubMed

Li, Zhaoqin; Xu, Dandan; Guo, Xulin

2014-11-07

Maintaining a healthy ecosystem is essential for maximizing sustainable ecological services of the best quality to human beings. Ecological and conservation research has provided a strong scientific background on identifying ecological health indicators and correspondingly making effective conservation plans. At the same time, ecologists have asserted a strong need for spatially explicit and temporally effective ecosystem health assessments based on remote sensing data. Currently, remote sensing of ecosystem health is only based on one ecosystem attribute: vigor, organization, or resilience. However, an effective ecosystem health assessment should be a comprehensive and dynamic measurement of the three attributes. This paper reviews opportunities of remote sensing, including optical, radar, and LiDAR, for directly estimating indicators of the three ecosystem attributes, discusses the main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system, and provides some future perspectives. The main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system are: (1) scale issue; (2) transportability issue; (3) data availability; and (4) uncertainties in health indicators estimated from remote sensing data. However, the Radarsat-2 constellation, upcoming new optical sensors on Worldview-3 and Sentinel-2 satellites, and improved technologies for the acquisition and processing of hyperspectral, multi-angle optical, radar, and LiDAR data and multi-sensoral data fusion may partly address the current challenges.

Self-regulation of common age-related challenges: benefits for older adults' psychological and physical health.

PubMed

Wrosch, Carsten; Dunne, Erin; Scheier, Michael F; Schulz, Richard

2006-06-01

This article addresses the role played by adaptive self-regulation in protecting older adults' psychological and physical health. A theoretical model is outlined illustrating how common age-related challenges (i.e., physical challenges and life regrets) can influence older adults' health. In addition, the proposed model suggests that older adults can avoid the adverse health effects of encountering these problems if they engage in adaptive self-regulation. Finally, this article reviews recent studies that examined the adaptive value of self-regulation processes for managing physical challenges and life regrets in the elderly. The findings from cross-sectional, longitudinal, and experimental studies document the importance of adaptive self-regulation for maintaining older adults' health.

The Public Health Challenge.

ERIC Educational Resources Information Center

Ember, Lois R.

1987-01-01

Discussed are public health challenges related to Acquired Immune Deficiency Syndrome (AIDS). A major challenge is changing habits and damping incipient fear. Education is considered by some to be one of the major public health weapons. Described are various programs, legal issues, and policies being considered and implemented. (RH)

A Framework to Address Challenges in Communicating the Developmental Origins of Health and Disease

PubMed Central

Winett, Liana; Wallack, Lawrence; Richardson, Dawn; Boone-Heinonen, Janne; Messer, Lynne

2017-01-01

Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts “upstream” to sufficiently combat the fundamental causes of disease. To translate these findings into improved public health, however, the distance between scientific discovery and population application will need to be bridged by conversations across a breadth of disciplines and social roles. And importantly, those involved will likely begin without a shared vocabulary or conceptual starting point. The purpose of this paper is to support and inform the translation of DOHaD findings from the bench to population-level health promotion and disease prevention, by: 1) Discussing the unique communication challenges inherent to translation of DOHaD for broad audiences, 2) Introducing the First-hit/Second-hit Framework with an epidemiologic planning matrix as a model for conceptualizing and structuring communication around DOHaD, and 3) Discussing the ways in which patterns of communicating DOHaD findings can expand the range of solutions considered, and encourage discussion of population-level solutions in relation to one another, rather than in isolation. PMID:27449924

A Framework to Address Challenges in Communicating the Developmental Origins of Health and Disease.

PubMed

Winett, Liana; Wallack, Lawrence; Richardson, Dawn; Boone-Heinonen, Janne; Messer, Lynne

2016-09-01

Findings from the field of Developmental Origins of Health and Disease (DOHaD) suggest that some of the most pressing public health problems facing communities today may begin much earlier than previously understood. In particular, this body of work provides evidence that social, physical, chemical, environmental, and behavioral influences in early life play a significant role in establishing vulnerabilities for chronic disease later in life. Further, because this work points to the importance of adverse environmental exposures that cluster in population groups, it suggests that existing opportunities to intervene at a population level may need to refocus their efforts "upstream" to sufficiently combat the fundamental causes of disease. To translate these findings into improved public health, however, the distance between scientific discovery and population application will need to be bridged by conversations across a breadth of disciplines and social roles. And importantly, those involved will likely begin without a shared vocabulary or conceptual starting point. The purpose of this paper is to support and inform the translation of DOHaD findings from the bench to population-level health promotion and disease prevention, by: (1) discussing the unique communication challenges inherent to translation of DOHaD for broad audiences, (2) introducing the First-hit/Second-hit Framework with an epidemiologic planning matrix as a model for conceptualizing and structuring communication around DOHaD, and (3) discussing the ways in which patterns of communicating DOHaD findings can expand the range of solutions considered and encourage discussion of population-level solutions in relation to one another, rather than in isolation.

Analysis of the mass media coverage of the Gates Foundation grand challenges in global health initiative.

PubMed

Verma, G

2009-03-01

The Grand Challenges were launched in 2003 by the Gates Foundation and other collaborators to address the health needs of developing countries. This paper outlines the current problem with health research and development in the context of inequality as conveyed by the 90/10 divide. The paper then looks at the focus and nature of press reporting of global health issues by analysing how press articles have portrayed the Grand Challenges in Global Health initiative. Analysis of the mass media illustrates that the focus of reporting on the Grand Challenges tends to be on utilitarian themes, leaving issues related to justice and equity comparatively under-reported.

Emerging challenges in implementing universal health coverage in Asia.

PubMed

Bredenkamp, Caryn; Evans, Timothy; Lagrada, Leizel; Langenbrunner, John; Nachuk, Stefan; Palu, Toomas

2015-11-01

As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure "supply-side readiness", i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed. On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint. While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia - and across the world. Copyright © 2015. Published by

A systematic review and checklist presenting the main challenges for health economic modeling in personalized medicine: towards implementing patient-level models.

PubMed

Degeling, Koen; Koffijberg, Hendrik; IJzerman, Maarten J

2017-02-01

The ongoing development of genomic medicine and the use of molecular and imaging markers in personalized medicine (PM) has arguably challenged the field of health economic modeling (HEM). This study aims to provide detailed insights into the current status of HEM in PM, in order to identify if and how modeling methods are used to address the challenges described in literature. Areas covered: A review was performed on studies that simulate health economic outcomes for personalized clinical pathways. Decision tree modeling and Markov modeling were the most observed methods. Not all identified challenges were frequently found, challenges regarding companion diagnostics, diagnostic performance, and evidence gaps were most often found. However, the extent to which challenges were addressed varied considerably between studies. Expert commentary: Challenges for HEM in PM are not yet routinely addressed which may indicate that either (1) their impact is less severe than expected, (2) they are hard to address and therefore not managed appropriately, or (3) HEM in PM is still in an early stage. As evidence on the impact of these challenges is still lacking, we believe that more concrete examples are needed to illustrate the identified challenges and to demonstrate methods to handle them.

Addressing health literacy in patient decision aids

PubMed Central

2013-01-01

Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies

New and improved proteomics technologies for understanding complex biological systems: Addressing a grand challenge in the life sciences

PubMed Central

Hood, Leroy E.; Omenn, Gilbert S.; Moritz, Robert L.; Aebersold, Ruedi; Yamamoto, Keith R.; Amos, Michael; Hunter-Cevera, Jennie; Locascio, Laurie

2014-01-01

This White Paper sets out a Life Sciences Grand Challenge for Proteomics Technologies to enhance our understanding of complex biological systems, link genomes with phenotypes, and bring broad benefits to the biosciences and the US economy. The paper is based on a workshop hosted by the National Institute of Standards and Technology (NIST) in Gaithersburg, MD, 14–15 February 2011, with participants from many federal R&D agencies and research communities, under the aegis of the US National Science and Technology Council (NSTC). Opportunities are identified for a coordinated R&D effort to achieve major technology-based goals and address societal challenges in health, agriculture, nutrition, energy, environment, national security, and economic development. PMID:22807061

Technologies for HIV prevention and care: challenges for health services.

PubMed

Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia

2015-09-01

This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.

The first federal budget under Prime Minister Justin Trudeau: Addressing social determinants of health?

PubMed

Ruckert, Arne; Labonté, Ronald

2016-08-15

A challenging budget environment during the Harper years has meant that crucial investments in the social determinants of health (SDHs) have increasingly been neglected. The tabling of what is widely considered a more progressive budget with expansionary fiscal elements under the new Prime Minister, Justin Trudeau, raises the question as to what extent this budget invests in policy areas that are crucial for achieving a more equitable distribution in the social determinants of health, as promised in the Liberal party platform. In this commentary, we argue that the first Liberal budget represents a step in the right direction, but that this first step needs to be followed up with a sustained commitment to address the pervasive (and unfair) social inequalities that are the root cause of persistent health inequities in Canada. We conclude that the first Trudeau budget, while moving in the right direction, does not fully embody the sustained policy changes needed to effectively address SDHs, including a more expansive role for the federal government in the redistribution of income and wealth.

Addressing Health Needs of an Aging Society through Medical-Religious Partnerships: What Do Clergy and Laity Think?

ERIC Educational Resources Information Center

Hale, W. Daniel; Bennett, Richard G.

2003-01-01

Purpose: This article reports on the interest within the religious community in a medical-religious partnership model designed to address some of the health challenges communities face as the population continues to age and become more diverse. Design and Methods: A geographically and religiously diverse group of 183 clergy who were attending a…

The Evidence Base for Mental Health Consultation in Early Childhood Settings: Research Synthesis Addressing Staff and Program Outcomes

ERIC Educational Resources Information Center

Brennan, Eileen M.; Bradley, Jennifer R.; Allen, Mary Dallas; Perry, Deborah F.

2008-01-01

Research Findings: One strategy to support early childhood providers' work with children exhibiting challenging behavior is offering mental health consultation services in order to build staff skills and confidence and reduce staff stress and turnover. Through systematic search procedures, 26 recent studies were identified that addressed the…

Energy-Intensive Processes Portfolio: Addressing Key Energy Challenges Across U.S. Industry

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

None

AMO is developing advanced technologies that cut energy use and carbon emissions in some of the most energy-intensive processes within U.S. manufacturing. The brochure describes the AMO R&D projects that address these challenges.

Personal Health, Person-centred Health and Personalised Medicine - Concepts, Consumers, Confusion and Challenges in the Informatics World.

PubMed

Rigby, M

2012-01-01

To define and assess 'Consumer Health Informatics' and related emergent issues in an era of new media and of personalisation of care, and from this to define what actions need to be taken to optimise benefits and address risks. Definition of key concepts; review of health personalisation, emergent health information and communication technologies and knowledge sources available to citizens and social media; and identification of unresolved issues threatening optimal use of each. A structured review supported by citations and examples. Several new aspects of consumer health informatics are emerging, including new knowledge sources, feedback on treatments and care providers, on-line videos, and a new generation of patient experience sites including those which are for profit and seek to influence treatment paradigms. Not just the information usage, but also the potential social challenges and malicious abuses, are global issues, and also transcend the traditional health community and thus should be addressed in partnership with other global agencies.

Integrated Approaches to Address the Social Determinants of Health for Reducing Health Inequity

PubMed Central

Mitlin, Diana; Mulholland, Catherine; Hardoy, Ana; Stern, Ruth

2007-01-01

The social and physical environments have long since been recognized as important determinants of health. People in urban settings are exposed to a variety of health hazards that are interconnected with their health effects. The Millennium Development Goals (MDGs) have underlined the multidimensional nature of poverty and the connections between health and social conditions and present an opportunity to move beyond narrow sectoral interventions and to develop comprehensive social responses and participatory processes that address the root causes of health inequity. Considering the complexity and magnitude of health, poverty, and environmental issues in cities, it is clear that improvements in health and health equity demand not only changes in the physical and social environment of cities, but also an integrated approach that takes into account the wider socioeconomic and contextual factors affecting health. Integrated or multilevel approaches should address not only the immediate, but also the underlying and particularly the fundamental causes at societal level of related health issues. The political and legal organization of the policy-making process has been identified as a major determinant of urban and global health, as a result of the role it plays in creating possibilities for participation, empowerment, and its influence on the content of public policies and the distribution of scarce resources. This paper argues that it is essential to adopt a long-term multisectoral approach to address the social determinants of health in urban settings. For comprehensive approaches to address the social determinants of health effectively and at multiple levels, they need explicitly to tackle issues of participation, governance, and the politics of power, decision making, and empowerment. PMID:17393340

A Human Rights-Based Approach to Farmworker Health: An Overarching Framework to Address the Social Determinants of Health.

PubMed

Ramos, Athena K

2018-01-01

Migrant and seasonal workers have a right to the highest attainable standard of health. Unfortunately, these farmworkers face a multitude of challenges. They are employed in one of the most dangerous industries and face serious occupational health risks, while positioned at the bottom of the social hierarchy. They often lack formal education and training, English language proficiency, legal status, access to information, and equitable opportunities to health and healthcare. This article will explore the international human rights conventions that support farmworkers' right to health and healthcare in the United States. International human rights may provide a valuable legal framework that could be used to advocate on behalf of farmworkers and address the social determinants of health. Therefore, a Human Rights-Based Approach to Farmworker health will be presented along with recommendations for how to advance health and access to healthcare among this population. Fostering the health and well-being of migrant and seasonal farmworkers is critical to advancing equity, social justice, and maintaining the workforce required to meet production needs and safeguard the economic competitiveness of the industry.

Surmounting the unique challenges in health disparities education: a multi-institution qualitative study.

PubMed

Carter-Pokras, Olivia; Bereknyei, Sylvia; Lie, Desiree; Braddock, Clarence H

2010-05-01

The National Consortium for Multicultural Education for Health Professionals (Consortium) comprises educators representing 18 US medical schools, funded by the National Institutes of Health. Collective lessons learned from curriculum implementation by principal investigators (PIs) have the potential to guide similar educational endeavors. Describe Consortium PI's self-reported challenges with curricular development, solutions and their new curricular products. Information was collected from PIs over 2 months using a 53-question structured three-part questionnaire. The questionnaire addressed PI demographics, curriculum implementation challenges and solutions, and newly created curricular products. Study participants were 18 Consortium PIs. Descriptive analysis was used for quantitative data. Narrative responses were analyzed and interpreted using qualitative thematic coding. Response rate was 100%. Common barriers and challenges identified by PIs were: finding administrative and leadership support, sustaining the momentum, continued funding, finding curricular space, accessing and engaging communities, and lack of education research methodology skills. Solutions identified included engaging stakeholders, project-sharing across schools, advocacy and active participation in committees and community, and seeking sustainable funding. All Consortium PIs reported new curricular products and extensive dissemination efforts outside their own institutions. The Consortium model has added benefits for curricular innovation and dissemination for cultural competence education to address health disparities. Lessons learned may be applicable to other educational innovation efforts.

Perceived benefits and challenges of coordinated approaches to chronic disease prevention in state health departments.

PubMed

Allen, Peg; Sequeira, Sonia; Best, Leslie; Jones, Ellen; Baker, Elizabeth A; Brownson, Ross C

2014-05-08

Chronic disease prevention efforts have historically been funded categorically according to disease or risk factor. Federal agencies are now progressively starting to fund combined programs to address common risk. The purpose of this study was to inform transitions to coordinated chronic disease prevention by learning views on perceived benefits and challenges of a coordinated approach to funding. A national survey on evidence-based public health was conducted from March through May 2013 among state health department employees working in chronic disease prevention (N = 865). Participants were asked to rank the top 3 benefits and top 3 challenges in coordinating chronic disease approaches from provided lists and could provide additional responses. Descriptive analyses, χ(2) tests, and analysis of variance were conducted. The most common perceived benefits of coordinated approaches to chronic disease prevention were improved health outcomes, common risk factors better addressed, and reduced duplication of program efforts. The most common perceived challenges were funding restrictions, such as disease-specific performance measures; competing priorities; lack of communication across programs; funding might be reduced; agency not structured for program coordination; and loss of disease-specific partner support. Rankings of benefits and challenges were similar across states and participant roles; the perceived challenges "lack of communication across programs" (P = .02) and "funding might be reduced" differed by program area (P < .001). Findings can be used by funding agencies and state health departments for planning, training, and technical assistance. The information on perceived challenges demonstrates the need to improve communication across programs, enhance organizational support for coordinated approaches, and create benefits for organizational partners.

Challenges in researching violence affecting health service delivery in complex security environments.

PubMed

Foghammar, Ludvig; Jang, Suyoun; Kyzy, Gulzhan Asylbek; Weiss, Nerina; Sullivan, Katherine A; Gibson-Fall, Fawzia; Irwin, Rachel

2016-08-01

Complex security environments are characterized by violence (including, but not limited to "armed conflict" in the legal sense), poverty, environmental disasters and poor governance. Violence directly affecting health service delivery in complex security environments includes attacks on individuals (e.g. doctors, nurses, administrators, security guards, ambulance drivers and translators), obstructions (e.g. ambulances being stopped at checkpoints), discrimination (e.g. staff being pressured to treat one patient instead of another), attacks on and misappropriation of health facilities and property (e.g. vandalism, theft and ambulance theft by armed groups), and the criminalization of health workers. This paper examines the challenges associated with researching the context, scope and nature of violence directly affecting health service delivery in these environments. With a focus on data collection, it considers how these challenges affect researchers' ability to analyze the drivers of violence and impact of violence. This paper presents key findings from two research workshops organized in 2014 and 2015 which convened researchers and practitioners in the fields of health and humanitarian aid delivery and policy, and draws upon an analysis of organizational efforts to address violence affecting healthcare delivery and eleven in-depth interviews with representatives of organizations working in complex security environments. Despite the urgency and impact of violence affecting healthcare delivery, there is an overall lack of research that is of health-specific, publically accessible and comparable, as well as a lack of gender-disaggregated data, data on perpetrator motives and an assessment of the 'knock-on' effects of violence. These gaps limit analysis and, by extension, the ability of organizations operating in complex security environments to effectively manage the security of their staff and facilities and to deliver health services. Increased research

Working with Local, State and Federal Partners to Address Health Education Needs of Hurricane Katrina Evacuees in Houston: A CDC Case Study

ERIC Educational Resources Information Center

Hoover, D. Michele; Dopson, Stephanie; Drehobl, Patricia

2010-01-01

For health educators to successfully meet the challenges of responding to public health emergencies, it is important to establish and understand the role of collaborations with local, state and federal partners in identifying potential public health issues and to develop theory-based models or strategies to address these issues before, during and…

Global nurse leader perspectives on health systems and workforce challenges.

PubMed

Gantz, Nancy Rollins; Sherman, Rose; Jasper, Melanie; Choo, Chua Gek; Herrin-Griffith, Donna; Harris, Kathy

2012-05-01

As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing's future. Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies. © 2012 Blackwell Publishing Ltd.

Experiences addressing health-related financial challenges with disease management among African American women with asthma.

PubMed

Patel, Minal R; Caldwell, Cleopatra H; Id-Deen, Effat; Clark, Noreen M

2014-06-01

Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available.

Experiences addressing health-related financial challenges with disease management among African American women with asthma

PubMed Central

Patel, Minal R.; Caldwell, Cleopatra H.; Id-Deen, Effat; Clark, Noreen M.

2018-01-01

Objective Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. Methods In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Results Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Conclusions Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available. PMID:24471517

Addressing Social Determinants Of Health Through Medical-Legal Partnerships.

PubMed

Regenstein, Marsha; Trott, Jennifer; Williamson, Alanna; Theiss, Joanna

2018-03-01

The US health care system needs effective tools to address complex social and environmental issues that perpetuate health inequities, such as food insecurity, education and employment barriers, and substandard housing conditions. The medical-legal partnership is a collaborative intervention that embeds civil legal aid professionals in health care settings to address seemingly intractable social problems that contribute to poor health outcomes and health disparities. More than three hundred health care organizations are home to medical-legal partnerships. This article draws upon national survey data and field research to identify three models of the medical-legal partnership that health care organizations have adopted and the core elements of infrastructure that they share. Financing and commitment from health care organizations are key considerations for sustaining and scaling up the medical-legal partnership as a health equity intervention.

Addressing the Analytic Challenges of Cross-Sectional Pediatric Pneumonia Etiology Data

PubMed Central

Feikin, Daniel R.; Scott, J. Anthony G.; Zeger, Scott L.; Murdoch, David R.; O’Brien, Katherine L.; Deloria Knoll, Maria

2017-01-01

Abstract Despite tremendous advances in diagnostic laboratory technology, identifying the pathogen(s) causing pneumonia remains challenging because the infected lung tissue cannot usually be sampled for testing. Consequently, to obtain information about pneumonia etiology, clinicians and researchers test specimens distant to the site of infection. These tests may lack sensitivity (eg, blood culture, which is only positive in a small proportion of children with pneumonia) and/or specificity (eg, detection of pathogens in upper respiratory tract specimens, which may indicate asymptomatic carriage or a less severe syndrome, such as upper respiratory infection). While highly sensitive nucleic acid detection methods and testing of multiple specimens improve sensitivity, multiple pathogens are often detected and this adds complexity to the interpretation as the etiologic significance of results may be unclear (ie, the pneumonia may be caused by none, one, some, or all of the pathogens detected). Some of these challenges can be addressed by adjusting positivity rates to account for poor sensitivity or incorporating test results from controls without pneumonia to account for poor specificity. However, no classical analytic methods can account for measurement error (ie, sensitivity and specificity) for multiple specimen types and integrate the results of measurements for multiple pathogens to produce an accurate understanding of etiology. We describe the major analytic challenges in determining pneumonia etiology and review how the common analytical approaches (eg, descriptive, case-control, attributable fraction, latent class analysis) address some but not all challenges. We demonstrate how these limitations necessitate a new, integrated analytical approach to pneumonia etiology data. PMID:28575372

First 'Global Flipped Classroom in One Health': From MOOCs to research on real world challenges.

PubMed

Ruiz de Castañeda, Rafael; Garrison, Amanda; Haeberli, Philippe; Crump, Lisa; Zinsstag, Jakob; Ravel, André; Flahault, Antoine; Bolon, Isabelle

2018-06-01

In 2016 and 2017 the first three MOOCs (Massive Online Open Course) addressing One Health were released, two of them by University of Geneva and University of Basel (Switzerland). With the support of Swiss School of Public Health and using these two highly interdisciplinary MOOCs, the first 'Global Flipped Classroom in One Health' was organized in Geneva and Basel in July 2017. This innovative event gathered 12 Swiss and international MOOC learners to work on specific public/global health challenges at the human-animal-ecosystem interface in interdisciplinary teams supported by experts from academia and international organisations (e.g. World Health Organization) based in Geneva, Basel and internationally. According to the final survey, the level of satisfaction by learners was high and they benefited from the experience in different ways: reinforcement of their knowledge and capacity to perform innovative research in One Health (e.g. using digital epidemiology), visits and meetings with experts in Global Health (e.g. World Health Organization and Institute of Global Health in Geneva, Swiss Tropical and Public Health Institute in Basel) and emerging research collaborations etc. A novel project-based learning and research model arising from MOOCs was successfully created, which offers opportunities for global education and research addressing real world challenges utilising a One Health approach.

Tool for evaluating research implementation challenges: A sense-making protocol for addressing implementation challenges in complex research settings

PubMed Central

2013-01-01

Background Many challenges arise in complex organizational interventions that threaten research integrity. This article describes a Tool for Evaluating Research Implementation Challenges (TECH), developed using a complexity science framework to assist research teams in assessing and managing these challenges. Methods During the implementation of a multi-site, randomized controlled trial (RCT) of organizational interventions to reduce resident falls in eight nursing homes, we inductively developed, and later codified the TECH. The TECH was developed through processes that emerged from interactions among research team members and nursing home staff participants, including a purposive use of complexity science principles. Results The TECH provided a structure to assess challenges systematically, consider their potential impact on intervention feasibility and fidelity, and determine actions to take. We codified the process into an algorithm that can be adopted or adapted for other research projects. We present selected examples of the use of the TECH that are relevant to many complex interventions. Conclusions Complexity theory provides a useful lens through which research procedures can be developed to address implementation challenges that emerge from complex organizations and research designs. Sense-making is a group process in which diverse members interpret challenges when available information is ambiguous; the groups’ interpretations provide cues for taking action. Sense-making facilitates the creation of safe environments for generating innovative solutions that balance research integrity and practical issues. The challenges encountered during implementation of complex interventions are often unpredictable; however, adoption of a systematic process will allow investigators to address them in a consistent yet flexible manner, protecting fidelity. Research integrity is also protected by allowing for appropriate adaptations to intervention protocols that

Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care.

PubMed

Barnett, Miya L; Lau, Anna S; Miranda, Jeanne

2018-05-07

Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.

New and improved proteomics technologies for understanding complex biological systems: addressing a grand challenge in the life sciences.

PubMed

Hood, Leroy E; Omenn, Gilbert S; Moritz, Robert L; Aebersold, Ruedi; Yamamoto, Keith R; Amos, Michael; Hunter-Cevera, Jennie; Locascio, Laurie

2012-09-01

This White Paper sets out a Life Sciences Grand Challenge for Proteomics Technologies to enhance our understanding of complex biological systems, link genomes with phenotypes, and bring broad benefits to the biosciences and the US economy. The paper is based on a workshop hosted by the National Institute of Standards and Technology (NIST) in Gaithersburg, MD, 14-15 February 2011, with participants from many federal R&D agencies and research communities, under the aegis of the US National Science and Technology Council (NSTC). Opportunities are identified for a coordinated R&D effort to achieve major technology-based goals and address societal challenges in health, agriculture, nutrition, energy, environment, national security, and economic development. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Sustainable health systems: addressing three key areas.

PubMed

Chhanabhai, Prajesh N; Holt, Alec; Benwell, George

2007-01-01

In the modern context sustainable health systems are being developed using the newest technological and communication technologies. This is proving to be a great success for the growth of Health Informatics and healthcare improvement. However this revolution is not being reached by a lot of the world population. This paper will address the importance of closing the Digital Divide, Empowerment of health consumers and the importance of converging communications. Key areas in the development of a truly sustainable health system.

Addressing population health and health inequalities: the role of fundamental causes.

PubMed

Cerdá, Magdalena; Tracy, Melissa; Ahern, Jennifer; Galea, Sandro

2014-09-01

As a case study of the impact of universal versus targeted interventions on population health and health inequalities, we used simulations to examine (1) whether universal or targeted manipulations of collective efficacy better reduced population-level rates and racial/ethnic inequalities in violent victimization; and (2) whether experiments reduced disparities without addressing fundamental causes. We applied agent-based simulation techniques to the specific example of an intervention on neighborhood collective efficacy to reduce population-level rates and racial/ethnic inequalities in violent victimization. The agent population consisted of 4000 individuals aged 18 years and older with sociodemographic characteristics assigned to match distributions of the adult population in New York City according to the 2000 U.S. Census. Universal experiments reduced rates of victimization more than targeted experiments. However, neither experiment reduced inequalities. To reduce inequalities, it was necessary to eliminate racial/ethnic residential segregation. These simulations support the use of universal intervention but suggest that it is not possible to address inequalities in health without first addressing fundamental causes.

Making Pedagogical Decisions to Address Challenges of Joint Jewish-Bedouin Environmental Projects in Israel

ERIC Educational Resources Information Center

Alkaher, Iris; Tal, Tali

2016-01-01

This interpretive study identifies challenges of working with Bedouin and Jewish Israeli youth in two multicultural projects: education for sustainability and place-conscious education. It also describes the ways the adult project leaders addressed these challenges and their views on the effectiveness of their decisions. Participants comprised 16…

Addressing the Big-Earth-Data Variety Challenge with the Hierarchical Triangular Mesh

NASA Technical Reports Server (NTRS)

Rilee, Michael L.; Kuo, Kwo-Sen; Clune, Thomas; Oloso, Amidu; Brown, Paul G.; Yu, Honfeng

2016-01-01

We have implemented an updated Hierarchical Triangular Mesh (HTM) as the basis for a unified data model and an indexing scheme for geoscience data to address the variety challenge of Big Earth Data. We observe that, in the absence of variety, the volume challenge of Big Data is relatively easily addressable with parallel processing. The more important challenge in achieving optimal value with a Big Data solution for Earth Science (ES) data analysis, however, is being able to achieve good scalability with variety. With HTM unifying at least the three popular data models, i.e. Grid, Swath, and Point, used by current ES data products, data preparation time for integrative analysis of diverse datasets can be drastically reduced and better variety scaling can be achieved. In addition, since HTM is also an indexing scheme, when it is used to index all ES datasets, data placement alignment (or co-location) on the shared nothing architecture, which most Big Data systems are based on, is guaranteed and better performance is ensured. Moreover, our updated HTM encoding turns most geospatial set operations into integer interval operations, gaining further performance advantages.

Integrating an Academic Electronic Health Record: Challenges and Success Strategies.

PubMed

Herbert, Valerie M; Connors, Helen

2016-08-01

Technology is increasing the complexity in the role of today's nurse. Healthcare organizations are integrating more health information technologies and relying on the electronic health record for data collection, communication, and decision making. Nursing faculty need to prepare graduates for this environment and incorporate an academic electronic health record into a nursing curriculum to meet student-program outcomes. Although the need exists for student preparation, some nursing programs are struggling with implementation, whereas others have been successful. To better understand these complexities, this project was intended to identify current challenges and success strategies of effective academic electronic health record integration into nursing curricula. Using Rogers' 1962 Diffusion of Innovation theory as a framework for technology adoption, a descriptive survey design was used to gain insights from deans and program directors of nursing schools involved with the national Health Informatics & Technology Scholars faculty development program or Cerner's Academic Education Solution Consortium, working to integrate an academic electronic health record in their respective nursing schools. The participants' experiences highlighted approaches used by these schools to integrate these technologies. Data from this project provide nursing education with effective strategies and potential challenges that should be addressed for successful academic electronic health record integration.

Resource allocation and funding challenges for regional local health departments in Nebraska.

PubMed

Chen, Li-Wu; Jacobson, Janelle; Roberts, Sara; Palm, David

2012-01-01

This study examined the mechanism of resource allocation among member counties and the funding challenges of regional health departments (RHDs) in Nebraska. DESIGN AND STUDY SETTING: In 2009, we conducted a qualitative case study of 2 Nebraska RHDs to gain insight into their experiences of making resource allocation decisions and confronting funding challenges. The 2 RHD sites were selected for this case study on the basis of their heterogeneity in terms of population distribution in member counties. Sixteen semistructured in-person interviews were conducted with RHD directors, staff, and board of health members. Interview data were coded and analyzed using NVivo qualitative analysis software (QSR International [Americas] Inc., Cambridge, MA). Our findings suggested that the directors of RHDs play an integral role in making resource allocation decisions on the basis of community needs, not on a formula or on individual county population size. Interviewees also reported that the size of the vulnerable population served by the RHD had a significant impact on the level of resources for RHD's programs. The RHD's decisions about resource allocation were also dependent on the amount and type of resources received from the state. Interviewees identified inadequacy and instability of funding as the 2 main funding challenges for their RHD. These challenges negatively impacted workforce capacity and the long-term sustainability of some programs. Regional health departments may not benefit from better leveraging resources and building a stronger structural capacity unless the issues of funding inadequacy and instability are addressed. Strategies that can be used by RHDs to address these funding challenges include seeking grants to support programs, leveraging existing resources, and building community partnerships to share resources. Future research is needed to identify RHDs' optimal workforce capacity, required funding level, and potential funding mechanisms.

Health systems challenges in cervical cancer prevention program in Malawi.

PubMed

Maseko, Fresier C; Chirwa, Maureen L; Muula, Adamson S

2015-01-01

system challenges are prevailing in the cervical cancer prevention program in Malawi. These challenges need to be addressed if the health system is to improve on the coverage of cervical cancer screening and treatment.

Non-governmental organizations in international health: past successes, future challenges.

PubMed

Gellert, G A

1996-01-01

Non-governmental organizations, or NGOs, are increasingly instrumental to the implementation of international health programs. Following an overview of current conditions in global health and the problems that could be targeted by NGOs, this article describes the activities and philosophies of several representative approaches in this sector. The attributes of NGOs that increase their potential effectiveness are discussed, including ability to reach areas of severe need, promotion of local involvement, low cost of operations, adaptiveness and innovation, independence, and sustainability. A summary is provided of major future challenges in international health that may be addressed by NGOs, with particular emphasis on tobacco-related disease, communicable diseases and the AIDS epidemic, maternal mortality and women's health, injury prevention and control, and the need to secure durable financial support.

Challenges in tackling tuberculosis on the Thai-Myanmar border: findings from a qualitative study with health professionals.

PubMed

Kaji, Aiko; Thi, Sein Sein; Smith, Terrence; Charunwatthana, Prakaykaew; Nosten, Francois H

2015-10-09

Myanmar and Thailand belong to the top 22 high burden countries for tuberculosis (TB). Health care organizations play an essential role in addressing TB control in the two bridging border jurisdictions, Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. However, health professionals face difficulties in TB control effort due to the nature of fluid population movements, resource constraints and ambiguous mechanisms to implement collaboration along the border. The purpose of this study is to identify the challenges to TB control among Myanmar migrants faced by stakeholders, focusing on the area of collaboration and interaction along the border. The study conducted in-depth interviews with health policy makers and health care providers responsible for developing and implementing policies and TB programs in Tak province, Thailand and Myawaddy district, Kayin state, Myanmar. The participants included members of government organizations, United Nations agencies, community based organizations, and international NGO. One or two key stakeholders from each organization were approached to participate in the study. We gathered baseline information to identify TB policies and programs available on websites, brochures, and publications. Observations including field notes were made on site. The data transcriptions were coded for qualitative data analysis. Coding also developed categories that led to key themes. A total of 31 respondents (18 in Thailand and 13 in Myanmar) participated in the study. The main theme reported by participants was challenges in limited corroboration and coordination among stakeholders. Unstructured information sharing and lack of communication hindered the stakeholders from engaging in TB control. The respondents stressed that referral mechanisms across the border need to be strengthened. Other challenges were associated with increasing loss to follow up and subsequent MDR cases, constraints of service delivery, shortage of human

Perceived Benefits and Challenges of Coordinated Approaches to Chronic Disease Prevention in State Health Departments

PubMed Central

Sequeira, Sonia; Best, Leslie; Jones, Ellen; Baker, Elizabeth A.; Brownson, Ross C.

2014-01-01

Introduction Chronic disease prevention efforts have historically been funded categorically according to disease or risk factor. Federal agencies are now progressively starting to fund combined programs to address common risk. The purpose of this study was to inform transitions to coordinated chronic disease prevention by learning views on perceived benefits and challenges of a coordinated approach to funding. Methods A national survey on evidence-based public health was conducted from March through May 2013 among state health department employees working in chronic disease prevention (N = 865). Participants were asked to rank the top 3 benefits and top 3 challenges in coordinating chronic disease approaches from provided lists and could provide additional responses. Descriptive analyses, χ2 tests, and analysis of variance were conducted. Results The most common perceived benefits of coordinated approaches to chronic disease prevention were improved health outcomes, common risk factors better addressed, and reduced duplication of program efforts. The most common perceived challenges were funding restrictions, such as disease-specific performance measures; competing priorities; lack of communication across programs; funding might be reduced; agency not structured for program coordination; and loss of disease-specific partner support. Rankings of benefits and challenges were similar across states and participant roles; the perceived challenges “lack of communication across programs” (P = .02) and “funding might be reduced” differed by program area (P < .001). Conclusion Findings can be used by funding agencies and state health departments for planning, training, and technical assistance. The information on perceived challenges demonstrates the need to improve communication across programs, enhance organizational support for coordinated approaches, and create benefits for organizational partners. PMID:24809362

Can nurses rise to the public health challenge? How a novel solution in nurse education can address this contemporary question.

PubMed

Turner-Wilson, Angela L; Mills, Anne M; Rees, Karen

2017-10-01

This paper raises the problem of how improvements in health outcomes, a key component in many governments' strategies, can be achieved. The work highlights a novel undergraduate educational approach which offers solutions to public health challenges within nursing. Against the backdrop of one UK university institution it discusses approaches that can guide nursing students towards a deeper understanding and engagement within the principles of public health. It then proposes how nurses can use their learning to become leaders of health improvement. Copyright © 2017 Elsevier Ltd. All rights reserved.

Challenges to collaboration in school mental health and strategies for overcoming them.

PubMed

Weist, Mark D; Mellin, Elizabeth A; Chambers, Kerri L; Lever, Nancy A; Haber, Deborah; Blaber, Christine

2012-02-01

This article reviews challenges to collaboration in school mental health (SMH) and presents practical strategies for overcoming them. The importance of collaboration to the success of SMH programs is reviewed, with a particular focus on collaboration between school- and community-employed professionals. Challenges to effective collaboration between school- and community-employed professionals in SMH are considered. Strategies for overcoming challenges to effective collaboration are presented. Marginalization of the SMH agenda, limited interdisciplinary teamwork, restricted coordination mechanisms, confidentiality concerns, and resource and funding issues are key challenges to collaboration. Strategies targeted toward each of these challenges may help improve the effectiveness of SMH programs and ultimately student outcomes. Collaboration between school- and community-employed professionals is critical to the success of SMH programs. Despite its promise, the success of SMH programs can be jeopardized by ineffective collaboration between school- and community-employed professionals. Strategies to overcome marginalization, promote authentic interdisciplinary teamwork, build effective coordination mechanisms, protect student and family confidentiality, and promote policy change and resource enhancements should be addressed in SMH improvement planning. © 2012, American School Health Association.

Addressing the Analytic Challenges of Cross-Sectional Pediatric Pneumonia Etiology Data.

PubMed

Hammitt, Laura L; Feikin, Daniel R; Scott, J Anthony G; Zeger, Scott L; Murdoch, David R; O'Brien, Katherine L; Deloria Knoll, Maria

2017-06-15

Despite tremendous advances in diagnostic laboratory technology, identifying the pathogen(s) causing pneumonia remains challenging because the infected lung tissue cannot usually be sampled for testing. Consequently, to obtain information about pneumonia etiology, clinicians and researchers test specimens distant to the site of infection. These tests may lack sensitivity (eg, blood culture, which is only positive in a small proportion of children with pneumonia) and/or specificity (eg, detection of pathogens in upper respiratory tract specimens, which may indicate asymptomatic carriage or a less severe syndrome, such as upper respiratory infection). While highly sensitive nucleic acid detection methods and testing of multiple specimens improve sensitivity, multiple pathogens are often detected and this adds complexity to the interpretation as the etiologic significance of results may be unclear (ie, the pneumonia may be caused by none, one, some, or all of the pathogens detected). Some of these challenges can be addressed by adjusting positivity rates to account for poor sensitivity or incorporating test results from controls without pneumonia to account for poor specificity. However, no classical analytic methods can account for measurement error (ie, sensitivity and specificity) for multiple specimen types and integrate the results of measurements for multiple pathogens to produce an accurate understanding of etiology. We describe the major analytic challenges in determining pneumonia etiology and review how the common analytical approaches (eg, descriptive, case-control, attributable fraction, latent class analysis) address some but not all challenges. We demonstrate how these limitations necessitate a new, integrated analytical approach to pneumonia etiology data. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Surmounting the Unique Challenges in Health Disparities Education: A Multi-Institution Qualitative Study

PubMed Central

Bereknyei, Sylvia; Lie, Desiree; Braddock, Clarence H.

2010-01-01

Background The National Consortium for Multicultural Education for Health Professionals (Consortium) comprises educators representing 18 US medical schools, funded by the National Institutes of Health. Collective lessons learned from curriculum implementation by principal investigators (PIs) have the potential to guide similar educational endeavors. Objective Describe Consortium PI’s self-reported challenges with curricular development, solutions and their new curricular products. Methods Information was collected from PIs over 2 months using a 53-question structured three-part questionnaire. The questionnaire addressed PI demographics, curriculum implementation challenges and solutions, and newly created curricular products. Study participants were 18 Consortium PIs. Descriptive analysis was used for quantitative data. Narrative responses were analyzed and interpreted using qualitative thematic coding. Results Response rate was 100%. Common barriers and challenges identified by PIs were: finding administrative and leadership support, sustaining the momentum, continued funding, finding curricular space, accessing and engaging communities, and lack of education research methodology skills. Solutions identified included engaging stakeholders, project-sharing across schools, advocacy and active participation in committees and community, and seeking sustainable funding. All Consortium PIs reported new curricular products and extensive dissemination efforts outside their own institutions. Conclusion The Consortium model has added benefits for curricular innovation and dissemination for cultural competence education to address health disparities. Lessons learned may be applicable to other educational innovation efforts. PMID:20352503

Addressing the Health Concerns of VA Women with Sexual Trauma

DTIC Science & Technology

2017-10-01

AWARD NUMBER: W81XWH-14-1-0368 TITLE: Addressing the Health Concerns of VA Women with Sexual Trauma PRINCIPAL INVESTIGATOR: Caron Zlotnick, PhD...develop and assess a computer-delivered intervention (Safety and Health Experiences Program; SHE) that will provide a screening and brief behavior...intervention for women veterans with any lifetime ST. More specifically, the intervention, SHE, will address interrelated health concerns for women

Challenges in using electronic health record data for CER: experience of 4 learning organizations and solutions applied.

PubMed

Bayley, K Bruce; Belnap, Tom; Savitz, Lucy; Masica, Andrew L; Shah, Nilay; Fleming, Neil S

2013-08-01

To document the strengths and challenges of using electronic health records (EHRs) for comparative effectiveness research (CER). A replicated case study of comparative effectiveness in hypertension treatment was conducted across 4 health systems, with instructions to extract data and document problems encountered using a specified list of required data elements. Researchers at each health system documented successes and challenges, and suggested solutions for addressing challenges. Data challenges fell into 5 categories: missing data, erroneous data, uninterpretable data, inconsistencies among providers and over time, and data stored in noncoded text notes. Suggested strategies to address these issues include data validation steps, use of surrogate markers, natural language processing, and statistical techniques. A number of EHR issues can hamper the extraction of valid data for cross-health system comparative effectiveness studies. Our case example cautions against a blind reliance on EHR data as a single definitive data source. Nevertheless, EHR data are superior to administrative or claims data alone, and are cheaper and timelier than clinical trials or manual chart reviews. All 4 participating health systems are pursuing pathways to more effectively use EHR data for CER.A partnership between clinicians, researchers, and information technology specialists is encouraged as a way to capitalize on the wealth of information contained in the EHR. Future developments in both technology and care delivery hold promise for improvement in the ability to use EHR data for CER.

Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

PubMed

Betancourt, Joseph R; Green, Alexander R; Carrillo, J Emilio; Ananeh-Firempong, Owusu

2003-01-01

Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.

Mental health and addiction workforce development: federal leadership is needed to address the growing crisis.

PubMed

Hoge, Michael A; Stuart, Gail W; Morris, John; Flaherty, Michael T; Paris, Manuel; Goplerud, Eric

2013-11-01

The mental health and addiction workforce has long been plagued by shortages, high turnover, a lack of diversity, and concerns about its effectiveness. This article presents a framework to guide workforce policy and practice, emphasizing the need to train other health care providers as well as individuals in recovery to address behavioral health needs; strengthen recruitment, retention, and training of specialist behavioral health providers; and improve the financial and technical assistance infrastructure to better support and sustain the workforce. The pressing challenge is to scale up existing plans and strategies and to implement them in ways that have a meaningful impact on the size and effectiveness of the workforce. The aging and increasing diversity of the US population, combined with the expanded access to services that will be created by health reform, make it imperative to take immediate action.

Lessons from the trenches: meeting evaluation challenges in school health education.

PubMed

Young, Michael; Denny, George; Donnelly, Joseph

2012-11-01

Those involved in school health education programs generally believe that health-education programs can play an important role in helping young people make positive health decisions. Thus, it is to document the effects of such programs through rigorous evaluations published in peer-reviewed journals. This paper helps the reader understand the context of school health program evaluation, examines several problems and challenges, shows how problems can often be fixed, or prevented, and demonstrates ways in which challenges can be met. A number of topics are addressed, including distinguishing between curricula evaluation and evaluation of outcomes, types of evaluation, identifying stakeholders in school health evaluation, selection of a program evaluator, recruiting participants, design issues, staff training, parental consent, instrumentation, program implementation and treatment fidelity, participant retention, data collection, data analysis and interpretation, presentation of results, and manuscript preparation and submission. Although there is a lack of health-education program evaluation, rigorous evaluations that have been conducted have, at least in some cases, led to wider dissemination of effective programs. These suggestions will help those interested in school health education understand the importance of evaluation and will provide important guidelines for those conducting evaluations of school health-education programs. © 2012, American School Health Association.

Seven challenges in international development assistance for health and ways forward.

PubMed

Sridhar, Devi

2010-01-01

This paper outlines seven challenges in development assistance for health, which in the current financial context, have become even more important to address. These include the following: (1) the proliferation of initiatives, focusing on specific diseases or issues, as well as (2) the lack of attention given to reforming the existing focal health institutions, the WHO and World Bank. (3) The lack of accountability of donors and their influence on priority-setting are part of the reason that there is "initiavitis," and resistance to creating a strong UN system. (4) Other than absolute quantity of aid, three other challenges linked to donors relate to the quality of aid financing particularly the pragmatic difficulties of financing horizontal interventions, (5) the marginal involvement of developing country governments as aid recipients, and (6) the heavy reliance on Northern-based organizations as managers of funds. (7) The final challenge discussed focuses on two unintended consequences of the recent linking of health and foreign policy for international development assistance. The paper then provides three suggestions for ways forward: creating new mechanisms to hold donors to account, developing national plans and strengthening national leadership in health, and South-South collaboration. © 2010 American Society of Law, Medicine & Ethics, Inc.

Food safety challenges and One Health within Europe.

PubMed

Boqvist, Sofia; Söderqvist, Karin; Vågsholm, Ivar

2018-01-03

This review discusses food safety aspects of importance from a One Health perspective, focusing on Europe. Using examples of food pathogen/food commodity combinations, spread of antimicrobial resistance in the food web and the risk of transmission of zoonotic pathogens in a circular system, it demonstrates how different perspectives are interconnected. The chosen examples all show the complexity of the food system and the necessity of using a One Health approach. Food safety resources should be allocated where they contribute most One Health benefits. Data on occurrence and disease burden and knowledge of source attribution are crucial in assessing costs and benefits of control measures. Future achievements in food safety, public health and welfare will largely be based on how well politicians, researchers, industry, national agencies and other stakeholders manage to collaborate using the One Health approach. It can be concluded that closer cooperation between different disciplines is necessary to avoid silo thinking when addressing important food safety challenges. The importance of this is often mentioned, but more proof of concept is needed by the research community.

Addressing the Health and Wellness Needs of Vulnerable Rockaway Residents in the Wake of Hurricane Sandy: Findings From a Health Coaching and Community Health Worker Program.

PubMed

Russell, David; Oberlink, Mia R; Shah, Shivani; Evans, Lauren; Bassuk, Karen

To describe the design and participants of a program that employed health coaches and community health workers to address the social, health, and long-term disaster recovery needs of Rockaway residents roughly 2 years after Hurricane Sandy made landfall. Baseline and exit questionnaires, containing demographic, health, and health care utilization measures, were administered to participants at the start and end of the program. Enrollment and encounter information was captured in program administrative records. Descriptive statistics were used to summarize participant characteristics, personal goals, referrals to local organizations and agencies, and outcomes. Qualitative analyses were used to identify recurring themes in challenges faced by participants and barriers to health and wellness. The program served 732 community residents, of whom 455 (62%) completed baseline and exit questionnaires. Participants were directly and/or indirectly impacted by Hurricane Sandy through property damage, closures of health care facilities, limited employment opportunities, and trouble securing affordable housing. Furthermore, many participants faced considerable adversities and struggled to manage chronic health conditions. Personal goals set by participants included locating health care and other resources (44%), weight management and healthy eating (35%), and self-management of chronic conditions (24%). Health coaches and community health workers engaged participants an average of 4 times-providing counseling and referrals to local organizations and services, including medical and dental services (29%), city-issued identification cards (27%), and health insurance and other entitlements (23%). Comparisons of baseline and exit surveys indicated significant improvements in self-reported health, health care utilization, and confidence managing health issues. No significant improvement was observed in the use of preventive health care services. The program represents a model for

Exploiting Advanced Hydrogel Technologies to Address Key Challenges in Regenerative Medicine

PubMed Central

Gentleman, Eileen

2018-01-01

Regenerative medicine aims to tackle a panoply of challenges, from repairing focal damage to articular cartilage to preventing pathological tissue remodelling after myocardial infarction. Hydrogels are water-swollen networks formed from synthetic or naturally derived polymers, and are emerging as important tools to address these challenges. Recent advances in hydrogel chemistries are enabling researchers to create hydrogels that can act as 3D ex vivo tissue models, allowing them to explore fundamental questions in cell biology by replicating tissues’ dynamic and non-linear physical properties. Enabled by emerging techniques such as 3D bioprinting, cell-laden hydrogels are also being developed with highly controlled tissue-specific architectures, vasculature, and biological functions that together can direct tissue repair. Moreover, advanced in situ forming and acellular hydrogels are increasingly finding use as delivery vehicles for bioactive compounds and in mediating host cell response. Here, we review advances in the design and fabrication of hydrogels for regenerative medicine. We also address how controlled chemistries are allowing for precise engineering of spatial and time-dependent properties in hydrogels with a look to how these materials will eventually translate to clinical applications. PMID:29316363

Cooperation of international Research Infrastructures to address environmental global challenges

NASA Astrophysics Data System (ADS)

Bonet García, Francisco J.; Suárez-Muñoz, María; Conchubhair, Diarmuid O.; Dohna, Tina; Lo Bue, Nadia

2017-04-01

Human impact on the planet is causing a set of global environmental problems that threaten the wellbeing of current and future generations. Examples of these environmental problems include climate change, decline of biodiversity, alteration of biogeochemical cycles, ocean acidification, etc. These environmental Global Challenges (GCs) are transnational and complex, combining elements of both natural and social factors. Providing solutions for these challenges can be significantly enhanced through the collaboration of various related institutions, governments and stakeholders. A deeper understanding of the causes and consequences of GCs, as well as the processes which control them is required. Environmental Research Infrastructures (DANUBIUS-RI) are key players in this learning process. Covering many fields of research, it is through RIs collaboration that GCs can be more fully addressed. However, the collaboration among environmental RIs is still limited nationally as well as internationally. Although contact is encouraged and interactions are common practice, there are few cases where RI managers initiate and foster transnational collaborations in order to address specific problems. The COOP+ project aims to explore and strengthen cooperation among global RIs by bringing various RIs together and working on the identification of requirements, strengths, knowledge gaps and other relevant items in regard to the selected GCs. For this purpose, 13 GCs have been selected: coral bleaching, marine debris, noise impact on marine fauna, Arctic sea ice melting, pollinators decline, threatened species, agriculture pollutants, nitrogen cycle, carbon and GHG, geohazards and extreme events, estuaries, global urbanization process, and ozone depletion. These GCs are being analysed and described by multidisciplinary teams of experts composed of scientists, RIs operators and other stakeholders. This assessment will derive a list of tasks and requirements to be fulfilled by the

COOP+ project: Promoting the cooperation among international Research Infrastructures to address global environmental challenges.

NASA Astrophysics Data System (ADS)

Bonet-García, Francisco; Materia, Paola; Kutsch, Werner; de Lucas, Jesús Marco; Tjulin, Anders

2016-04-01

During the Anthropocene, mankind will face several global environmental challenges. One of the first and more successful responses provided by Science to these challenges is the collecting of long-term series of biophysical variables in order to improve our knowledge of natural systems. The huge amount of information gathered during the last decades by Research Infrastructures (RIs) has helped to understand the structure and functioning of natural systems at local and regional scales. But how can we address the global cross-scale and cross-disciplinary challenges posed by the global environment change? We believe that it will be necessary to observe, model better and understand the whole biosphere using long term data generated by international RIs. RIs play a key role on many of the last advances and discoveries in science, from the observation of the Higgs Boson at CERN to the exploration of the Universe by the telescopes of the European Southern Observatory in Chile. The scale of complexity, instrumentation, computing resources, technological advances, and also of the investments, and the size of research collaborations, do not have precedents in Science. RIs in environmental field are developing fast, but the corresponding communities need yet to further reflect the need for a wider global collaboration because the challenges to tackle are in essence of global nature. This contribution describes how COOP+ project (EU Horizon 2020 Coordination and Support Action) will promote the cooperation among RIs at a global scale to address global environmental challenges. Our project evolves from the experience of the sucessful FP7 COOPEUS project (see http://www.coopeus.eu), which explored the use and access to data from RIs in environmental research in Europe and USA. The general goal of COOP+ is to strengthen the links and coordination of the ESFRI RIs related to Marine Science (EMSO), Arctic and Atmospheric Research (EISCAT), Carbon Observation (ICOS) and Biodiversity

National health insurance policy in Nepal: challenges for implementation.

PubMed

Mishra, Shiva Raj; Khanal, Pratik; Karki, Deepak Kumar; Kallestrup, Per; Enemark, Ulrika

2015-01-01

The health system in Nepal is characterized by a wide network of health facilities and community workers and volunteers. Nepal's Interim Constitution of 2007 addresses health as a fundamental right, stating that every citizen has the right to basic health services free of cost. But the reality is a far cry. Only 61.8% of the Nepalese households have access to health facilities within 30 min, with significant urban (85.9%) and rural (59%) discrepancy. Addressing barriers to health services needs urgent interventions at the population level. Recently (February 2015), the Government of Nepal formed a Social Health Security Development Committee as a legal framework to start implementing a social health security scheme (SHS) after the National Health Insurance Policy came out in 2013. The program has aimed to increase the access of health services to the poor and the marginalized, and people in hard to reach areas of the country, though challenges remain with financing. Several aspects should be considered in design, learning from earlier community-based health insurance schemes that suffered from low enrollment and retention of members as well as from a pro-rich bias. Mechanisms should be built for monitoring unfair pricing and unaffordable copayments, and an overall benefit package be crafted to include coverage of major health services including non-communicable diseases. Regulations should include such issues as accreditation mechanisms for private providers. Health system strengthening should move along with the roll-out of SHS. Improving the efficiency of hospital, motivating the health workers, and using appropriate technology can improve the quality of health services. Also, as currently a constitution drafting is being finalized, careful planning and deliberation is necessary about what insurance structure may suit the proposed future federal structure in Nepal.

Addressing the health needs of the homeless.

PubMed

John, William; Law, Kate

2011-03-01

Several authors have alluded to the complex health needs of the homeless population in the UK. The correlation between homelessness and a wide range of health problems has been explored in the literature. This paper presents a literature review exploring the biological, psychosocial and sexual health needs of single homeless people. The relationship between health and homelessness is analysed in relation to theories of health inequalities, which suggest that being homeless may be both a cause and a consequence of ill health. The contemporary nurse can play a vital role in helping to overcome the barriers that homeless people face when accessing health services. This paper explores the skills and approaches that nurses in a wide variety of settings can employ in addressing the health issues of homeless clients.

Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care.

PubMed Central

Betancourt, Joseph R.; Green, Alexander R.; Carrillo, J. Emilio; Ananeh-Firempong, Owusu

2003-01-01

OBJECTIVES: Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. METHODS: The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. RESULTS: Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. CONCLUSIONS: Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans. PMID:12815076

Police on the front line of community geriatric health care: challenges and opportunities.

PubMed

Brown, Rebecca T; Ahalt, Cyrus; Steinman, Michael A; Kruger, Kelly; Williams, Brie A

2014-11-01

As the population ages, police increasingly serve as first responders to incidents involving older adults in which aging-related health plays a critical role. The goals of this study were to assess police officers' knowledge of aging-related health, to identify challenges police experience in their encounters with older adults, and to describe their recommendations for how to address those challenges. This was a mixed-methods study of 141 San Francisco police officers recruited from mandatory police trainings between 2011 and 2013. Descriptive statistics were used to analyze 141 self-administered questionnaires, and principles of grounded theory were used to analyze open-ended questionnaire responses and 11 additional qualitative interviews. Eighty-nine percent of officers reported interacting with older adults at least monthly. Although 84% of police reported prior training in working with older adults, only 32% rated themselves as knowledgeable about aging-related health. Participants described themselves as first responders to medical and social emergencies involving older adults and identified several challenges, including identifying and responding to aging-related conditions and ensuring appropriate medical and social service handoffs. To address these challenges, officers recommended developing trainings focused on recognizing and responding to aging-related conditions and improving police knowledge of community resources for older adults. They also called for enhanced communication and collaboration between police and clinicians. These findings suggest that, because they assume a front-line role in responding to older adults with complex medical and social needs, many police may benefit from additional knowledge about aging-related health and community resources. Collaboration between police and healthcare providers presents an important opportunity to develop geriatrics training and interprofessional systems of care to support police work with a rapidly

Application of GIS technology in public health: successes and challenges.

PubMed

Fletcher-Lartey, Stephanie M; Caprarelli, Graziella

2016-04-01

The uptake and acceptance of Geographic Information Systems (GIS) technology has increased since the early 1990s and public health applications are rapidly expanding. In this paper, we summarize the common uses of GIS technology in the public health sector, emphasizing applications related to mapping and understanding of parasitic diseases. We also present some of the success stories, and discuss the challenges that still prevent a full scope application of GIS technology in the public health context. Geographical analysis has allowed researchers to interlink health, population and environmental data, thus enabling them to evaluate and quantify relationships between health-related variables and environmental risk factors at different geographical scales. The ability to access, share and utilize satellite and remote-sensing data has made possible even wider understanding of disease processes and of their links to the environment, an important consideration in the study of parasitic diseases. For example, disease prevention and control strategies resulting from investigations conducted in a GIS environment have been applied in many areas, particularly in Africa. However, there remain several challenges to a more widespread use of GIS technology, such as: limited access to GIS infrastructure, inadequate technical and analytical skills, and uneven data availability. Opportunities exist for international collaboration to address these limitations through knowledge sharing and governance.

The new "Indigenous health" incentive payment: issues and challenges.

PubMed

Couzos, Sophie; Delaney Thiele, Dea

2010-02-01

Paying incentives above the baseline Medicare Benefits Schedule to health services for the additional work required to meet the health needs of Aboriginal people or Torres Strait Islanders might mitigate inequalities of care, but evidence supporting this is lacking. The proposed "Indigenous health" incentive payment to reduce Aboriginal health disadvantage, which is largely aimed at increasing the responsiveness of mainstream general practices, provides an opportunity to examine the assumptions behind this and other recent health reform bids. Contentious implementation issues include: the ineligibility of several Aboriginal community controlled health services (ACCHSs) to receive this payment; determining Aboriginality and the potential for misappropriation of payments; the difficulty accounting for practice population diversity and patient mobility; and concerns about the benefits or otherwise to the Aboriginal community. Evaluation of the measure will present problems: to attribute outcomes, an evaluation must disaggregate outcomes by type of service provider (general practice or ACCHS). If these challenges are not addressed, this initiative may end up merely funding coordination of care for those Aboriginal people and Torres Strait Islanders who are already regular users of the health system.

Addressing Barriers to the Development and Adoption of Rapid Diagnostic Tests in Global Health.

PubMed

Miller, Eric; Sikes, Hadley D

Immunochromatographic rapid diagnostic tests (RDTs) have demonstrated significant potential for use as point-of-care diagnostic tests in resource-limited settings. Most notably, RDTs for malaria have reached an unparalleled level of technological maturity and market penetration, and are now considered an important complement to standard microscopic methods of malaria diagnosis. However, the technical development of RDTs for other infectious diseases, and their uptake within the global health community as a core diagnostic modality, has been hindered by a number of extant challenges. These range from technical and biological issues, such as the need for better affinity agents and biomarkers of disease, to social, infrastructural, regulatory and economic barriers, which have all served to slow their adoption and diminish their impact. In order for the immunochromatographic RDT format to be successfully adapted to other disease targets, to see widespread distribution, and to improve clinical outcomes for patients on a global scale, these challenges must be identified and addressed, and the global health community must be engaged in championing the broader use of RDTs.

Addressing Barriers to the Development and Adoption of Rapid Diagnostic Tests in Global Health

PubMed Central

Miller, Eric; Sikes, Hadley D.

2015-01-01

Immunochromatographic rapid diagnostic tests (RDTs) have demonstrated significant potential for use as point-of-care diagnostic tests in resource-limited settings. Most notably, RDTs for malaria have reached an unparalleled level of technological maturity and market penetration, and are now considered an important complement to standard microscopic methods of malaria diagnosis. However, the technical development of RDTs for other infectious diseases, and their uptake within the global health community as a core diagnostic modality, has been hindered by a number of extant challenges. These range from technical and biological issues, such as the need for better affinity agents and biomarkers of disease, to social, infrastructural, regulatory and economic barriers, which have all served to slow their adoption and diminish their impact. In order for the immunochromatographic RDT format to be successfully adapted to other disease targets, to see widespread distribution, and to improve clinical outcomes for patients on a global scale, these challenges must be identified and addressed, and the global health community must be engaged in championing the broader use of RDTs. PMID:26594252

Addressing the challenges of cross-jurisdictional data linkage between a national clinical quality registry and government-held health data.

PubMed

Andrew, Nadine E; Sundararajan, Vijaya; Thrift, Amanda G; Kilkenny, Monique F; Katzenellenbogen, Judith; Flack, Felicity; Gattellari, Melina; Boyd, James H; Anderson, Phil; Grabsch, Brenda; Lannin, Natasha A; Johnston, Trisha; Chen, Ying; Cadilhac, Dominique A

2016-10-01

To describe the challenges of obtaining state and nationally held data for linkage to a non-government national clinical registry. We reviewed processes negotiated to achieve linkage between the Australian Stroke Clinical Registry (AuSCR), the National Death Index, and state held hospital data. Minutes from working group meetings, national workshop meetings, and documented communications with health department staff were reviewed and summarised. Time from first application to receipt of data was more than two years for most state data-sets. Several challenges were unique to linkages involving identifiable data from a non-government clinical registry. Concerns about consent, the re-identification of data, duality of data custodian roles and data ownership were raised. Requirements involved the development of data flow methods, separating roles and multiple governance and ethics approvals. Approval to link death data presented the fewest barriers. To our knowledge, this is the first time in Australia that person-level data from a clinical quality registry has been linked to hospital and mortality data across multiple Australian jurisdictions. Implications for Public Health: The administrative load of obtaining linked data makes projects such as this burdensome but not impossible. An improved national centralised strategy for data linkage in Australia is urgently needed. © 2016 Public Health Association of Australia.

eHealth Recruitment Challenges

ERIC Educational Resources Information Center

Thompson, Debbe; Canada, Ashanti; Bhatt, Riddhi; Davis, Jennifer; Plesko, Lisa; Baranowski, Tom; Cullen, Karen; Zakeri, Issa

2006-01-01

Little is known about effective eHealth recruitment methods. This paper presents recruitment challenges associated with enrolling African-American girls aged 8-10 years in an eHealth obesity prevention program, their effect on the recruitment plan, and potential implications for eHealth research. Although the initial recruitment strategy was…

Redesigning Health Care Practices to Address Childhood Poverty.

PubMed

Fierman, Arthur H; Beck, Andrew F; Chung, Esther K; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Siegel, Benjamin; Chamberlain, Lisa J; Conroy, Kathleen; Federico, Steven G; Flanagan, Patricia J; Garg, Arvin; Gitterman, Benjamin A; Grace, Aimee M; Gross, Rachel S; Hole, Michael K; Klass, Perri; Kraft, Colleen; Kuo, Alice; Lewis, Gena; Lobach, Katherine S; Long, Dayna; Ma, Christine T; Messito, Mary; Navsaria, Dipesh; Northrip, Kimberley R; Osman, Cynthia; Sadof, Matthew D; Schickedanz, Adam B; Cox, Joanne

2016-04-01

Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty. Copyright © 2016 Academic Pediatric Association. All rights reserved.

The Public Health Nutrition workforce and its future challenges: the US experience.

PubMed

Haughton, Betsy; George, Alexa

2008-08-01

To describe the US public health nutrition workforce and its future social, biological and fiscal challenges. Literature review primarily for the four workforce surveys conducted since 1985 by the Association of State and Territorial Public Health Nutrition Directors. The United States. Nutrition personnel working in governmental health agencies. The 1985 and 1987 subjects were personnel in full-time budgeted positions employed in governmental health agencies providing predominantly population-based services. In 1994 and 1999 subjects were both full-time and part-time, employed in or funded by governmental health agencies, and provided both direct-care and population-based services. The workforce primarily focuses on direct-care services for pregnant and breast-feeding women, infants and children. The US Department of Agriculture funds 81.7 % of full-time equivalent positions, primarily through the WIC Program (Special Supplemental Nutrition Program for Women, Infants, and Children). Of those personnel working in WIC, 45 % have at least 10 years of experience compared to over 65 % of the non-WIC workforce. Continuing education needs of the WIC and non-WIC workforces differ. The workforce is increasingly more racially/ethnically diverse and with 18.2 % speaking Spanish as a second language. The future workforce will need to focus on increasing its diversity and cultural competence, and likely will need to address retirement within leadership positions. Little is known about the workforce's capacity to address the needs of the elderly, emergency preparedness and behavioural interventions. Fiscal challenges will require evidence-based practice demonstrating both costs and impact. Little is known about the broader public health nutrition workforce beyond governmental health agencies.

Addressing challenges to MMPI-2-RF-based testimony: questions and answers.

PubMed

Ben-Porath, Yossef S

2012-11-01

Introduction of a new version of a psychological test brings with it challenges that can be accentuated by the adversarial nature of the legal process. In the case of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF), these challenges can be addressed by becoming familiar with the rationale for and the methods used in revising the inventory, the information contained in the test manuals, and the growing peer-reviewed literature on the test. Potential challenges to MMPI-2-RF-based testimony are identified in this article and discussed in question and answer format. The questions guiding this discussion are based on the Daubert factors, established in 1993 by the US Supreme Court as criteria for gauging the scientific validity of proffered expert testimony. The answers to these questions apply more broadly to testimony in depositions, pre-trial hearings, and at trial. Consideration of the MMPI-2-RF in light of the Daubert factors indicates that the instrument has been subjected to extensive empirical testing and that a substantial peer-reviewed literature is available to guide and support its use. Information about the known and potential rate of error associated with MMPI-2-RF scores is available, and standard procedures for administration, scoring, and interpretation of the inventory are detailed in the test administration manual. Indicators of MMPI-2-RF acceptance can be cited, and criticisms of the MMPI-2-RF can be addressed with information available in the test documents and an extensive, modern, and actively growing peer-reviewed literature.

The experiences and challenges faced by rehabilitation community service therapists within the South African Primary Healthcare health system

PubMed Central

2017-01-01

Background Twenty-two years after the promulgation of a plethora of progressive health policies since 1994, the South African public health system reflects a number of stumbling blocks regarding implementation. Rehabilitation professionals are not sufficiently equipped nor allowed the opportunity to comprehensively implement Primary Healthcare (PHC) from a bottom-up approach, thus engaging communities. Training on addressing social health determinants and their impact on ill-health and health outcomes is inadequate. The inadequate understanding of the advocacy role that rehabilitation professionals could play in addressing social health determinants remains a challenge in healthcare. Rehabilitation, a pillar of PHC, remains poorly understood in terms of its role within the health system. Aim We argue for rehabilitation as a vehicle for addressing social determinants of health with community service practitioners playing a critical role in addressing the inequities within the healthcare package. Setting The article reflects the opportunities and challenges faced by rehabilitation community service therapists in the delivery of rehabilitation services in a rural area of the Eastern Cape province of South Africa. Methods A single case study from the perspective of a researcher was used to explore the experience and reflection of the first author during her community service as an occupational therapist. Results The case study highlights some existing gaps within the delivery of rehabilitation services in the rural Eastern Cape. A community service package with a specific approach towards addressing social determinants of health for persons with disability at a community level is suggested. Conclusion Advocating for a rehabilitation service package to shift to community-based levels is critical. It is envisaged that a community-based approach will facilitate an understanding of the barriers faced by persons with disabilities as constituting disability, thus

Challenges and Opportunities for Tribal Waters: Addressing Disparities in Safe Public Drinking Water on the Crow Reservation in Montana, USA.

PubMed

Doyle, John T; Kindness, Larry; Realbird, James; Eggers, Margaret J; Camper, Anne K

2018-03-21

Disparities in access to safe public drinking water are increasingly being recognized as contributing to health disparities and environmental injustice for vulnerable communities in the United States. As the Co-Directors of the Apsaálooke Water and Wastewater Authority (AWWWA) for the Crow Tribe, with our academic partners, we present here the multiple and complex challenges we have addressed in improving and maintaining tribal water and wastewater infrastructure, including the identification of diverse funding sources for infrastructure construction, the need for many kinds of specialized expertise and long-term stability of project personnel, ratepayer difficulty in paying for services, an ongoing legacy of inadequate infrastructure planning, and lack of water quality research capacity. As a tribal entity, the AWWWA faces additional challenges, including the complex jurisdictional issues affecting all phases of our work, lack of authority to create water districts, and additional legal and regulatory gaps-especially with regards to environmental protection. Despite these obstacles, the AWWWA and Crow Tribe have successfully upgraded much of the local water and wastewater infrastructure. We find that ensuring safe public drinking water for tribal and other disadvantaged U.S. communities will require comprehensive, community-engaged approaches across a broad range of stakeholders to successfully address these complex legal, regulatory, policy, community capacity, and financial challenges.

Challenges and Opportunities for Tribal Waters: Addressing Disparities in Safe Public Drinking Water on the Crow Reservation in Montana, USA

PubMed Central

Doyle, John T.; Kindness, Larry; Realbird, James; Camper, Anne K.

2018-01-01

Disparities in access to safe public drinking water are increasingly being recognized as contributing to health disparities and environmental injustice for vulnerable communities in the United States. As the Co-Directors of the Apsaálooke Water and Wastewater Authority (AWWWA) for the Crow Tribe, with our academic partners, we present here the multiple and complex challenges we have addressed in improving and maintaining tribal water and wastewater infrastructure, including the identification of diverse funding sources for infrastructure construction, the need for many kinds of specialized expertise and long-term stability of project personnel, ratepayer difficulty in paying for services, an ongoing legacy of inadequate infrastructure planning, and lack of water quality research capacity. As a tribal entity, the AWWWA faces additional challenges, including the complex jurisdictional issues affecting all phases of our work, lack of authority to create water districts, and additional legal and regulatory gaps—especially with regards to environmental protection. Despite these obstacles, the AWWWA and Crow Tribe have successfully upgraded much of the local water and wastewater infrastructure. We find that ensuring safe public drinking water for tribal and other disadvantaged U.S. communities will require comprehensive, community-engaged approaches across a broad range of stakeholders to successfully address these complex legal, regulatory, policy, community capacity, and financial challenges. PMID:29561815

Important challenges for coordination and inter-municipal cooperation in health care services: a Delphi study

PubMed Central

2013-01-01

Background Demographical changes have stimulated a coordination reform in the Norwegian health care sector, creating new working practices and extending coordination within and between primary and hospital care, increasing the need for inter-municipal cooperation (IMC). This study aimed to identify challenges to coordination and IMC in the Norwegian health care sector as a basis for further theorizing and managerial advice in this growing area of research and practice. Methods A Delphi study of consensus development was used. Experts in coordination and IMC in health care services were selected by the healthcare manager or the councillor in their respective municipalities. In the first round, an expert panel received open-ended questions addressing possible challenges, and their answers were categorized and consolidated as the basis for further validation in the second round. The expert panel members were then asked to point out important statements in the third round, before the most important statements ranked by a majority of the members were rated again in the fourth round, including the option to explain the ratings. The same procedure was used in round five, with the exception that the expert panel members could view the consolidated results of their previous rankings as the basis for a new and final rating. The statements reaching consensus in round five were abstracted and themed. Results Nineteen experts consented to participate. Nine experts (47%) completed all of the five rounds. Eight statements concerning coordination reached consensus, resulting in four themes covering these challenges: different culture, uneven balance of power, lack of the possibility to communicate electronically, and demanding tasks in relation to resources. Three statements regarding challenges to IMC reached consensus, resulting in following themes: coopetition, complex leadership, and resistance to change. Conclusions This study identified several important challenges for

The case for the World Health Organization's Commission on Social Determinants of Health to address gender identity.

PubMed

Pega, Frank; Veale, Jaimie F

2015-03-01

We analyzed the case of the World Health Organization's Commission on Social Determinants of Health, which did not address gender identity in their final report. We argue that gender identity is increasingly being recognized as an important social determinant of health (SDH) that results in health inequities. We identify right to health mechanisms, such as established human rights instruments, as suitable policy tools for addressing gender identity as an SDH to improve health equity. We urge the World Health Organization to add gender identity as an SDH in its conceptual framework for action on the SDHs and to develop and implement specific recommendations for addressing gender identity as an SDH.

Challenges for health care development in Croatia.

PubMed

Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja

2012-09-01

The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.

Tailored Educational Approaches for Consumer Health: A Model to Address Health Promotion in an Era of Personalized Medicine.

PubMed

Cohn, Wendy F; Lyman, Jason; Broshek, Donna K; Guterbock, Thomas M; Hartman, David; Kinzie, Mable; Mick, David; Pannone, Aaron; Sturz, Vanessa; Schubart, Jane; Garson, Arthur T

2018-01-01

To develop a model, based on market segmentation, to improve the quality and efficiency of health promotion materials and programs. Market segmentation to create segments (groups) based on a cross-sectional questionnaire measuring individual characteristics and preferences for health information. Educational and delivery recommendations developed for each group. General population of adults in Virginia. Random sample of 1201 Virginia residents. Respondents are representative of the general population with the exception of older age. Multiple factors known to impact health promotion including health status, health system utilization, health literacy, Internet use, learning styles, and preferences. Cluster analysis and discriminate analysis to create and validate segments. Common sized means to compare factors across segments. Developed educational and delivery recommendations matched to the 8 distinct segments. For example, the "health challenged and hard to reach" are older, lower literacy, and not likely to seek out health information. Their educational and delivery recommendations include a sixth-grade reading level, delivery through a provider, and using a "push" strategy. This model addresses a need to improve the efficiency and quality of health promotion efforts in an era of personalized medicine. It demonstrates that there are distinct groups with clearly defined educational and delivery recommendations. Health promotion professionals can consider Tailored Educational Approaches for Consumer Health to develop and deliver tailored materials to encourage behavior change.

Public health workforce: challenges and policy issues

PubMed Central

Beaglehole, Robert; Dal Poz, Mario R

2003-01-01

This paper reviews the challenges facing the public health workforce in developing countries and the main policy issues that must be addressed in order to strengthen the public health workforce. The public health workforce is diverse and includes all those whose prime responsibility is the provision of core public health activities, irrespective of their organizational base. Although the public health workforce is central to the performance of health systems, very little is known about its composition, training or performance. The key policy question is: Should governments invest more in building and supporting the public health workforce and infrastructure to ensure the more effective functioning of health systems? Other questions concern: the nature of the public health workforce, including its size, composition, skills, training needs, current functions and performance; the appropriate roles of the workforce; and how the workforce can be strengthened to support new approaches to priority health problems. The available evidence to shed light on these policy issues is limited. The World Health Organization is supporting the development of evidence to inform discussion on the best approaches to strengthening public health capacity in developing countries. WHO's priorities are to build an evidence base on the size and structure of the public health workforce, beginning with ongoing data collection activities, and to map the current public health training programmes in developing countries and in Central and Eastern Europe. Other steps will include developing a consensus on the desired functions and activities of the public health workforce and developing a framework and methods for assisting countries to assess and enhance the performance of public health training institutions and of the public health workforce. PMID:12904251

Challenges Addressing Unmet Need for Contraception: Voices of Family Planning Service Providers in Rural Tanzania.

PubMed

Baraka, Jitihada; Rusibamayila, Asinath; Kalolella, Admirabilis; Baynes, Colin

2015-12-01

Provider perspectives have been overlooked in efforts to address the challenges of unmet need for family planning (FP). This qualitative study was undertaken in Tanzania, using 22 key informant interviews and 4 focus group discussions. The research documents perceptions of healthcare managers and providers in a rural district on the barriers to meeting latent demand for contraception. Social-ecological theory is used to interpret the findings, illustrating how service capability is determined by the social, structural and organizational environment. Providers' efforts to address unmet need for FP services are constrained by unstable reproductive preferences, low educational attainment, and misconceptions about contraceptive side effects. Societal and organizational factors--such as gender dynamics, economic conditions, religious and cultural norms, and supply chain bottlenecks, respectively--also contribute to an adverse environment for meeting needs for care. Challenges that healthcare providers face interact and produce an effect which hinders efforts to address unmet need. Interventions to address this are not sufficient unless the supply of services is combined with systems strengthening and social engagement strategies in a way that reflects the multi-layered, social institutional problems.

Health Information Technology Challenges to Support Patient-Centered Care Coordination

PubMed Central

Séroussi, B.; Jaulent, M.-C.; Lehmann, C. U.

2015-01-01

Summary Objectives To provide an editorial introduction to the 2015 IMIA Yearbook of Medical Informatics. Methods We provide a brief overview of the 2015 special topic “Patient-Centered Care Coordination”, discuss the addition of two new sections to the Yearbook, Natural Language Processing and Public Health & Epidemiology Informatics, and present our editorial plans for the upcoming celebration of the 25th anniversary of the Yearbook. Results Care delivery currently occurs through the processing of complex clinical pathways designed for increasingly multi-morbid patients by various practitioners in different settings. To avoid the consequences of the fragmentation of services, care should be organized to coordinate all providers, giving them the opportunity to share the same holistic view of the patient’s condition, and to be informed of the planned clinical pathway that establishes the roles and interventions of each one. The adoption and use of electronic health records (EHRs) is a solution to address health information sharing and care coordination challenges. However, while EHRs are necessary, they are not sufficient to achieve care coordination, creating information availability does not mean the information will be accessed. This edition of the Yearbook acknowledges the fact that health information technology (HIT), and EHRs in particular, are not yet fully addressing the challenges in care coordination. Emerging trends, tools, and applications of HIT to support care coordination are presented through the keynote paper, survey papers, and working group contributions. Conclusions In 2015, the IMIA Yearbook has been extended to emphasize two fields of biomedical informatics through new sections. Next year, the 25th anniversary of the Yearbook will be celebrated in grand style! A special issue with a touch of reflection, a bit of rediscovery, and some “science-fiction” will be published in addition to the usual edition. PMID:26123912

Health Information Technology Challenges to Support Patient-Centered Care Coordination.

PubMed

Séroussi, B; Jaulent, M-C; Lehmann, C U

2015-08-13

To provide an editorial introduction to the 2015 IMIA Yearbook of Medical Informatics. We provide a brief overview of the 2015 special topic "Patient-Centered Care Coordination", discuss the addition of two new sections to the Yearbook, Natural Language Processing and Public Health & Epidemiology Informatics, and present our editorial plans for the upcoming celebration of the 25th anniversary of the Yearbook. Care delivery currently occurs through the processing of complex clinical pathways designed for increasingly multi-morbid patients by various practitioners in different settings. To avoid the consequences of the fragmentation of services, care should be organized to coordinate all providers, giving them the opportunity to share the same holistic view of the patient's condition, and to be informed of the planned clinical pathway that establishes the roles and interventions of each one. The adoption and use of electronic health records (EHRs) is a solution to address health information sharing and care coordination challenges. However, while EHRs are necessary, they are not sufficient to achieve care coordination, creating information availability does not mean the information will be accessed. This edition of the Yearbook acknowledges the fact that health information technology (HIT), and EHRs in particular, are not yet fully addressing the challenges in care coordination. Emerging trends, tools, and applications of HIT to support care coordination are presented through the keynote paper, survey papers, and working group contributions. In 2015, the IMIA Yearbook has been extended to emphasize two fields of biomedical informatics through new sections. Next year, the 25th anniversary of the Yearbook will be celebrated in grand style! A special issue with a touch of reflection, a bit of rediscovery, and some "science-fiction" will be published in addition to the usual edition.

Back to the basics: Identifying and addressing underlying challenges in achieving high quality and relevant health statistics for indigenous populations in Canada

PubMed Central

Smylie, Janet; Firestone, Michelle

2015-01-01

Canada is known internationally for excellence in both the quality and public policy relevance of its health and social statistics. There is a double standard however with respect to the relevance and quality of statistics for Indigenous populations in Canada. Indigenous specific health and social statistics gathering is informed by unique ethical, rights-based, policy and practice imperatives regarding the need for Indigenous participation and leadership in Indigenous data processes throughout the spectrum of indicator development, data collection, management, analysis and use. We demonstrate how current Indigenous data quality challenges including misclassification errors and non-response bias systematically contribute to a significant underestimate of inequities in health determinants, health status, and health care access between Indigenous and non-Indigenous people in Canada. The major quality challenge underlying these errors and biases is the lack of Indigenous specific identifiers that are consistent and relevant in major health and social data sources. The recent removal of an Indigenous identity question from the Canadian census has resulted in further deterioration of an already suboptimal system. A revision of core health data sources to include relevant, consistent, and inclusive Indigenous self-identification is urgently required. These changes need to be carried out in partnership with Indigenous peoples and their representative and governing organizations. PMID:26793283

Emerging health issues: the widening challenge for population health promotion.

PubMed

McMichael, Anthony J; Butler, Colin D

2006-12-01

The spectrum of tasks for health promotion has widened since the Ottawa Charter was signed. In 1986, infectious diseases still seemed in retreat, the potential extent of HIV/AIDS was unrecognized, the Green Revolution was at its height and global poverty appeared less intractable. Global climate change had not yet emerged as a major threat to development and health. Most economists forecast continuous improvement, and chronic diseases were broadly anticipated as the next major health issue. Today, although many broadly averaged measures of population health have improved, many of the determinants of global health have faltered. Many infectious diseases have emerged; others have unexpectedly reappeared. Reasons include urban crowding, environmental changes, altered sexual relations, intensified food production and increased mobility and trade. Foremost, however, is the persistence of poverty and the exacerbation of regional and global inequality. Life expectancy has unexpectedly declined in several countries. Rather than being a faint echo from an earlier time of hardship, these declines could signify the future. Relatedly, the demographic and epidemiological transitions have faltered. In some regions, declining fertility has overshot that needed for optimal age structure, whereas elsewhere mortality increases have reduced population growth rates, despite continuing high fertility. Few, if any, Millennium Development Goals (MDG), including those for health and sustainability, seem achievable. Policy-makers generally misunderstand the link between environmental sustainability (MDG #7) and health. Many health workers also fail to realize that social cohesion and sustainability--maintenance of the Earth's ecological and geophysical systems--is a necessary basis for health. In sum, these issues present an enormous challenge to health. Health promotion must address population health influences that transcend national boundaries and generations and engage with the

Hispanic Women's Expectations of Campus-Based Health Clinics Addressing Sexual Health Concerns

ERIC Educational Resources Information Center

Stephens, Dionne P.; Thomas, Tami L.

2011-01-01

Although the number of Hispanic women attending postsecondary institutions has significantly increased in the past decade, knowledge about their use of campus health services to address sexuality-related issues remains low. Increased information about this population is crucial given that sexual health indicators have shown Hispanic women in…

Work-related Mental Health Surveillance in Brazil: characteristics, difficulties, and challenges.

PubMed

Araújo, Tania Maria; Palma, Tarciso de Figueiredo; Araújo, Natália do Carmo

2017-10-01

This paper addresses the challenges and difficulties in Work-related Mental Health (WMH) Surveillance in Brazil, based on a review of the bibliographic literature. From the compilation of identified academic research, it seeks to foster reflections about the current landscape of surveillance actions, its main obstacles, and possibilities for improvement. A survey of national publications was carried out using Scielo, Lilacs and PUBMED databases from 2002 until 2017. Systematizing the results allows us to group the following themes: Epidemiology of WMH in Brazil; Policies for WMH and VISAT; Work Environment for Mental Health; and, Actions and Interventions in the VISAT and WMH. The surveillance actions are still in the early stages; however, there is an effort to strengthen the RENAST, materialized in the creation of protocols and the promotion of national meetings which reflect the construction of a new surveillance model for worker health. We noted a search for new conceptual models of mental illness, a redefinition of the focus of care, and of intervention approaches highlighting the active role of workers, who are essential players in facing the challenges in this area.

Beyond Bellagio: addressing the challenge of sustainable child health in developing countries.

PubMed

Bhutta, Z A

2004-05-01

Despite the hype and ostensible investments in child survival strategies, the state of child health in much of the developing world is alarming. Not only are global investments and support programmes for child health by the development agencies declining, but commensurate support for maternal and child health by poor countries themselves is poor. In order to make a meaningful contribution to maternal and child health and survival, a multi-pronged approach is needed which not only focuses on the proximal determinants of child health but also some of the underlying factors governing the status of women in society and expenditures on health and development.

Policy approaches to address the social and environmental determinants of health inequity in Asia-pacific.

PubMed

Friel, Sharon; Loring, Belinda; Aungkasuvapala, Narongsakdi; Baum, Fran; Blaiklock, Alison; Chiang, Tung-Liang; Cho, Youngtae; Dakulala, Paison; Guo, Yan; Hashimoto, Hideki; Horton, Kellie; Jayasinghe, Saroj; Matheson, Don; Nguyen, Huong Thanh; Otto, Caleb; Rao, Mala; Reid, Paaparangi; Surjadi, Charles

2012-11-01

Asia Pacific is home to over 60% of the world's population and the fastest growing economies. Many of the leadership in the Asia Pacific region is becoming increasingly aware that improving the conditions for health would go a long way to sustaining economic prosperity in the region, as well as improving global and local health equity. There is no biological reason why males born in Cambodia can expect to live 23 years less than males born in Japan, or why females born in Tuvalu live 23 years shorter than females in New Zealand or why non-Indigenous Australian males live 12 years longer than Indigenous men. The nature and drivers of health inequities vary greatly among different social, cultural and geo-political contexts and effective solutions must take this into account. This paper utilizes the CSDH global recommendations as a basis for looking at the actions that are taking place to address the structural drivers and conditions of daily living that affect health inequities in the Asia Pacific context. While there are signs of action and hope, substantial challenges remain for health equity in Asia Pacific. The gains that have been made to date are not equally distributed and may be unsustainable as the world encounters new economic, social and environmental challenges. Tackling health inequities is a political imperative that requires leadership, political courage, social action, a sound evidence base and progressive public policy.

THE FUKUSHIMA RADIOLOGICAL EMERGENCY AND CHALLENGES IDENTIFIED FOR FUTURE PUBLIC HEALTH RESPONSES

PubMed Central

Miller, Charles W.

2015-01-01

On 11 March 2011, northern Japan was rocked by first a magnitude 9.0 earthquake off the eastern coast and then an ensuing tsunami. The Fukushima Daiichi Nuclear Power Plant complex was hit by these twin disasters, and a cascade of events was initiated that led to radionuclide releases causing widespread radioactive contamination of residential areas, agricultural land, and coastal waters. Radioactive material from Japan was subsequently transmitted to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to be a concern for health effects, but the presence of this material in the environment was enough to create a public health emergency in the U.S. The radiation safety and public health communities in the U.S. are identifying challenges they faced in responding to this incident. This paper discusses three of those challenges: (1) The growing shortage of trained radiation subject matter experts in the field of environmental transport and dosimetry of radionuclides; (2) the need to begin expressing all radiation-related quantities in terms of the International System of Units; and (3) the need to define when a radiation dose is or is not one of “public health concern.” This list represents only a small subset of the list of challenges being identified by public health agencies that responded to the Fukushima incident. However, these three challenges are fundamental to any radiological emergency response. Addressing them will have a significant positive impact on how the U.S. responds to the next radiological emergency. PMID:22469934

The Fukushima radiological emergency and challenges identified for future public health responses.

PubMed

Miller, Charles W

2012-05-01

On 11 March 2011, northern Japan was rocked by first a magnitude 9.0 earthquake off the eastern coast and then an ensuing tsunami. The Fukushima Daiichi Nuclear Power Plant complex was hit by these twin disasters, and a cascade of events was initiated that led to radionuclide releases causing widespread radioactive contamination of residential areas, agricultural land, and coastal waters. Radioactive material from Japan was subsequently transmitted to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to be a concern for health effects, but the presence of this material in the environment was enough to create a public health emergency in the U.S. The radiation safety and public health communities in the U.S. are identifying challenges they faced in responding to this incident. This paper discusses three of those challenges: (1) The growing shortage of trained radiation subject matter experts in the field of environmental transport and dosimetry of radionuclides; (2) the need to begin expressing all radiation-related quantities in terms of the International System of Units; and (3) the need to define when a radiation dose is or is not one of "public health concern." This list represents only a small subset of the list of challenges being identified by public health agencies that responded to the Fukushima incident. However, these three challenges are fundamental to any radiological emergency response. Addressing them will have a significant positive impact on how the U.S. responds to the next radiological emergency.

Addressing implementation challenges during guideline development - a case study of Swedish national guidelines for methods of preventing disease.

PubMed

Richter-Sundberg, Linda; Kardakis, Therese; Weinehall, Lars; Garvare, Rickard; Nyström, Monica E

2015-01-22

Many of the world's life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines. Seven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework. The study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues. This case study

Challenges in doing multi-disciplinary health promotion research in Germany.

PubMed

Igel, Ulrike; Gausche, Ruth; Lück, Martina; Lipek, Tobias; Spielau, Ulrike; Garz, Maria; Kiess, Wieland; Grande, Gesine

2017-08-23

Health problems such as obesity are increasingly addressed by complex intervention programmes which operate at multiple levels of influence (e.g. families, schools, neighbourhoods) involving partners from various academic, professional and cultural backgrounds. Following a complex participatory health promotion approach is challenging, because conflicting interests as well as contextual constraints may occur which are rarely discussed empirically. Process evaluations of some programmes investigate factors influencing the implementation process. However, researchers' perspectives on inter- and transdisciplinary work are mostly neglected. This paper aims at illustrating and critically analysing challenges that arose in the planning and implementation of a health promotion project in a socially deprived neighbourhood in Germany. Drawing on minutes, email conversations, and research diary entries we reflect on discrepancies and difficult interactions within the research team, with collaborating (academic) institutions (interdisciplinary work) and with the community partners (transdisciplinary work) respectively. Differences in language, interests, success criteria, professional preferences and habits as well as contextual factors are worked out and coping strategies or solutions are proposed. According to our experiences, bringing to light researchers' positions, preferences and interactions with the community is necessary to find a balance between research and practice, to develop adequate solutions for challenging situations and to evaluate the process, effectiveness and transferability of a programme. Health promotion research should report not only on the effectiveness of interventions but also on struggles, unsuccessful attempts and useful (or useless) strategies to fuel discourse on opportunities in and the efficacy and transferability of health promotion projects. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions

The challenge of big data in public health: an opportunity for visual analytics.

PubMed

Ola, Oluwakemi; Sedig, Kamran

2014-01-01

Public health (PH) data can generally be characterized as big data. The efficient and effective use of this data determines the extent to which PH stakeholders can sufficiently address societal health concerns as they engage in a variety of work activities. As stakeholders interact with data, they engage in various cognitive activities such as analytical reasoning, decision-making, interpreting, and problem solving. Performing these activities with big data is a challenge for the unaided mind as stakeholders encounter obstacles relating to the data's volume, variety, velocity, and veracity. Such being the case, computer-based information tools are needed to support PH stakeholders. Unfortunately, while existing computational tools are beneficial in addressing certain work activities, they fall short in supporting cognitive activities that involve working with large, heterogeneous, and complex bodies of data. This paper presents visual analytics (VA) tools, a nascent category of computational tools that integrate data analytics with interactive visualizations, to facilitate the performance of cognitive activities involving big data. Historically, PH has lagged behind other sectors in embracing new computational technology. In this paper, we discuss the role that VA tools can play in addressing the challenges presented by big data. In doing so, we demonstrate the potential benefit of incorporating VA tools into PH practice, in addition to highlighting the need for further systematic and focused research.

The Challenge of Big Data in Public Health: An Opportunity for Visual Analytics

PubMed Central

Ola, Oluwakemi; Sedig, Kamran

2014-01-01

Public health (PH) data can generally be characterized as big data. The efficient and effective use of this data determines the extent to which PH stakeholders can sufficiently address societal health concerns as they engage in a variety of work activities. As stakeholders interact with data, they engage in various cognitive activities such as analytical reasoning, decision-making, interpreting, and problem solving. Performing these activities with big data is a challenge for the unaided mind as stakeholders encounter obstacles relating to the data’s volume, variety, velocity, and veracity. Such being the case, computer-based information tools are needed to support PH stakeholders. Unfortunately, while existing computational tools are beneficial in addressing certain work activities, they fall short in supporting cognitive activities that involve working with large, heterogeneous, and complex bodies of data. This paper presents visual analytics (VA) tools, a nascent category of computational tools that integrate data analytics with interactive visualizations, to facilitate the performance of cognitive activities involving big data. Historically, PH has lagged behind other sectors in embracing new computational technology. In this paper, we discuss the role that VA tools can play in addressing the challenges presented by big data. In doing so, we demonstrate the potential benefit of incorporating VA tools into PH practice, in addition to highlighting the need for further systematic and focused research. PMID:24678376

The role of community health workers (CHWs) in health promotion research: ethical challenges and practical solutions.

PubMed

Terpstra, Jennifer; Coleman, Karen J; Simon, Gayle; Nebeker, Camille

2011-01-01

This article aims to describe the role of community health workers (CHWs) in health promotion research and address the challenges and ethical concerns associated with this research approach. A series of six focus groups are conducted with project managers and investigators (n = 5 to 11 per session) who have worked with CHWs in health promotion research. These focus groups are part of a larger study funded by the National Institutes of Health titled "Training in Research Ethics and Standards" (Project TRES). Participants are asked to describe their training needs for CHWs with respect to human subject protections as well as to identify associated challenges regarding research practice (i.e., recruitment, random assignment, protocol implementation, etc.). Findings reveal a number of challenges that investigators and project managers encounter when working with CHWs on research projects involving the community. These include characteristics inherent to CHWs such as education level and personal beliefs about their own community and its needs, institutional regulations regarding research practice, and problems inherent to research studies such as training materials and protocols that cannot account for the complexity of conducting research in community settings. Investigators should carefully consider the role that CHWs have in their communities before creating research programs that depend on the CHWs' existing social networks and their propensity to be natural helpers. These strengths could lead to compromises in research requirements for random assignment, control groups, and fully informed consent.

Making the invisible visible: are health social workers addressing the social determinants of health?

PubMed

Craig, Shelley L; Bejan, Raluca; Muskat, Barbara

2013-01-01

This study explored the ways in which health social workers (HSW) address the social determinants of health (SDH) within their social work practice. Social workers (n = 54) employed at major hospitals across Toronto had many years of practice in health care (M = 11 years; SD = 10.32) and indicated that SDH were a top priority in their daily work; with 98% intentionally intervening with at least one and 91% attending to three or more. Health care services were most often addressed (92%), followed by housing (72%), disability (79%), income (72%), and employment security (70%). Few HSW were tackling racism, Aboriginal status, gender, or social exclusion in their daily practice.

Addressing Earth Science Data Access Challenges through User Experience Research

NASA Astrophysics Data System (ADS)

Hemmings, S. N.; Banks, B.; Kendall, J.; Lee, C. M.; Irwin, D.; Toll, D. L.; Searby, N. D.

2013-12-01

The NASA Capacity Building Program (Earth Science Division, Applied Sciences Program) works to enhance end-user capabilities to employ Earth observation and Earth science (EO/ES) data in decision-making. Open data access and user-tailored data delivery strategies are critical elements towards this end. User Experience (UX) and User Interface (UI) research methods can offer important contributions towards addressing data access challenges, particularly at the interface of science application/product development and product transition to end-users. This presentation focuses on developing nation contexts and describes methods, results, and lessons learned from two recent UX/UI efforts conducted in collaboration with NASA: the SERVIRglobal.net redesign project and the U.S. Water Partnership (USWP) Portal development effort. SERVIR, a collaborative venture among NASA, USAID, and global partners, seeks to improve environmental management and climate change response by helping governments and other stakeholders integrate EO and geospatial technologies into decision-making. The USWP, a collaboration among U.S. public and private sectors, harnesses U.S.-based resources and expertise to address water challenges in developing nations. SERVIR's study, conducted from 2010-2012, assessed and tested user needs, preferences, and online experiences to generate a more user-friendly online data portal at SERVIRglobal.net. The portal provides a central access interface to data and products from SERVIR's network of hubs in East Africa, the Hindu Kush Himalayas, and Mesoamerica. The second study, conducted by the USWP Secretariat and funded by the U.S. Department of State, seeks to match U.S.-based water information resources with developing nation stakeholder needs. The USWP study utilizes a multi-pronged approach to identify key design requirements and to understand the existing water data portal landscape. Adopting UX methods allows data distributors to design customized UIs that

School-based youth health nurses: roles, responsibilities, challenges, and rewards.

PubMed

Barnes, Margaret; Courtney, Mary D; Pratt, Jan; Walsh, Anne M

2004-01-01

A case study and focus-group discussions were conducted with 10 youth health nurses (nurses) employed in the recently introduced School-Based Youth Health Nurse Program (SBYHNP) to identify their roles, responsibilities, and professional development needs. Major roles are support, referral, health promotion, and marketing. Clients include high school students, teachers, and parents; the majority of whom are female and aged 13-16 years. Health issues addressed during individual consultations are predominantly psychosocial but also include medical, sexual health and sexuality issues, health surveillance, and risk-taking behaviors. Nurses also provide clients with health information and promote enhanced personal skill development during these consultations. Health promotion strategies undertaken by nurses were predominantly health education and health information displays. Nurses reported marketing their role and function within the school to be an essential and often difficult aspect of their role. Professional development through the SBYHNP was excellent; however, there was concern relating to the availability of future educational opportunities. The SBYHNP provides nurses with a new, challenging, autonomous role within the school environment and the opportunity to expand their role to incorporate all aspects of the health-promoting schools' framework.

Technical challenges in designing post-marketing eCRFs to address clinical safety and pharmacovigilance needs.

PubMed

Lu, Zhengwu

2010-01-01

To identify key challenges and propose technical considerations in designing electronic case report form (eCRF) for post-marketing studies, the author undertakes a comprehensive literature review of peer reviewed and grey literature to assess the key aspects, processes, standards, recommendations, and best practices in designing eCRFs based on industry experience in designing and supporting electronic data capture (EDC) studies. Literature search using strings on MEDLINE and PUBMED returned few papers directly related to CRF design. Health informatics and general practice journals were searched and results reviewed. Many conference, government commission, health professional and special interests group websites provide relevant information from practical experience - summarization of this information is presented. Further, we presented a list of concrete technical considerations in dealing with EDC technology/system limitations based on literature assessment and industry implementation experience. It is recognized that cross-functional teams be involved in eCRF design process and decision making. To summarize the keys in designing eCRFs to address post-market study safety and pharmacovigilance needs, the first is to identify required data elements from the study protocol supporting data analyses and reporting requirements. Secondly, accepted best practices, CDASH & CDISC guidelines, and company internal or therapeutic unit standard should be considered and applied. Coding (MedDRA & WHODD) mapping should be managed and implemented as well when possible. Finally, we need to be on top of the EDC technologies, challenge the technologies, drive EDC improvement via working with vendors, and utilize the technologies to drive clinical effectiveness. Copyright (c) 2009 Elsevier Inc. All rights reserved.

Unguided Mental Health Self-help Apps: Reflections on Challenges through a Clinician's Lens.

PubMed

Mehrotra, Seema; Kumar, Satish; Sudhir, Paulomi; Rao, Girish N; Thirthalli, Jagadisha; Gandotra, Aditi

2017-01-01

The past one decade has witnessed a boom in the availability of Internet-based self-help apps in the field of mental health. Several apps have emerged that aim to provide information and strategies to empower individuals with self-help approaches to deal with issues and concerns related to mental health. A large number of these apps in developing countries are likely to be those which depend entirely on the users to go over the self-help program on their own (unguided internet-based self-help). Only a few apps add a component of periodic professional contact/technical support through phone/email or other means to supplement the self-help strategies suggested in the app that the user is expected to utilize. This scenario poses several challenges in use of unguided self-help apps for mental health. This paper enumerates some of these challenges for potential users of the apps from the perspective of clinicians. These range from difficulties in choosing the right app, limited scope for contextualization, and motivation management to awareness about when to step up to a higher intensity intervention. Despite these challenges, unguided self-help apps can serve important purposes, and hence we propose a few recommendations to address such challenges.

Unguided Mental Health Self-help Apps: Reflections on Challenges through a Clinician's Lens

PubMed Central

Mehrotra, Seema; Kumar, Satish; Sudhir, Paulomi; Rao, Girish N.; Thirthalli, Jagadisha; Gandotra, Aditi

2017-01-01

The past one decade has witnessed a boom in the availability of Internet-based self-help apps in the field of mental health. Several apps have emerged that aim to provide information and strategies to empower individuals with self-help approaches to deal with issues and concerns related to mental health. A large number of these apps in developing countries are likely to be those which depend entirely on the users to go over the self-help program on their own (unguided internet-based self-help). Only a few apps add a component of periodic professional contact/technical support through phone/email or other means to supplement the self-help strategies suggested in the app that the user is expected to utilize. This scenario poses several challenges in use of unguided self-help apps for mental health. This paper enumerates some of these challenges for potential users of the apps from the perspective of clinicians. These range from difficulties in choosing the right app, limited scope for contextualization, and motivation management to awareness about when to step up to a higher intensity intervention. Despite these challenges, unguided self-help apps can serve important purposes, and hence we propose a few recommendations to address such challenges. PMID:29200577

Incorporating intersectionality theory into population health research methodology: challenges and the potential to advance health equity.

PubMed

Bauer, Greta R

2014-06-01

Intersectionality theory, developed to address the non-additivity of effects of sex/gender and race/ethnicity but extendable to other domains, allows for the potential to study health and disease at different intersections of identity, social position, processes of oppression or privilege, and policies or institutional practices. Intersectionality has the potential to enrich population health research through improved validity and greater attention to both heterogeneity of effects and causal processes producing health inequalities. Moreover, intersectional population health research may serve to both test and generate new theories. Nevertheless, its implementation within health research to date has been primarily through qualitative research. In this paper, challenges to incorporation of intersectionality into population health research are identified or expanded upon. These include: 1) confusion of quantitative terms used metaphorically in theoretical work with similar-sounding statistical methods; 2) the question of whether all intersectional positions are of equal value, or even of sufficient value for study; 3) distinguishing between intersecting identities, social positions, processes, and policies or other structural factors; 4) reflecting embodiment in how processes of oppression and privilege are measured and analysed; 5) understanding and utilizing appropriate scale for interactions in regression models; 6) structuring interaction or risk modification to best convey effects, and; 7) avoiding assumptions of equidistance or single level in the design of analyses. Addressing these challenges throughout the processes of conceptualizing and planning research and in conducting analyses has the potential to improve researchers' ability to more specifically document inequalities at varying intersectional positions, and to study the potential individual- and group-level causes that may drive these observed inequalities. A greater and more thoughtful incorporation

Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review.

PubMed

Sunguya, Bruno F; Mlunde, Linda B; Ayer, Rakesh; Jimba, Masamine

2017-01-03

Human resource for health crisis has impaired global efforts against malaria in highly endemic countries. To address this, the World Health Organization (WHO) recommended scaling-up of community health workers (CHWs) and related cadres owing to their documented success in malaria and other disease prevention and management. Evidence is inconsistent on the roles and challenges they encounter in malaria interventions. This systematic review aims to summarize evidence on roles and challenges of CHWs and related cadres in integrated community case management for malaria (iCCM). This systematic review retrieved evidence from PubMed, CINAHL, ISI Web of Knowledge, and WHO regional databases. Terms extracted from the Boolean phrase used for PubMed were also used in other databases. The review included studies with Randomized Control Trial, Quasi-experimental, Pre-post interventional, Longitudinal and cohort, Cross-sectional, Case study, and Secondary data analysis. Because of heterogeneity, only narrative synthesis was conducted for this review. A total of 66 articles were eligible for analysis out of 1380 studies retrieved. CHWs and related cadre roles in malaria interventions included: malaria case management, prevention including health surveillance and health promotion specific to malaria. Despite their documented success, CHWs and related cadres succumb to health system challenges. These are poor and unsustainable finance for iCCM, workforce related challenges, lack of and unsustainable supply of medicines and diagnostics, lack of information and research, service delivery and leadership challenges. Community health workers and related cadres had important preventive, case management and promotive roles in malaria interventions. To enable their effective integration into the health systems, the identified challenges should be addressed. They include: introducing sustainable financing on iCCM programmes, tailoring their training to address the identified gaps

Challenges towards realization of health care sector goals of Tanzania development vision 2025: training and deployment of graduate human resource for health.

PubMed

Siril, Nathanael; Kiwara, Angwara; Simba, Daud

2013-06-01

Human resource for health (HRH) is an essential building block for effective and efficient health care system. In Tanzania this component is faced by many challenges which in synergy with others make the health care system inefficient. In vision 2025 the country recognizes the importance of the health care sector in attaining quality livelihood for its citizens. The vision is in its 13th year since its launch. Given the central role of HRH in attainment of this vision, how the HRH is trained and deployed deserves a deeper understanding. To analyze the factors affecting training and deployment process of graduate level HRH of three core cadres; Medical Doctors, Doctor of Dental Surgery and Bachelor of Pharmacy towards realization of development vision 2025. Explorative study design in five training institutions for health and Ministry of Health and Social Welfare (MoHSW) headquarters utilizing in-depth interviews, observations and review of available documents methodology. The training Institutions which are cornerstone for HRH training are understaffed, underfunded (donor dependent), have low admitting capacities and lack co-ordination with other key stakeholders dealing with health. The deployment of graduate level HRH is affected by; limited budget, decision on deployment handled by another ministry rather than MoHSW, competition between health care sector and other sectors and lack of co-ordination between employer, trainers and other key health care sector stakeholders. Awareness on vision 2025 is low in the training institutions. For the vision 2025 health care sector goals to be realized well devised strategies on raising its awareness in the training institutions is recommended. Quality livelihood as stated in vision 2025 will be a forgotten dream if the challenges facing the training and deployment of graduate level HRH will not be addressed timely. It is the authors' view that reduction of donor dependency syndrome, extension of retirement age for academic

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective.

PubMed

Wainberg, Milton L; Scorza, Pamela; Shultz, James M; Helpman, Liat; Mootz, Jennifer J; Johnson, Karen A; Neria, Yuval; Bradford, Jean-Marie E; Oquendo, Maria A; Arbuckle, Melissa R

2017-05-01

Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

PubMed Central

Wainberg, Milton L.; Scorza, Pamela; Shultz, James M.; Helpman, Liat; Mootz, Jennifer J.; Johnson, Karen A.; Neria, Yuval; Bradford, Jean-Marie E.; Oquendo, Maria A.; Arbuckle, Melissa R.

2017-01-01

Purpose of Review Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Recent Findings Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Summary Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions. PMID:28425023

What do we know about the needs and challenges of health systems? A scoping review of the international literature.

PubMed

Roncarolo, Federico; Boivin, Antoine; Denis, Jean-Louis; Hébert, Rejean; Lehoux, Pascale

2017-09-08

While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries. We searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.'s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis. 292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category. This scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the

Forum on stigma, discrimination, and health: policies and research challenges. Introduction.

PubMed

Monteiro, Simone; Villela, Wilza Vieira

2012-01-01

This introduction outlines the Forum on stigma, discrimination, and health: policies and research challenges, including four articles and a final commentary. The first article reviews the development of international research on the relationship between discrimination and health. The second analyzes the recent Brazilian research output on AIDS, stigma, and discrimination. The third article addresses conceptual and methodological aspects of the relations between discrimination and health from an epidemiological perspective. The forth examines the process of affirming sexual rights in Brazil, involving the judiciary system, public policies, and the executive and legislative branches of government, among others. The fifth paper presents comments and questions on the contents discussed in the first four articles. The reflections aim to provide conceptual and methodological contributions for research and health policies on stigma and discrimination, given the gaps identified in the international and Brazilian literature.

Health Journalism: Health Reporting Status and Challenges

PubMed Central

Keshvari, Mahrokh; Yamani, Niko; Adibi, Peyman; Shahnazi, Hossein

2018-01-01

Background: Media play crucial role in disseminating health information. Due to the importance of accurate health news reports, and the national need to professionalism in health journalism, this study aimed to investigate the characteristics of health journalists, and health reporting status and the challenges involved. Materials and Methods: Using consensus sampling, this descriptive cross-sectional study was conducted on all health news reporters in Isfahan (34 journalists) in 2015–2016. Data collection was done via a researcher-made questionnaire. Content validity of the questionnaire was determined by qualitative method and based on the opinions of six experts. The test–retest reliability coefficient was 98.0. Data analysis was done by Statistical Package for the Social Sciences, version 16 and descriptive statistics and content analysis were used for analyzing the responses to two open questions. Results: Among 34 journalists, 56% were women and 44% men; the majority of journalists (65%) had no specialized training on health reporting, 35% of journalists were not able to understand the health issues, and the knowledge of medical terminology in 59% of them was moderate to low. The most important required skill for reporters was the ability to interpret medical research reports (88%), 97% were eager to participate in specialized health education. Conclusions: Our study showed that health journalists lacked knowledge and specialized training for dissemination of health news. This has brought about serious challenges. Thus, development and implementation of training courses in close collaboration with educational department of the Ministry of Health and news programs professionals at Islamic Republic of Iran Broadcasting is highly recommended. PMID:29344040

Health Journalism: Health Reporting Status and Challenges.

PubMed

Keshvari, Mahrokh; Yamani, Niko; Adibi, Peyman; Shahnazi, Hossein

2018-01-01

Media play crucial role in disseminating health information. Due to the importance of accurate health news reports, and the national need to professionalism in health journalism, this study aimed to investigate the characteristics of health journalists, and health reporting status and the challenges involved. Using consensus sampling, this descriptive cross-sectional study was conducted on all health news reporters in Isfahan (34 journalists) in 2015-2016. Data collection was done via a researcher-made questionnaire. Content validity of the questionnaire was determined by qualitative method and based on the opinions of six experts. The test-retest reliability coefficient was 98.0. Data analysis was done by Statistical Package for the Social Sciences, version 16 and descriptive statistics and content analysis were used for analyzing the responses to two open questions. Among 34 journalists, 56% were women and 44% men; the majority of journalists (65%) had no specialized training on health reporting, 35% of journalists were not able to understand the health issues, and the knowledge of medical terminology in 59% of them was moderate to low. The most important required skill for reporters was the ability to interpret medical research reports (88%), 97% were eager to participate in specialized health education. Our study showed that health journalists lacked knowledge and specialized training for dissemination of health news. This has brought about serious challenges. Thus, development and implementation of training courses in close collaboration with educational department of the Ministry of Health and news programs professionals at Islamic Republic of Iran Broadcasting is highly recommended.

Rotorcraft Health Management Issues and Challenges

NASA Technical Reports Server (NTRS)

Zakrajsek, James J.; Dempsey, Paula J.; Huff, Edward M.; Augustin, Michael; Safa-Bakhsh, Robab; Ephraim, Piet; Grabil, Paul; Decker, Harry J.

2006-01-01

This paper presents an overview of health management issues and challenges that are specific to rotorcraft. Rotorcraft form a unique subset of air vehicles in that their propulsion system is used not only for propulsion, but also serves as the primary source of lift and maneuvering of the vehicle. No other air vehicle relies on the propulsion system to provide these functions through a transmission system with single critical load paths without duplication or redundancy. As such, health management of the power train is a critical and unique part of any rotorcraft health management system. This paper focuses specifically on the issues and challenges related to the dynamic mechanical components in the main power train. This includes the transmission and main rotor mechanisms. This paper will review standard practices used for rotorcraft health management, lessons learned from fielded trials, and future challenges.

The Case for the World Health Organization’s Commission on Social Determinants of Health to Address Gender Identity

PubMed Central

Veale, Jaimie F.

2015-01-01

We analyzed the case of the World Health Organization’s Commission on Social Determinants of Health, which did not address gender identity in their final report. We argue that gender identity is increasingly being recognized as an important social determinant of health (SDH) that results in health inequities. We identify right to health mechanisms, such as established human rights instruments, as suitable policy tools for addressing gender identity as an SDH to improve health equity. We urge the World Health Organization to add gender identity as an SDH in its conceptual framework for action on the SDHs and to develop and implement specific recommendations for addressing gender identity as an SDH. PMID:25602894

A framework for regional primary health care to organise actions to address health inequities.

PubMed

Freeman, Toby; Javanparast, Sara; Baum, Fran; Ziersch, Anna; Mackean, Tamara

2018-06-01

Regional primary health-care organisations plan, co-ordinate, and fund some primary health-care services in a designated region. This article presents a framework for examining the equity performance of regional primary health-care organisations, and applies it to Australian Medicare Locals (funded from 2011 to 2015). The framework was developed based on theory, literature, and researcher deliberation. Data were drawn from Medicare Local documents, an online survey of 210 senior Medicare Local staff, and interviews with 50 survey respondents. The framework encompassed equity in planning, collection of equity data, community engagement, and strategies to address equity in access, health outcomes, and social determinants of health. When the framework was applied to Medicare Locals, their inclusion of equity as a goal, collection of equity data, community engagement, and actions improving equity of access were strong, but there were gaps in broader advocacy, and strategies to address social determinants of health, and equity in quality of care. The equity framework allows a platform for advancing knowledge and international comparison of the health equity efforts of regional primary health-care organisations.

Public health agendas addressing violence against rural women - an analysis of local level health services in the State of Rio Grande do Sul, Brazil.

PubMed

da Costa, Marta Cocco; Lopes, Marta Julia Marques; Soares, Joannie dos Santos Fachinelli

2015-05-01

This study analyses health managers' perceptions of local public health agendas addressing violence against rural women in municipalities in the southern part of the State Rio Grande do Sul in Brazil. It consists of an exploratory descriptive study utilizing a qualitative approach. Municipal health managers responsible for planning actions directed at women's health and primary health care were interviewed. The analysis sought to explore elements of programmatic vulnerability related to violence in the interviewees' narratives based on the following dimensions of programmatic vulnerability: expression of commitment, transformation of commitment into action, and planning and coordination. It was found that local health agendas directed at violence against rural women do not exist. Health managers are therefore faced with the challenge of defining lines of action in accordance with the guidelines and principles of the SUS. The repercussions of this situation are expressed in fragile comprehensive services for these women and programmatic vulnerability.

Global health issues and challenges.

PubMed

Dickenson-Hazard, Nancy

2004-01-01

To describe issues, challenges and potential strategies in achieving nursing's global preferred future, focused on promoting healthy communities worldwide. Three sets of Arista conferences, a total of 7 conferences, were sponsored by Sigma Theta Tau International Honor Society of Nursing. Arista2 and Arista3--the focus of this report--were held in different world regions. A total of 109 invited multi-disciplinary participants identified conditions that affect nursing and health care, strategic actions to address those conditions, and recommendations for the nursing profession. Reports from each conference are synthesized in this executive summary. Both common and unique themes were identified in various world regions. Key components of the preferred future were professional restructuring and the delivery of holistic, human, and culturally appropriate care. Participants in all regional conferences recommended strategic actions regarding: student-centered educational systems, environments in which nurses practice, the way nurses lead, the knowledge nurses need, the settings in which nurses work, the conditions under which the profession operates, the influence of nurses, and the ways nurses learn.

South African Academic Health--the future challenge.

PubMed

van Zyl, G J

2004-02-01

In South Africa, significant changes in Academic Health have taken place since the first democratic elections in 1994. Academic Health came from a separated academic hospital, departmental-based curriculum and research focussed on achievement, and an abundance of money, to a position of integrated service delivery with specific reference to primary health care, separation of service levels, a new integrated curriculum, research focussed according to the need and contract research, and financial constraints with limited budgets. The management of this change is a task challenging the manager in all fields of Academic Health. Leaders need to know their environment and organisation to be able to manage change. Academic Health centres are experiencing major changes as a result of the effects of managed care, reduced rate and growing expenditure on health services. In addition to restructuring of the clinical services, Academic Health centres are being challenged to sustain their academic mission and priorities in the face of resource constraints. In order to tackle these challenges, institutions need physicians in administrative positions at all levels who can provide leadership and thoughtful managerial initiatives. The future challenge for managers focuses on service delivery, research, health education and training, Academic Health management, professionalism and financial management.

Facilitating interprofessional learning about human rights in public health contexts: challenges and strategies.

PubMed

Haigh, Neil; Haigh, Fiona

2007-12-01

Occasions when public health practitioners engage in professional learning increasingly involve them in encounters with (a) concepts that originate from unfamiliar disciplines and that may be multidisciplinary, complex and sometimes contested, (b) colleagues who have different discipline and profession backgrounds, and (c) modes of learning and teaching that are unfamiliar. While these factors can enhance both the processes and products of learning, they can also present significant challenges when those learning occasions are designed and facilitated. Drawing on our own reflected-on experience of working in such contexts and a body of related literature, we elaborate on these interrelated challenges and propose three strategies that can help address them. The strategies entail encouragement and support for establishing common commitments and values, perspective-taking and self-reflexivity, conversation and storytelling. Specific examples of challenges and strategies are derived, in particular, from a learning agenda associated with the mainstreaming of a human rights approach to public health. That agenda requires practitioners to understand the concept of human rights, appreciate its relevance for public health work and be capable of integrating a human right perspective into their day-to-day work.

Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings

PubMed Central

Wang, ShuQi; Lifson, Mark A.; Inci, Fatih; Liang, Li-Guo; Sheng, Ye-Feng; Demirci, Utkan

2016-01-01

The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed. PMID:26777725

Transformation of the education of health professionals in China: progress and challenges.

PubMed

Hou, Jianlin; Michaud, Catherine; Li, Zhihui; Dong, Zhe; Sun, Baozhi; Zhang, Junhua; Cao, Depin; Wan, Xuehong; Zeng, Cheng; Wei, Bo; Tao, Lijian; Li, Xiaosong; Wang, Weimin; Lu, Yingqing; Xia, Xiulong; Guo, Guifang; Zhang, Zhiyong; Cao, Yunfei; Guan, Yuanzhi; Meng, Qingyue; Wang, Qing; Zhao, Yuhong; Liu, Huaping; Lin, Huiqing; Ke, Yang; Chen, Lincoln

2014-08-30

In this Review we examine the progress and challenges of China's ambitious 1998 reform of the world's largest health professional educational system. The reforms merged training institutions into universities and greatly expanded enrolment of health professionals. Positive achievements include an increase in the number of graduates to address human resources shortages, acceleration of production of diploma nurses to correct skill-mix imbalance, and priority for general practitioner training, especially of rural primary care workers. These developments have been accompanied by concerns: rapid expansion of the number of students without commensurate faculty strengthening, worries about dilution effect on quality, outdated curricular content, and ethical professionalism challenged by narrow technical training and growing admissions of students who did not express medicine as their first career choice. In this Review we underscore the importance of rebalance of the roles of health sciences institutions and government in educational policies and implementation. The imperative for reform is shown by a looming crisis of violence against health workers hypothesised as a result of many factors including deficient educational preparation and harmful profit-driven clinical practices. Copyright © 2014 Elsevier Ltd. All rights reserved.

Using structured and unstructured data to identify patients' need for services that address the social determinants of health.

PubMed

Vest, Joshua R; Grannis, Shaun J; Haut, Dawn P; Halverson, Paul K; Menachemi, Nir

2017-11-01

Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. A cross-sectional study described patients in need of SDH services offered by a safety-net hospital's federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data. Copyright © 2017. Published by Elsevier B.V.

Public health challenges in sun protection.

PubMed

Eide, Melody J; Weinstock, Martin A

2006-01-01

Sunscreens are a popular choice for protection from ultraviolet radiation, and hence, important components in the public health campaign to reduce the burden of skin cancer. Public health messages in skin cancer prevention have been used effectively in educational campaigns. The benefits of sunscreen extend beyond skin cancer prevention into other aspects of health and disease prevention: sunscreen decreases the risk for sunburn during physical activity outdoors and seems not to increase the risk for osteoporosis. Public health efforts have laid a solid foundation on which to face the continuing challenge of promoting and developing effective public health campaigns and health policies that encourage sunscreen use, sun protection, and the primary prevention of skin cancer. In this article, the controversies, concerns, and challenges of sunscreen use as it relates to public health are discussed.

Human resources for health in southeast Asia: shortages, distributional challenges, and international trade in health services.

PubMed

Kanchanachitra, Churnrurtai; Lindelow, Magnus; Johnston, Timothy; Hanvoravongchai, Piya; Lorenzo, Fely Marilyn; Huong, Nguyen Lan; Wilopo, Siswanto Agus; dela Rosa, Jennifer Frances

2011-02-26

In this paper, we address the issues of shortage and maldistribution of health personnel in southeast Asia in the context of the international trade in health services. Although there is no shortage of health workers in the region overall, when analysed separately, five low-income countries have some deficit. All countries in southeast Asia face problems of maldistribution of health workers, and rural areas are often understaffed. Despite a high capacity for medical and nursing training in both public and private facilities, there is weak coordination between production of health workers and capacity for employment. Regional experiences and policy responses to address these challenges can be used to inform future policy in the region and elsewhere. A distinctive feature of southeast Asia is its engagement in international trade in health services. Singapore and Malaysia import health workers to meet domestic demand and to provide services to international patients. Thailand attracts many foreign patients for health services. This situation has resulted in the so-called brain drain of highly specialised staff from public medical schools to the private hospitals. The Philippines and Indonesia are the main exporters of doctors and nurses in the region. Agreements about mutual recognition of professional qualifications for three groups of health workers under the Association of Southeast Asian Nations Framework Agreement on Services could result in increased movement within the region in the future. To ensure that vital human resources for health are available to meet the needs of the populations that they serve, migration management and retention strategies need to be integrated into ongoing efforts to strengthen health systems in southeast Asia. There is also a need for improved dialogue between the health and trade sectors on how to balance economic opportunities associated with trade in health services with domestic health needs and equity issues. Copyright © 2011

Growing partners: building a community-academic partnership to address health disparities in rural North Carolina.

PubMed

De Marco, Molly; Kearney, William; Smith, Tosha; Jones, Carson; Kearney-Powell, Arconstar; Ammerman, Alice

2014-01-01

Community-based participatory research (CBPR) holds tremendous promise for addressing public health disparities. As such, there is a need for academic institutions to build lasting partnerships with community organizations. Herein we have described the process of establishing a relationship between a research university and a Black church in rural North Carolina. We then discuss Harvest of Hope, the church-based pilot garden project that emerged from that partnership. The partnership began with a third-party effort to connect research universities with Black churches to address health disparities. Building this academic-community partnership included collaborating to determine research questions and programming priorities. Other aspects of the partnership included applying for funding together and building consensus on study budget and aims. The academic partners were responsible for administrative details and the community partners led programming and were largely responsible for participant recruitment. The community and academic partners collaborated to design and implement Harvest of Hope, a church-based pilot garden project involving 44 youth and adults. Community and academic partners shared responsibility for study design, recruitment, programming, and reporting of results. The successful operation of the Harvest of Hope project gave rise to a larger National Institutes of Health (NIH)-funded study, Faith, Farming and the Future (F3) involving 4 churches and 60 youth. Both projects were CBPR efforts to improve healthy food access and reducing chronic disease. This partnership continues to expand as we develop additional CBPR projects targeting physical activity, healthy eating, and environmental justice, among others. Benefits of the partnership include increased community ownership and cultural appropriateness of interventions. Challenges include managing expectations of diverse parties and adequate communication. Lessons learned and strategies for building

Implementation challenges of free maternity services policy in Kenya: the health workers' perspective.

PubMed

Wamalwa, Emmanuel Wekesa

2015-01-01

Kenya implemented the policy of free maternity services to reduce maternal mortality and morbidity. For successful implementation of this policy, there is need to monitor the implementation progress, identify the challenges and mitigate them and determine better strategies for implementation based on emerging implementation issues. This study was carried out to determine the challenges facing policy implementation and strategies for better implementation. This was a cross-sectional descriptive study carried at the Rift Valley Provincial General Hospital (RVPGH) and Bondeni maternity. All the staff who work at Bondeni Maternity (including nursing officer in-charge) were included in the study. All the staff who work at the Maternity Unit of the RVPGH were included in the study, as well as the Medical Superintendent of the facility. A total of 110 respondents were sampled. A questionnaire and interview guide were used to collect data. Data was analyzed using SPSS software. A response rate of 91% (n=100) was achieved. Major implementation challenges include inadequate supplies (86%), inadequate funding (38%), staff shortage (92%), lack of motivation among health workers (62%), overwhelming workload (89%) and abuse of services by clients (32%). Strategies for better implementation include employment of more staff, motivation of health workers, improvement in policy financing, training of health workers and provision of adequate supplies. Implementation of free maternity services policy in Kenya is facing challenges but there exists strategies, which, if implemented, will help address these challenges.

Student assistance program: a new approach for student success in addressing behavioral health and life events.

PubMed

Veeser, Peggy Ingram; Blakemore, Carol Warren

2006-01-01

College health centers, whether large or small, often find it challenging to provide counseling and supportive services for all students (including remotely located students) 24 hours a day, 7 days a week. Student assistance programs (SAPs) are services provided to students through a contractual arrangement to the university or college as a part of student services. The goal is to address psychosocial concerns that may interfere with academic performance within the realm of short-term counseling. These services range from traditional behavioral health concerns about stress and depressive reactions to how to find child care with foreign-speaking services. In this article, the authors describe a method to provide such short-term counseling to a 2,200-student health-science campus. They present data from 1 year of service as well as the benefits and limitations.

Engaging Undergraduates to Solve Global Health Challenges: A New Approach Based on Bioengineering Design

PubMed Central

Oden, Maria; Mirabal, Yvette; Epstein, Marc

2010-01-01

Recent reports have highlighted the need for educational programs to prepare students for careers developing and disseminating new interventions that improve global public health. Because of its multi-disciplinary, design-centered nature, the field of Biomedical Engineering can play an important role in meeting this challenge. This article describes a new program at Rice University to give undergraduate students from all disciplines a broad background in bioengineering and global health and provides an initial assessment of program impact. Working in partnership with health care providers in developing countries, students in the Beyond Traditional Borders (BTB) initiative learn about health challenges of the poor and put this knowledge to work immediately, using the engineering design process as a framework to formulate solutions to complex global health challenges. Beginning with a freshman design project and continuing through a capstone senior design course, the BTB curriculum uses challenges provided by partners in the developing world to teach students to integrate perspectives from multiple disciplines, and to develop leadership, communication, and teamwork skills. Exceptional students implement their designs under the guidance of clinicians through summer international internships. Since 2006, 333 students have designed more than 40 technologies and educational programs; 28 have been implemented in sub-Saharan Africa, Latin America, the Caribbean, southeast Asia, and the United States. More than 18,000 people have benefited from these designs. 95% of alumni who completed an international internship reported that participation in the program changed or strengthened their career plans to include a focus on global health medicine, research, and/or policy. Empowering students to use bioengineering design to address real problems is an effective way to teach the new generation of leaders needed to solve global health challenges. PMID:20387116

Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

PubMed

Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

2015-01-01

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry

Addressing Children's Oral Health in the New Millennium: Trends in the Dental Workforce

PubMed Central

Mertz, Elizabeth; Mouradian, Wendy

2009-01-01

The Surgeon General's Report on Oral Health (SGROH) and the Call to Action to Promote Oral Health outlined the need to increase the diversity, capacity and flexibility of the dental workforce to reduce oral health disparities. This paper provides an update on dental workforce trends since the SGROH in the context of children's oral health needs. Major challenges remain to ensure a workforce that is adequate to address the needs of all children. The dentist to population ratio is declining, while mal-distribution of dentists continues for rural and underserved communities. The diversity of the dental workforce has only improved slightly, while the diversity of the pediatric population has increased substantially. More pediatric dentists have been trained, and dental educational programs are preparing students for practice in underserved areas, but the impact of these efforts on underserved children is uncertain. Other workforce developments with the potential to improve children's oral health include: enhanced training in children's oral health for general dentists; expanded scope of practice for allied dental health professionals; new dental practitioners including the dental health aid therapist; and increased engagement of pediatricians and other medical practitioners in children's oral health. The evidence for increasing caries experience in young children points to the need for continued efforts to bolster the oral health workforce. However, workforce strategies alone will not be sufficient to change this situation. Requisite policy changes, educational efforts and strong partnerships with communities will be needed to effect substantive changes in children's oral health. PMID:19854121

Addressing children's oral health in the new millennium: trends in the dental workforce.

PubMed

Mertz, Elizabeth; Mouradian, Wendy E

2009-01-01

Oral Health in America: A Report of the Surgeon General (SGROH) and National Call to Action to Promote Oral Health outlined the need to increase the diversity, capacity, and flexibility of the dental workforce to reduce oral health disparities. This paper provides an update on dental workforce trends since the SGROH in the context of children's oral health needs. Major challenges remain to ensure a workforce that is adequate to address the needs of all children. The dentist-to-population ratio is declining while shortages of dentists continue in rural and underserved communities. The diversity of the dental workforce has only improved slightly, and the the diversity of the pediatric population has increased substantially. More pediatric dentists have been trained, and dental educational programs are preparing students for practice in underserved areas, but the impact of these efforts on underserved children is uncertain. Other workforce developments with the potential to improve children's oral health include enhanced training in children's oral health for general dentists, expanded scope of practice for allied dental health professionals, new dental practitioners including the dental health aid therapist, and increased engagement of pediatricians and other medical practitioners in children's oral health. The evidence for increasing caries experience in young children points to the need for continued efforts to bolster the oral health workforce. However, workforce strategies alone will not be sufficient to change this situation. Requisite policy changes, educational efforts, and strong partnerships with communities will be needed to effect substantive changes in children's oral health.

Rethinking the relationship between socioeconomic status and health: Challenging how socioeconomic status is currently used in health inequality research.

PubMed

Gagné, Thierry; Ghenadenik, Adrian E

2018-02-01

The Scandinavian Journal of Public Health recently reiterated the importance of addressing social justice and health inequalities in its new editorial policy announcement. One of the related challenges highlighted in that issue was the limited use of sociological theories able to inform the complexity linking the resources and mechanisms captured by the concept of socioeconomic status. This debate article argues that part of the problem lies in the often unchallenged reliance on a generic conceptualization and operationalization of socioeconomic status. These practices hinder researchers' capacity to examine in finer detail how resources and circumstances promote the unequal distribution of health through distinct yet intertwined pathways. As a potential way forward, this commentary explores how research practices can be challenged through concrete publication policies and guidelines. To this end, we propose a set of recommendations as a tool to strengthen the study of socioeconomic status and, ultimately, the quality of health inequality research. Authors, reviewers, and editors can become champions of change toward the implementation of sociological theory by holding higher standards regarding the conceptualization, operationalization, analysis, and interpretation of results in health inequality research.

Recommendations on Arresting Global Health Challenges Facing Adolescents and Young Adults.

PubMed

Lassi, Zohra S; Salam, Rehana A; Bhutta, Zulfiqar A

The health challenges faced by young people are more complex than adults and can compromise their full growth and development. Attention must be paid to the health of this age group, yet adolescents and youth remain largely invisible and often disappear from the major global datasets. The aim of this paper is to discuss the global health challenges faced by adolescents and youth, global legislations and guidelines pertaining to this particular age group, recommendations to arrest these challenges, and research priorities. Major direct and indirect global health risks faced by adolescents include early pregnancy and childbirth, femicide, honor killing, female genital mutilation, nutritional habits and choices, social media, and peer pressure. There are no standard legal age cut-offs for adulthood; rather, the age varies for different activities, such as age of consent or the minimum age that young people can legally work, leave school, drive, buy alcohol, marry, be held accountable for criminal action, and make medical decisions. This reflects the fact that the existing systems and structures are focused on either children or adults, with very few investments and interventions directed specifically to young people. Existing legislation and guidelines need transformation to bring about a specific focus on adolescents in the domains of substance use and sexual behaviors, and the capacity for adolescent learning should be exploited through graduated legal and policy frameworks. Sustainable development goals provide an opportunity to target this neglected and vulnerable age group. A multisectoral approach is needed to bring about healthy change and address the challenges faced by adolescents and youth, from modifications at a broader legislative and policy level to ground-level (community-level) implementations. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Addressing Obstetrical Challenges at 12 Rural Ugandan Health Facilities: Findings from an International Ultrasound and Skills Development Training for Midwives in Uganda.

PubMed

Kinnevey, Christina; Kawooya, Michael; Tumwesigye, Tonny; Douglas, David; Sams, Sarah

2016-01-01

Like much of Sub-Saharan Africa, Uganda is facing significant maternal and fetal health challenges. Despite the fact that the majority of the Uganda population is rural and the major obstetrical care provider is the midwife, there is a lack of data in the literature regarding rural health facilities' and midwives' knowledge of ultrasound technology and perspectives on important maternal health issues such as deficiencies in prenatal services. A survey of the current antenatal diagnostic and management capabilities of midwives at 12 rural Ugandan health facilities was performed as part of an international program initiated to provide ultrasound machines and formal training in their use to midwives at antenatal care clinics. The survey revealed that the majority of pregnant women attend less than the recommended minimum of four antenatal care visits. There were significant knowledge deficits in many prenatal conditions that require ultrasound for early diagnosis, such as placenta previa and macrosomia. The cost of providing ultrasound machines and formal training to 12 midwives was $6,888 per powered rural health facility and $8,288 for non-powered rural health facilities in which solar power was required to maintain ultrasound. In order to more successfully meet Millennium Development Goal 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV) through decreasing maternal to child transmission of HIV, the primary healthcare provider, which is the midwife in Uganda, must be competent at the diagnosis and management of a wide spectrum of obstetrical challenges. A trained ultrasound-based approach to obstetrical care is a cost effective method to take on these goals.

The Role Of Nonprofit Hospitals In Identifying And Addressing Health Inequities In Cities.

PubMed

Carroll-Scott, Amy; Henson, Rosie Mae; Kolker, Jennifer; Purtle, Jonathan

2017-06-01

For nonprofit hospitals to maintain their tax-exempt status, the Affordable Care Act requires them to conduct a community health needs assessment, in which they evaluate the health needs of the community they serve, and to create an implementation strategy, in which they propose ways to address these needs. We explored the extent to which nonprofit urban hospitals identified equity among the health needs of their communities and proposed health equity strategies to address this need. We conducted a content analysis of publicly available community health needs assessments and implementation strategies from 179 hospitals in twenty-eight US cities in the period August-December 2016. All of the needs assessments included at least one implicit health equity term (such as disparities , disadvantage , poor , or minorities ), while 65 percent included at least one explicit health equity term ( equity , health equity , inequity , or health inequity ). Thirty-five percent of implementation strategies included one or more explicit health equity terms, but only 9 percent included an explicit activity to promote health equity. While needs assessment reporting requirements have the potential to encourage urban nonprofit hospitals to address health inequities in their communities, hospitals need incentives and additional capacity to invest in strategies that address the underlying structural social and economic conditions that cause health inequities. Project HOPE—The People-to-People Health Foundation, Inc.

Unmanned Aerial Systems: Further Actions Needed to Fully Address Air Force and Army Pilot Workforce Challenges

DTIC Science & Technology

2016-03-16

UNMANNED AERIAL SYSTEMS Further Actions Needed to Fully Address Air Force and Army Pilot Workforce Challenges...Armed Services, U.S. Senate March 16, 2016 UNMANNED AERIAL SYSTEMS Further Actions Needed to Fully Address Air Force and Army Pilot Workforce ...High-performing organizations use complete and current data to inform their strategic human capital planning and remain open to reevaluating workforce

Role of local government in responding to environmental health challenges: a case study of Chungnam.

PubMed

Myung, Hyung-Nam; Lee, Hoo-Young

2017-01-01

The purpose of this study is to introduce the establishment process, policy target, and projects for "Chungnam's master plan on environmental health policy (2017-2020)" as the local government's role in addressing local environmental health challenges. We first analyzed existing studies and social issues on the media related to "Chungnam's master plan" to understand Chungnam's environmental health status and discussed domestic and international policy trends and related plans. An environmental health perception questionnaire survey and a Delphi expert questionnaire survey were conducted among provincial residents to collect various actors' opinions on Chungnam's environmental health issues and policy. An expert advisory panel was launched, and a residents' voice workshop and cities-and-guns-policy-suggestion workshop were held. The vision of Chungnam's environmental health policy is minimizing environmental hazards. We finally selected "Pleasant environment, healthy people, happy Chungnam" to represent the will to shape a pleasant environment and prevent and manage health damages for a happy Chungnam. We selected five strategies based on status analysis and a review of domestic and international policy trends and related plans and identified 2 targets (policy objectives) to accomplish the strategies. The strategies to achieve the first target, "Leader in environmental health policy: Chungnam," include 'Empowering active provincial capabilities,' 'Setting up province-specific systems for environmental health surveys and research,' and 'Preventing and managing newly emerging pollutants.' The strategies for the second target, "Everyone is healthy: Chungnam," include 'Relieving health inequalities among vulnerable regions and residents' and 'Enlarging the resident-friendly environmental health policy.' We developed 29 projects in total, according to these strategies. The establishment of "Chungnam's master plan" is highly valuable; we developed it through discussion

Addressing Safety in Schools: CDC's Division of Adolescent & School Health

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2007

2007-01-01

The mission of the Division of Adolescent and School Health (DASH) is to prevent the most serious health risks among children, adolescents, and young adults. Its goal is to prevent unintentional injuries and violence by enabling the nation's schools to address safety through coordinated school health programs. It attempts to achieve this goal…

The Challenges and Triumphs in Addressing Students' Intersectional Identities for Black Culture Centers

ERIC Educational Resources Information Center

Harris, Jessica C.; Patton, Lori D.

2017-01-01

This study examines how directors of Black culture centers (BCCs) address Black students' intersectional identities. We highlight the challenges that directors of BCCs face as they attempt to preserve a race salient agenda, while accounting for other critical facets of students' social identities. Findings explore how directors hold differing…

International Nursing: Constructing an Advanced Practice Registered Nurse Practice Model in the UAE: Using Innovation to Address Cultural Implications and Challenges in an International Enterprise.

PubMed

Behrens, Sue A

Despite utilization of the advanced practice registered nurse (APRN) in the United States health care system, there is little information about the introduction, utilization, and challenges of the APRN role globally, especially in the Middle East. This article will look at how one hospital in the United Arab Emirates introduced the APRN role to a health care environment of a country where it has not been recognized historically. Cultural challenges and barriers for the implementation of the role include regulatory, societal, and institutional. Innovation and collaboration are necessary to address these challenges and barriers and to pave the way for a successful advanced practice model pilot, as well as for the future use of the role. Innovation is also one of the key performance indicators for the country's health care. However, the idea of advanced practice is a new concept that has been outside the mainstream health care practice for the United Arab Emirates. To help with the implementation, a road map was developed to outline the steps necessary to provide a safe practice environment. The plan included aligning with the ministry of health nursing and midwifery council, as well as the Health Authority of Abu Dhabi, to help them learn more about the US model of advanced practice, along with benefits, and outcomes of the role. Developing the role of the APRN will benefit the future state of the health care infrastructure for not only the United Arab Emirates but throughout the Middle East.

Barriers to addressing the societal determinants of health: public health units and poverty in Ontario, Canada.

PubMed

Raphael, Dennis

2003-12-01

Despite Canada's reputation as a leader in health promotion and population health concepts, actual public health practice for the most part remains wedded to downstream strategies focussed on behaviour change. In Canada's largest province this has led to the implementation of a heart health promotion approach focussed on diet, activity and tobacco use. This is so despite increasing evidence that these approaches are generally ineffective, particularly for those at greatest risk. In addition, these strategies appear to divert public and governmental attention away from addressing the broader societal determinants of health. Examples of Ontario public health units that have begun to address societal determinants of health provide a counterbalance to the dominant paradigm that frames health as an individual responsibility. These new approaches focus attention upon the health-threatening effects of governments' regressive social and economic policies in a manner consistent with the best principles of health promotion.

Proposing a health promotion framework to address gambling problems in Australian Indigenous communities.

PubMed

Fogarty, Marisa; Coalter, Nicola; Gordon, Ashley; Breen, Helen

2018-02-01

Gambling impacts affect Australian Indigenous families and communities in diverse and complex ways. Indigenous people throughout Australia engage in a broad range of regulated and unregulated gambling activities. Challenges in this area include the complexities that come with delivering services and programmes between the most remote regions, to highly populated towns and cities of Australia. There is little knowledge transfer between states and territories in Australia and no conceptual understanding or analysis of what constitutes 'best practice' in gambling service delivery for Indigenous people, families and communities. This article reviews health promotion approaches used in Australia, with a particular focus on Indigenous and gambling-based initiatives. Contributing to this review is an examination of health promotion strategies used in Indigenous gambling service delivery in the Northern Territory, New South Wales and Western Australia, demonstrating diversity and innovation in approaches. The article concludes by emphasizing the potential value of adopting health promotion strategies to underpin programme and service delivery for addressing gambling problems in Australian Indigenous communities. However, success is contingent on robust, evidence-based programme design, implementation and evaluation that adhere to health promotion principles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Media depictions of health topics: challenge and stigma formats.

PubMed

Smith, Rachel

2007-01-01

This article explored the notion that media depictions of health concerns come in one of two formats: challenge and stigma. After explicating the five features that should appear in challenge format and the seven features of stigma formats, we analyzed the content of health messages in magazines, brochures, and posters (n = 75) in a metropolitan area. The results of a two-factor confirmatory factor model showed that the five suggested features for challenge formats did, indeed, appear together (alpha = .76), and the seven features for stigma formats, also, appeared together (alpha = .90), and showed no residual relationship. In other words, the results suggest that media depictions of health topics appear in either challenge or stigma formats (r = - .87). Health issues appearing in magazine advertisements and articles presented messages in challenge formats, while brochures and posters from largely nonprofit and government groups depicted health issues in stigma formats. Some health topics appeared most often in challenge formats (including cancer, heart disease, and scoliosis), while others appeared in stigma formats (including tuberculosis, hepatitis, smoking, and sexually transmitted diseases [STDs]). Findings suggest that media depictions of health differ, and the implications of stigma and challenge formats are discussed.

In the right words: addressing language and culture in providing health care.

PubMed

2003-08-01

As part of its continuing mission to serve trustees, executives, and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from philanthropy, research, health care practice, and policy on April 4, 2003, to discuss the roles of language and culture in providing effective health care. During this Issue Dialogue, In the Right Words: Addressing Language and Culture in Providing Health Care, health grantmakers and experts from policy and practice participated in an open exchange of ideas and perspectives on language access and heard from fellow grantmakers who are funding innovative programs in this area. Together they explored ways to effectively support comprehensive language services, including the use of interpreters and translation of written materials. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It focuses on the challenges and opportunities involved with ensuring language access for the growing number of people who require it. Sections include: recent immigration trends and demographic changes; the effect of language barriers on health outcomes and health care processes; laws and policies regarding the provision of language services to patients, including an overview of public financing mechanisms; strategies for improving language access, including enhancing access in delivery settings, promoting advocacy and policy change, improving interpreter training, and advancing research; and roles for foundations in supporting improved language access, including examples of current activities. The Issue Dialogue focused mainly on activities and programs that ensure linguistic access to health care for all patients. Although language and culture are clearly inseparable, a full exploration of the field of cultural competence and initiatives that promote its application to the health care setting are beyond the scope

"Birth Control can Easily Take a Back Seat": Challenges Providing IUDs in Community Health Care Settings.

PubMed

Biggs, M Antonia; Kaller, Shelly; Harper, Cynthia C; Freedman, Lori; Mays, Aisha R

2018-01-01

To assess community health centers' (CHCs) capacity to offer streamlined intrauterine devices (IUDs) services. Prior to implementing a contraceptive training project, we surveyed health care staff (N=97) from 11 CHC sites that offer IUDs onsite. Twenty interviews with clinicians explored more deeply their challenges offering IUDs in the CHC setting. Most practices required multiple visits for IUD placement, most (66%) clinician survey respondents had placed an IUD and 19% had placed an IUD as emergency contraception. Need for screening tests, scheduling challenges, pressures to meet patient quotas, and lack of priority given to women's health hindered streamlined IUD provision. Although access to IUDs has increased, significant barriers to provision in CHC settings persist. Clinic policies may need to address a variety of system and provider-level barriers to meet the needs of patients.

The diffusion of virtual communities in health care: concepts and challenges.

PubMed

Demiris, George

2006-08-01

This paper providers an overview and discussion of virtual communities in health care. Furthermore, we aim to discuss in this context ethical, legal and technical considerations and the current status of research in this domain. We searched medical and social science literature including survey studies, randomized and non-randomized controlled interventions and reviews. The literature indicates that a virtual community in health care as a group of people using telecommunication with the purposes of delivering health care and education, and/or providing support, covers a wide range of clinical specialties, technologies and stakeholders. Examples include peer-to-peer networks, virtual health care delivery and research teams. Ethical challenges including the concepts of identity and deception, privacy and confidentiality and technical issues, such as sociability and usability are discussed. Virtual communities may empower patients and enhance coordination of care services; however, there is not sufficient systematic evidence of the effectiveness of virtual communities on clinical outcomes or patient empowerment. Researchers need to address issues, such as sample sizes and experimental design to further the research field in this domain. When practitioners utilize virtual community tools to communicate with patients or colleagues they have to maximize sociability and usability of this mode of communication, while addressing concerns for privacy and the fear of de-humanizing practice, and the lack of clarity or relevance of current legislative frameworks.

Elections: DOD Needs More Comprehensive Planning to Address Military and Overseas Absentee Voting Challenges

DTIC Science & Technology

2016-04-01

Acknowledgments Contact Acknowledgments Related GAO Products Page 75 GAO-16-378 DOD Overseas Absentee Voting U.S. Postal Service: Actions... Products Page 76 GAO-16-378 DOD Overseas Absentee Voting Election Reform: Nine States’ Experiences Implementing Federal Requirements for...ELECTIONS DOD Needs More Comprehensive Planning to Address Military and Overseas Absentee Voting Challenges

[Employees health education--challenges according to the educational level].

PubMed

Korzeniowska, Elzbieta; Puchalski, Krzysztof

2012-01-01

Article addresses the problem of increasing Polish employees health education effectiveness according to the differences in educational level. Research model assume that effective method of developing recommendations improving the health education will synthesise scientific findings regarding methodology of conducting such education and knowledge about needs of two target groups: low and high educated employees. Educational solutions were searched in publications related to: health education, andragogy, propaganda and direct marketing. The empirical material used to characterize two target groups came from four research (qualitative and quantitative) conducted by the National Centre for Workplace Health Promotion (Nofer Institute of Occupational Medicine) in 2007-2010. Low educated employees' health education should be focused on increasing responsibility for health and strengthening their self-confidence according to the introduction of healthy lifestyle changes. To achieve these goals, important issue is to build their motivation to develop knowledge about taking care of health. In providing such information we should avoid the methods associated with school. Another important issue is creating an appropriate infrastructure and conditions facilitating the change of harmful behaviors undertaken at home and in the workplace. According to high-educated employees a challenge is to support taking health behaviors--although they are convinced it is important for their health, such behaviors are perceived as a difficult and freedom restriction. Promoting behavior change techniques, avoiding prohibitions in the educational messages and creating favorable climate for taking care of health in groups they participate are needed.

Challenges to Native American health care.

PubMed

Noren, J; Kindig, D; Sprenger, A

1998-01-01

Native American health care programs face complex and unprecedented challenges resulting from the increased assumption of clinical operations by tribal authorities, shortfalls in Federal funding, modifications in state and Federal health and welfare programs, and intensifying involvement with managed care organizations. These challenges are further complicated by service populations that are increasing at a faster rate than the growth in funding. The authors conducted onsite surveys of 39 Native American health programs in 10 states in order to assess the organizational and management problems they faced. The trend toward transfer of health programs from the Indian Health Service to tribal operation seems likely to continue and accelerate. The survey results indicate that in order for programs to be effective in the long run, they will need to be guided by skilled managers able to adapt to these powerful changes in the health care environment.

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments

PubMed Central

Tangcharoensathien, Viroj; Srisookwatana, Orapan; Pinprateep, Poldej; Posayanonda, Tipicha; Patcharanarumol, Walaiporn

2017-01-01

Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs) and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA) and United Nations General Assembly (UNGA) resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors. Capacity development at individual, institutional and system level to generate evidence and ensure it is used by multisectoral agencies is as critical as strengthening the health literacy of people and the overall good governance of a

Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities.

PubMed

Bhutta, Zulfiqar A; Hafeez, Assad; Rizvi, Arjumand; Ali, Nabeela; Khan, Amanullah; Ahmad, Faatehuddin; Bhutta, Shereen; Hazir, Tabish; Zaidi, Anita; Jafarey, Sadequa N

2013-06-22

Globally, Pakistan has the third highest burden of maternal, fetal, and child mortality. It has made slow progress in achieving the Millennium Development Goals (MDGs) 4 and 5 and in addressing common social determinants of health. The country also has huge challenges of political fragility, complex security issues, and natural disasters. We undertook an in-depth analysis of Pakistan's progress towards MDGs 4 and 5 and the principal determinants of health in relation to reproductive, maternal, newborn, and child health and nutrition. We reviewed progress in relation to new and existing public sector programmes and the challenges posed by devolution in Pakistan. Notwithstanding the urgent need to tackle social determinants such as girls' education, empowerment, and nutrition in Pakistan, we assessed the effect of systematically increasing coverage of various evidence-based interventions on populations at risk (by residence or poverty indices). We specifically focused on scaling up interventions using delivery platforms to reach poor and rural populations through community-based strategies. Our model indicates that with successful implementation of these strategies, 58% of an estimated 367,900 deaths (15,900 maternal, 169,000 newborn, 183,000 child deaths) and 49% of an estimated 180,000 stillbirths could be prevented in 2015. Copyright © 2013 Elsevier Ltd. All rights reserved.

Designing a community-based lay health advisor training curriculum to address cancer health disparities.

PubMed

Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, F Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, B Lee

2013-05-01

Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

Challenges in adapting existing clinical natural language processing systems to multiple, diverse health care settings.

PubMed

Carrell, David S; Schoen, Robert E; Leffler, Daniel A; Morris, Michele; Rose, Sherri; Baer, Andrew; Crockett, Seth D; Gourevitch, Rebecca A; Dean, Katie M; Mehrotra, Ateev

2017-09-01

Widespread application of clinical natural language processing (NLP) systems requires taking existing NLP systems and adapting them to diverse and heterogeneous settings. We describe the challenges faced and lessons learned in adapting an existing NLP system for measuring colonoscopy quality. Colonoscopy and pathology reports from 4 settings during 2013-2015, varying by geographic location, practice type, compensation structure, and electronic health record. Though successful, adaptation required considerably more time and effort than anticipated. Typical NLP challenges in assembling corpora, diverse report structures, and idiosyncratic linguistic content were greatly magnified. Strategies for addressing adaptation challenges include assessing site-specific diversity, setting realistic timelines, leveraging local electronic health record expertise, and undertaking extensive iterative development. More research is needed on how to make it easier to adapt NLP systems to new clinical settings. A key challenge in widespread application of NLP is adapting existing systems to new clinical settings. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Addressing current and future challenges for the NHS: the role of good leadership.

PubMed

Elton, Lotte

2016-10-03

Purpose This paper aims to describe and analyse some of the ways in which good leadership can enable those working within the National Health Service (NHS) to weather the changes and difficulties likely to arise in the coming years, and takes the format of an essay written by the prize-winner of the Faculty of Medical Leadership and Management's Student Prize. The Faculty of Medical Leadership and Management ran its inaugural Student Prize in 2015-2016, which aimed at medical students with an interest in medical leadership. In running the Prize, the Faculty hoped to foster an enthusiasm for and understanding of the importance of leadership in medicine. Design/methodology/approach The Faculty asked entrants to discuss the role of good leadership in addressing the current and future challenges faced by the NHS, making reference to the Leadership and Management Standards for Medical Professionals published by the Faculty in 2015. These standards were intended to help guide current and future leaders and were grouped into three categories, namely, self, team and corporate responsibility. Findings This paper highlights the political nature of health care in the UK and the increasing impetus on medical professionals to navigate debates on austerity measures and health-care costs, particularly given the projected deficit in NHS funding. It stresses the importance of building organisational cultures prizing transparency to prevent future breaches in standards of care and the value of patient-centred approaches in improving satisfaction for both patients and staff. Identification of opportunities for collaboration and partnership is emphasised as crucial to assuage the burden that lack of appropriate social care places on clinical services. Originality/value This paper offers a novel perspective - that of a medical student - on the complex issues faced by the NHS over the coming years and utilises a well-regarded set of standards in conceptualising the role that health

Inernational research in health care management: its need in the 21st century, methodological challenges, ethical issues, pitfalls, and practicalities.

PubMed

Buttigieg, Sandra C; Rathert, Cheryl; D'Aunno, Thomas A; Savage, Grant T

2015-01-01

This commentary argues in favor of international research in the 21st century. Advances in technology, science, communication, transport, and infrastructure have transformed the world into a global village. Industries have increasingly adopted globalization strategies. Likewise, the health sector is more internationalized whereby comparisons between diverse health systems, international best practices, international benchmarking, cross-border health care, and cross-cultural issues have become important subjects in the health care literature. The focus has now turned to international, collaborative, cross-national, and cross-cultural research, which is by far more demanding than domestic studies. In this commentary, we explore the methodological challenges, ethical issues, pitfalls, and practicalities within international research and offer possible solutions to address them. The commentary synthesizes contributions from four scholars in the field of health care management, who came together during the annual meeting of the Academy of Management to discuss with members of the Health Care Management Division the challenges of international research. International research is worth pursuing; however, it calls for scholarly attention to key methodological and ethical issues for its success. This commentary addresses salient issues pertaining to international research in one comprehensive account.

Female genital cutting: confronting cultural challenges and health complications across the lifespan.

PubMed

Farage, Miranda A; Miller, Kenneth W; Tzeghai, Ghebre E; Azuka, Charles E; Sobel, Jack D; Ledger, William J

2015-01-01

Female genital cutting affects over 140 million women worldwide. Prevalent in certain countries of Africa and the Middle East, the practice continues among immigrants to industrialized countries. Female genital cutting is a deeply rooted tradition that confers honor on a woman and her family, yet also a traumatic experience that creates significant dermatological, gynecological, obstetric and infectious disease complications. Little is known about postmenopausal health in cut women. The international community views this practice as a human rights violation. In addition to genital health complications, the medical community must confront an understudied concern of what happens as this population ages. These challenges must be addressed to provide optimal care to women affected by female genital cutting.

A consideration of user financial incentives to address health inequalities.

PubMed

Oliver, Adam; Brown, Lawrence D

2012-04-01

Health inequalities and user financial incentives to encourage health-related behavior change are two topical issues in the health policy discourse, and this article attempts to combine the two; namely, we try to address whether the latter can be used to reduce the former in the contexts of the United Kingdom and the United States. Payments for some aspects of medical adherence may offer a promising way to address, to some extent, inequalities in health and health care in both countries. However, payments for more sustained behavior change, such as that associated with smoking cessation and weight loss, have thus far shown little long-term effect, although more research that tests the effectiveness of different incentive mechanism designs, informed by the findings of behavioral economics, ought to be undertaken. Many practical, political, ethical, and ideological objections can be waged against user financial incentives in health, and this article reviews a number of them, but the justifiability of and limits to these incentives require more academic and public discourse so as to gain a better understanding of the circumstances in which they can legitimately be used.

Data Lakes and Data Visualization: An Innovative Approach to Address the Challenges of Access to Health Care in Mississippi.

PubMed

Krause, Denise D

2015-01-01

There are a variety of challenges to developing strategies to improve access to health care, but access to data is critical for effective evidence-based decision-making. Many agencies and organizations throughout Mississippi have been collecting quality health data for many years. However, those data have historically resided in data silos and have not been readily shared. A strategy was developed to build and coordinate infrastructure, capacity, tools, and resources to facilitate health workforce and population health planning throughout the state. Realizing data as the foundation upon which to build, the primary objective was to develop the capacity to collect, store, maintain, visualize, and analyze data from a variety of disparate sources -- with the ultimate goal of improving access to health care. Specific aims were to: 1) build a centralized data repository and scalable informatics platform, 2) develop a data management solution for this platform and then, 3) derive value from this platform by facilitating data visualization and analysis. A managed data lake was designed and constructed for health data from disparate sources throughout the state of Mississippi. A data management application was developed to log and track all data sources, maps and geographies, and data marts. With this informatics platform as a foundation, a variety of tools are used to visualize and analyze data. To illustrate, a web mapping application was developed to examine the health workforce geographically and attractive data visualizations and dynamic dashboards were created to facilitate health planning and research. Samples of data visualizations that aim to inform health planners and policymakers are presented. Many agencies and organizations throughout the state benefit from this platform. The overarching goal is that by providing timely, reliable information to stakeholders, Mississippians in general will experience improved access to quality care.

Data Lakes and Data Visualization: An Innovative Approach to Address the Challenges of Access to Health Care in Mississippi

PubMed Central

Krause, Denise D.

2015-01-01

Background: There are a variety of challenges to developing strategies to improve access to health care, but access to data is critical for effective evidence-based decision-making. Many agencies and organizations throughout Mississippi have been collecting quality health data for many years. However, those data have historically resided in data silos and have not been readily shared. A strategy was developed to build and coordinate infrastructure, capacity, tools, and resources to facilitate health workforce and population health planning throughout the state. Objective: Realizing data as the foundation upon which to build, the primary objective was to develop the capacity to collect, store, maintain, visualize, and analyze data from a variety of disparate sources -- with the ultimate goal of improving access to health care. Specific aims were to: 1) build a centralized data repository and scalable informatics platform, 2) develop a data management solution for this platform and then, 3) derive value from this platform by facilitating data visualization and analysis. Methods: A managed data lake was designed and constructed for health data from disparate sources throughout the state of Mississippi. A data management application was developed to log and track all data sources, maps and geographies, and data marts. With this informatics platform as a foundation, a variety of tools are used to visualize and analyze data. To illustrate, a web mapping application was developed to examine the health workforce geographically and attractive data visualizations and dynamic dashboards were created to facilitate health planning and research. Results: Samples of data visualizations that aim to inform health planners and policymakers are presented. Many agencies and organizations throughout the state benefit from this platform. Conclusion: The overarching goal is that by providing timely, reliable information to stakeholders, Mississippians in general will experience improved

Challenge of improving postoperative pain management: case studies of three acute pain services in the UK National Health Service.

PubMed

Powell, A E; Davies, H T O; Bannister, J; Macrae, W A

2009-06-01

Previous national survey research has shown significant deficits in routine postoperative pain management in the UK. This study used an organizational change perspective to explore in detail the organizational challenges faced by three acute pain services in improving postoperative pain management. Case studies were conducted comprising documentary review and semi-structured interviews (71) with anaesthetists, surgeons, nurses, other health professionals, and managers working in and around three broadly typical acute pain services. Although the precise details differed to some degree, the three acute pain services all faced the same broad range of inter-related challenges identified in the organizational change literature (i.e. structural, political, cultural, educational, emotional, and physical/technological challenges). The services were largely isolated from wider organizational objectives and activities and struggled to engage other health professionals in improving postoperative pain management against a background of limited resources, turbulent organizational change, and inter- and intra-professional politics. Despite considerable efforts they struggled to address these challenges effectively. The literature on organizational change and quality improvement in health care suggests that it is only by addressing the multiple challenges in a comprehensive way across all levels of the organization and health-care system that sustained improvements in patient care can be secured. This helps to explain why the hard work and commitment of acute pain services over the years have not always resulted in significant improvements in routine postoperative pain management for all surgical patients. Using this literature and adopting a whole-organization quality improvement approach tailored to local circumstances may produce a step-change in the quality of routine postoperative pain management.

Addressing global change challenges for Central Asian socio-ecosystems

NASA Astrophysics Data System (ADS)

Qi, Jiaguo; Bobushev, Temirbek S.; Kulmatov, Rashid; Groisman, Pavel; Gutman, Garik

2012-06-01

Central Asia is one of the most vulnerable regions on the planet earth to global climate change, depending on very fragile natural resources. The Soviet legacy has left the five countries (Kazakhstan, Tajikistan, Kyrgyzstan, Turkmenistan, and Uzbekistan) with a highly integrated system but they are facing great challenges with tensions that hinder regional coordination of food and water resources. With increasing climate variability and warming trend in the region, food and water security issues become even more crucial now and, if not addressed properly, could affect the regional stability. The long-term drivers of these two most critical elements, food and water, are climate change; the immediate and probably more drastic factors affecting the food and water security are land uses driven by institutional change and economic incentives. As a feedback, changes in land use and land cover have directly implications on water uses, food production, and lifestyles of the rural community in the region. Regional and international efforts have been made to holistically understand the cause, extent, rate and societal implications of land use changes in the region. Much of these have been understood, or under investigation by various projects, but solutions or research effort to develop solutions, to these urgent regional issues are lacking. This article, serves as an introduction to the special issue, provides a brief overview of the challenges facing the Central Asian countries and various international efforts in place that resulted in the publications of this special issue.

Rising to the challenge: addressing the concerns of people working in the sex industry.

PubMed

Shaver, Frances M; Lewis, Jacqueline; Maticka-Tyndale, Eleanor

2011-02-01

In September 2010, three Canadian Criminal Code provisions related to prostitution were ruled unconstitutional because they increase the risk of harm to people working in the sex industry (PWSI). Using data from studies with PWSI and key informants conducted in several Canadian cities, we examine three domains related to worker health and safety: occupational health and safety, perceptions of and behaviors toward workers, and access to essential services. Addressing these issues necessitates moving beyond decriminalization. We conclude that using a harm reduction/labor rights framework would enhance our ability to address issues related to the physical, social, and mental well-being as well as rights of PWSI.

Considering organizational factors in addressing health care disparities: two case examples.

PubMed

Griffith, Derek M; Yonas, Michael; Mason, Mondi; Havens, Betsy E

2010-05-01

Policy makers and practitioners have yet to successfully understand and eliminate persistent racial differences in health care quality. Interventions to address these racial health care disparities have largely focused on increasing cultural awareness and sensitivity, promoting culturally competent care, and increasing providers' adherence to evidence-based guidelines. Although these strategies have improved some proximal factors associated with service provision, they have not had a strong impact on racial health care disparities. Interventions to date have had limited impact on racial differences in health care quality, in part, because they have not adequately considered or addressed organizational and institutional factors. In this article, we describe an emerging intervention strategy to reduce health care disparities called dismantling (undoing) racism and how it has been adapted to a rural public health department and an urban medical system. These examples illustrate the importance of adapting interventions to the organizational and institutional context and have important implications for practitioners and policy makers.

Recent advances to address European Union Health Security from cross border chemical health threats.

PubMed

Duarte-Davidson, R; Orford, R; Wyke, S; Griffiths, M; Amlôt, R; Chilcott, R

2014-11-01

The European Union (EU) Decision (1082/2013/EU) on serious cross border threats to health was adopted by the European Parliament in November 2013, in recognition of the need to strengthen the capacity of Member States to coordinate the public health response to cross border threats, whether from biological, chemical, environmental events or events which have an unknown origin. Although mechanisms have been in place for years for reporting cross border health threats from communicable diseases, this has not been the case for incidents involving chemicals and/or environmental events. A variety of collaborative EU projects have been funded over the past 10 years through the Health Programme to address gaps in knowledge on health security and to improve resilience and response to major incidents involving chemicals. This paper looks at the EU Health Programme that underpins recent research activities to address gaps in resilience, planning, responding to and recovering from a cross border chemical incident. It also looks at how the outputs from the research programme will contribute to improving public health management of transnational incidents that have the potential to overwhelm national capabilities, putting this into context with the new requirements as the Decision on serious cross border threats to health as well as highlighting areas for future development. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Health care in China: improvement, challenges, and reform.

PubMed

Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

2013-02-01

Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues.

Managing Human Resources. Greater OPM Leadership Needed To Address Critical Challenges. Report to the Congress.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. General Government Div.

The General Accounting Office examined the Office of Personnel Management's (OPM's) leadership role in addressing critical human resource problems and preparing the government to meet future challenges. Federal managers, OPM employees, and federal personnel officials were surveyed to study federal government problems in hiring, managing, and…

Improving local health through community health workers in Cambodia: challenges and solutions.

PubMed

Ozano, Kim; Simkhada, Padam; Thann, Khem; Khatri, Rose

2018-01-06

Volunteer community health workers (CHWs) are an important link between the public health system and the community. The 'Community Participation Policy for Health' in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives. Qualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres. Findings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers. The fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently

Policy challenges and reforms in small EU member state health systems: a narrative literature review.

PubMed

Azzopardi-Muscat, Natasha; Funk, Tjede; Buttigieg, Sandra C; Grech, Kenneth E; Brand, Helmut

2016-12-01

The EU directive on patients' rights and cross-border care is of particular interest to small states as it reinforces the concept of health system cooperation. An analysis of the challenges faced by small states, as well as a deep evaluation of their health system reform characteristics is timely and justified. This paper identifies areas in which EU level cooperation may bring added value to these countries' health systems. Literature search is based primarily on PUBMED and is limited to English-language papers published between January 2000 and September 2014. Results of 76 original research papers appearing in peer-reviewed journals are summarised in a literature map and narrative review. Primary care, health workforce and medicines emerge as the salient themes in the review. Lack of capacity and small market size are found to be the frequently encountered challenges in governance and delivery of services. These constraints appear to also impinge on the ability of small states to effectively implement health system reforms. The EU appears to play a marginal role in supporting small state health systems, albeit the stimulus for reform associated with EU accession. Small states face common health system challenges which could potentially be addressed through enhanced health system cooperation at EU level. The lessons learned from research on small states may be of relevance to health systems organized at regional level in larger European states. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

The Role of Health Education in Addressing Uncertainty about Health and Cell Phone Use--A Commentary

ERIC Educational Resources Information Center

Ratnapradipa, Dhitinut; Dundulis, William P., Jr.; Ritzel, Dale O.; Haseeb, Abdul

2012-01-01

Although the fundamental principles of health education remain unchanged, the practice of health education continues to evolve in response to the rapidly changing lifestyles and technological advances. Emerging health risks are often associated with these lifestyle changes. The purpose of this article is to address the role of health educators…

Addressing Open Water Data Challenges in the Bureau of Reclamation

NASA Astrophysics Data System (ADS)

Brekke, L. D.; Danner, A.; Nagode, J.; Rocha, J.; Poulton, S.; Anderson, A.

2017-12-01

The Bureau of Reclamation is largest wholesaler of water in the United States. Located in the 17 western states, Reclamation serves water to 31 million people, provides irrigated water to 20 percent of Western farmers, and is the second largest producer of hydroelectric power in the United States. Through these activities, Reclamation generates large amounts of water and water-related data, describing reservoirs and river system conditions, hydropower, environmental compliance activities, infrastructure assets, and other aspects of Reclamation's mission activities. Reclamation aims to make water and water-related data sets more easily found, accessed, and used in decision-making activities in order to benefit the public, private sector, and research communities. Historically, there has not been an integrated, bureau-wide system to store data in machine-readable formats; nor a system to permit centralized browsing, open access, and web-services. Reclamation began addressing these limitations by developing the Reclamation Water Information System (RWIS), released in Spring 2017 (https://water.usbr.gov/). A bureau-wide team contributed to RWIS development, including water data stewards, database administrators, and information technology (IT) specialists. The first RWIS release publishes reservoir time series data from Reclamation's five regions and includes a map interface for sites identification, a query interface for data discovery and access, and web-services for automated retrieval. As RWIS enhancement continues, the development team is developing a companion system - the Reclamation Information Sharing Environment (RISE) - to provide access to the other data subjects and types (geospatial, documents). While RWIS and RISE are promising starts, Reclamation continues to face challenges in addressing open water data goals: making data consolidation and open publishing a value-added activity for programs that publish data locally, going beyond providing open access

Are we ready to accept the challenge? Addressing the shortcomings of contemporary qualitative health research.

PubMed

Lau, Sofie Rosenlund; Traulsen, Janine M

Qualitative approaches represent an important contributor to health care research. However, several researchers argue that contemporary qualitative research does not live up to its full potential. By presenting a snapshot of contemporary qualitative research in the field of social and administrative pharmacy, this study challenges contributors to the field by asking: Are we ready to accept the challenge and take qualitative research one step further? The purpose of this study was to initiate a constructive dialogue on the need for increased transparency in qualitative data analysis, including explicitly reflecting upon theoretical perspectives affecting the research process. Content analysis was used to evaluate levels of theoretical visibility and analysis transparency in selected qualitative research articles published in Research in Social and Administrative Pharmacy between January 2014 and January 2015. In 14 out of 21 assessed papers, the use of theory was found to be Seemingly Absent (lowest level of theory use), and the data analyses did not include any interpretive endeavors. Only two papers consistently applied theory throughout the entire study and clearly took the data analyses from a descriptive to an interpretive level. It was found that the aim of the majority of assessed papers was to change or modify a given practice, which however, resulted in a lack of both theoretical underpinnings and analysis transparency. This study takes the standpoint that theory and high-quality analysis go hand-in-hand. Based on the content analysis, articles that were deemed to be high in quality were explicit about the theoretical framework of their study and transparent in how they analyzed their data. It was found that theory contributed to the transparency of how the data were analyzed and interpreted. Two ways of improving contemporary qualitative research in the field of social and administrative pharmacy are discussed: engaging with social theory and establishing

The challenges of good governance in the aquatic animal health sector.

PubMed

Kahn, S; Mylrea, G; Yaacov, K Bar

2012-08-01

Animal health is fundamental to efficient animal production and, therefore, to food security and human health. This holds true for both terrestrial and aquatic animals. Although partnership between producers and governmental services is vital for effective animal health programmes, many key activities are directly carried out by governmental services. Noting the need to improve the governance of such services in many developing countries, the World Organisation for Animal Health (OIE), using the OIE Tool for the Evaluation of Performance of Veterinary Services, conducts assessments of Veterinary Services and Aquatic Animal Health Services (AAHS) to help strengthen governance and support more effective delivery of animal health programmes. While good governance and the tools to improve governance in the aquatic animal sector are largely based on the same principles as those that apply in the terrestrial animal sector, there are some specific challenges in the aquatic sector that have a bearing on the governance of services in this area. For example, the aquaculture industry has experienced rapid growth and the use of novel species is increasing; there are important gaps in scientific knowledge on diseases of aquatic animals; there is a need for more information on sustainable production; the level of participation of the veterinary profession in aquatic animal health is low; and there is a lack of standardisation in the training of aquatic animal health professionals. Aquaculture development can be a means of alleviating poverty and hunger in developing countries. However, animal diseases, adverse environmental impacts and food safety risks threaten to limit this development. Strengthening AAHS governance and, in consequence, aquatic animal health programmes, is the best way to ensure a dynamic and sustainable aquaculture sector in future. This paper discusses the specific challenges to AAHS governance and some OIE initiatives to help Member Countries to address

Role of local government in responding to environmental health challenges: a case study of Chungnam

PubMed Central

Lee, Hoo-Young

2017-01-01

The purpose of this study is to introduce the establishment process, policy target, and projects for “Chungnam’s master plan on environmental health policy (2017-2020)” as the local government’s role in addressing local environmental health challenges. We first analyzed existing studies and social issues on the media related to “Chungnam’s master plan” to understand Chungnam’s environmental health status and discussed domestic and international policy trends and related plans. An environmental health perception questionnaire survey and a Delphi expert questionnaire survey were conducted among provincial residents to collect various actors’ opinions on Chungnam’s environmental health issues and policy. An expert advisory panel was launched, and a residents’ voice workshop and cities-and-guns-policy-suggestion workshop were held. The vision of Chungnam’s environmental health policy is minimizing environmental hazards. We finally selected “Pleasant environment, healthy people, happy Chungnam” to represent the will to shape a pleasant environment and prevent and manage health damages for a happy Chungnam. We selected five strategies based on status analysis and a review of domestic and international policy trends and related plans and identified 2 targets (policy objectives) to accomplish the strategies. The strategies to achieve the first target, “Leader in environmental health policy: Chungnam,” include ‘Empowering active provincial capabilities,’ ‘Setting up province-specific systems for environmental health surveys and research,’ and ‘Preventing and managing newly emerging pollutants.’ The strategies for the second target, “Everyone is healthy: Chungnam,” include ‘Relieving health inequalities among vulnerable regions and residents’ and ‘Enlarging the resident-friendly environmental health policy.’ We developed 29 projects in total, according to these strategies. The establishment of “Chungnam’s master

The role of public-private partnerships in addressing the biomedical innovation challenge.

PubMed

Said, Maya; Zerhouni, Elias

2014-11-01

Without a step change in the productivity of pharmaceutical research and development, it will be difficult to tackle the public health challenges facing societies worldwide. Public–private partnerships could play a key role in achieving this step change, but they need to be well designed and led.

Designing a Community-Based Lay Health Advisor Training Curriculum to Address Cancer Health Disparities

PubMed Central

Gwede, Clement K.; Ashley, Atalie A.; McGinnis, Kara; Montiel-Ishino, F. Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B.; Wathington, Deanna; Dash-Pitts, Lolita; Green, B. Lee

2012-01-01

Introduction Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. Approach and Strategies Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic–community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Discussion and Conclusions Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research. PMID:22982709

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.

Health technology assessment in Iran: challenges and views

PubMed Central

Olyaeemanesh, Alireza; Doaee, Shila; Mobinizadeh, Mohammadreza; Nedjati, Mina; Aboee, Parisa; Emami-Razavi, Seyed Hassan

2014-01-01

Background: Various decisions have been made on technology application at all levels of the health system in different countries around the world. Health technology assessment is considered as one of the best scientific tools at the service of policy- makers. This study attempts to investigate the current challenges of Iran’s health technology assessment and provide appropriate strategies to establish and institutionalize this program. Methods: This study was carried out in two independent phases. In the first, electronic databases such as Medline (via Pub Med) and Scientific Information Database (SID) were searched to provide a list of challenges of Iran’s health technology assessment. The views and opinions of the experts and practitioners on HTA challenges were studied through a questionnaire in the second phase which was then analyzed by SPSS Software version 16. This has been an observational and analytical study with a thematic analysis. Results: In the first phase, seven papers were retrieved; from which, twenty- two HTA challenges in Iran were extracted by the researchers; and they were used as the base for designing a structured questionnaire of the second phase. The views of the experts on the challenges of health technology assessment were categorized as follows: organizational culture, stewardship, stakeholders, health system management, infrastructures and external pressures which were mentioned in more than 60% of the cases and were also common in the views. Conclusion: The identification and prioritization of HTA challenges which were approved by those experts involved in the strategic planning of the Department of Health Technology Assessment will be a step forward in the promotion of an evidence- based policy- making and in the production of comprehensive scientific evidence. PMID:25695015

Promoting correct car seat use in parents of young children: challenges, recommendations, and implications for health communication.

PubMed

Weaver, Nancy L; Brixey, Suzanne N; Williams, Janice; Nansel, Tonja R

2013-03-01

Injuries involving motor vehicles continue to be the biggest threat to the safety of children. Although child safety seats (CSS) have been established as a central countermeasure in decreasing injury risk, the majority of parents do not use the correct car seat correctly. There are many challenges in promoting correct car seat use, which itself is a complex behavior. To advance this critical protective behavior, the public health community would benefit from clarifying CSS messaging, communicating clearly, and addressing the conflicting recommendations of product use. In this article, we present current challenges in promoting CSS use and draw on health communication and other fields to offer recommendations for future work in this area.

CDC's Health Equity Resource Toolkit: disseminating guidance for state practitioners to address obesity disparities.

PubMed

Payne, Gayle Holmes; James, Stephen D; Hawley, Lisa; Corrigan, Bethany; Kramer, Rachel E; Overton, Samantha N; Farris, Rosanne P; Wasilewski, Yvonne

2015-01-01

Obesity has been on the rise in the United States over the past three decades, and is high. In addition to population-wide trends, it is clear that obesity affects some groups more than others and can be associated with age, income, education, gender, race and ethnicity, and geographic region. To reverse the obesity epidemic, the Centers for Disease Control and Prevention) promotes evidence-based and practice-informed strategies to address nutrition and physical activity environments and behaviors. These public health strategies require translation into actionable approaches that can be implemented by state and local entities to address disparities. The Centers for Disease Control and Prevention used findings from an expert panel meeting to guide the development and dissemination of the Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities (available at http://www.cdc.gov/obesity/health_equity/toolkit.html). The Toolkit helps public health practitioners take a systematic approach to program planning using a health equity lens. The Toolkit provides a six-step process for planning, implementing, and evaluating strategies to address obesity disparities. Each section contains (a) a basic description of the steps of the process and suggested evidence-informed actions to help address obesity disparities, (b) practical tools for carrying out activities to help reduce obesity disparities, and (c) a "real-world" case study of a successful state-level effort to address obesity with a focus on health equity that is particularly relevant to the content in that section. Hyperlinks to additional resources are included throughout. © 2014 Society for Public Health Education.

Social Justice Leadership and Inclusion: Exploring Challenges in an Urban District Struggling to Address Inequities

ERIC Educational Resources Information Center

DeMatthews, David; Mawhinney, Hanne

2014-01-01

Research Approach: This cross case study describes the challenges that two principals working in one urban school district addressed while attempting to transform their school cultures to embrace an inclusion model. Analysis of interviews and observations in each school revealed the actions, values, and orientations of the individual leaders and…

Addressing the Challenges and Needs of English-Speaking Caribbean Immigrant Students: Guidelines for School Counselors

ERIC Educational Resources Information Center

Morrison, Stephaney; Bryan, Julia

2014-01-01

Caribbean students are among the distinct immigrant groups in U.S. public schools with particular needs to be addressed by school counselors. This article discusses the challenges Caribbean immigrant students face that create obstacles to their academic and personal/social success. Guidelines for school counselors are outlined, which can be used…

Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study

PubMed Central

Akama, Eliud; Bukusi, Elizabeth A; Musoke, Pamela; Nalwa, Wafula Z; Odeny, Thomas A; Onono, Maricianah; Spangler, Sydney A; Turan, Janet M; Wanga, Iris; Abuogi, Lisa L

2017-01-01

Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes. PMID:28207061

Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study.

PubMed

Helova, Anna; Akama, Eliud; Bukusi, Elizabeth A; Musoke, Pamela; Nalwa, Wafula Z; Odeny, Thomas A; Onono, Maricianah; Spangler, Sydney A; Turan, Janet M; Wanga, Iris; Abuogi, Lisa L

2017-03-01

Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes.

Addressing the Common Pathway Underlying Hypertension and Diabetes in People Who Are Obese by Maximizing Health: The Ultimate Knowledge Translation Gap

PubMed Central

Dean, Elizabeth; Lomi, Constantina; Bruno, Selma; Awad, Hamzeh; O'Donoghue, Grainne

2011-01-01

In accordance with the WHO definition of health, this article examines the alarming discord between the epidemiology of hypertension, type 2 diabetes mellitus (T2DM), and obesity and the low profile of noninvasive (nondrug) compared with invasive (drug) interventions with respect to their prevention, reversal and management. Herein lies the ultimate knowledge translation gap and challenge in 21st century health care. Although lifestyle modification has long appeared in guidelines for medically managing these conditions, this evidence-based strategy is seldom implemented as rigorously as drug prescription. Biomedicine focuses largely on reducing signs and symptoms; the effects of the problem rather than the problem. This article highlights the evidence-based rationale supporting prioritizing the underlying causes and contributing factors for hypertension and T2DM, and, in turn, obesity. We argue that a primary focus on maximizing health could eliminate all three conditions, at best, or, at worst, minimize their severity, complications, and medication needs. To enable such knowledge translation and maximizing health outcome, the health care community needs to practice as an integrated team, and address barriers to effecting maximal health in all patients. Addressing the ultimate knowledge translation gap, by aligning the health care paradigm to 21st century needs, would constitute a major advance. PMID:21423684

Policy Options for Addressing Health System and Human Resources for Health Crisis in Liberia Post-Ebola Epidemic.

PubMed

Budy, Fidel C T

2015-01-01

Qualified healthcare workers within an effective health system are critical in promoting and achieving greater health outcomes such as those espoused in the Millennium Development Goals. Liberia is currently struggling with the effects of a brutal 14-year long civil war that devastated health infrastructures and caused most qualified health workers to flee and settle in foreign countries. The current output of locally trained health workers is not adequate for the tasks at hand. The recent Ebola Virus Disease (EVD) exposed the failings of the Liberian healthcare system. There is limited evidence of policies that could be replicated in Liberia to encourage qualified diaspora Liberian health workers to return and contribute to managing the phenomenon. This paper reviews the historical context for the human resources for health crisis in Liberia; it critically examines two context-specific health policy options to address the crisis, and recommends reverse brain drain as a policy option to address the immediate and critical crisis facing the health care sector in Liberia.

Global women's health in 2010: facing the challenges.

PubMed

Lester, Felicia; Benfield, Nerys; Fathalla, Mohamed M F

2010-11-01

Women's health is closely linked to a nation's level of development, with the leading causes of death in women in resource-poor nations attributable to preventable causes. Unlike many health problems in rich nations, the cure relies not only on the discovery of new medications or technology but also getting basic services to the people who need them most and addressing underlying injustice. In order to do this, political will and financial resources must be dedicated to developing and evaluating a scaleable approach to strengthen health systems, support community-based programs, and promote widespread campaigns to address gender inequality, including promoting girls' education. The Millennium Development Goals (MDGs) have highlighted the importance of addressing maternal health and promoting gender equality for the overall development strategy of a nation. We must capitalize on the momentum created by this and other international campaigns and continue to advocate for comprehensive strategies to improve global women's health.

[Health disparities: local realities and future challenges].

PubMed

Bodenmann, P; Green, A R

2012-11-28

Since 1887, the Policlinique Médicale Universitaire (PMU) has brought care to vulnerable populations who are at risk of poor physical, mental and social health. These include marginalised Swiss natives and immigrant communities (asylum seekers, undocumented immigrants). These patients are at risk of health disparities given their poor access to the health care system and lack of adapted quality care. Clinical approach must address these potential disparities, reinforced by a research describing them in order to explain their cause, and propose possible solutions, and a medical training addressing these topics from the undergraduate to the attending level. Through those holistic clinical approach, robust research and improved medical training, health providers will contribute to give quality care to all citizens, without exception!

The Human Microbiota, Infectious Disease, and Global Health: Challenges and Opportunities.

PubMed

Waldman, Abraham J; Balskus, Emily P

2018-01-12

Despite significant advances in treating infectious diseases worldwide, morbidity and mortality associated with pathogen infection remains extraordinarily high and represents a critical scientific and global health challenge. Current strategies to combat these infectious agents include a combination of vaccines, small molecule drugs, increased hygiene standards, and disease-specific interventions. While these approaches have helped to drastically reduce the incidence and number of deaths associated with infection, continued investment in current strategies and the development of novel therapeutic approaches will be required to address these global health threats. Recently, human- and vector-associated microbiotas, the assemblages of microorganisms living on and within their hosts, have emerged as a potentially important factor mediating both infection risk and disease progression. These complex microbial communities are involved in intricate and dynamic interactions with both pathogens as well as the innate and adaptive immune systems of their hosts. Here, we discuss recent findings that have illuminated the importance of resident microbiotas in infectious disease, emphasizing opportunities for novel therapeutic intervention and future challenges for the field. Our discussion will focus on four major global health threats: tuberculosis, malaria, HIV, and enteric/diarrheal diseases. We hope this Perspective will highlight the many opportunities for chemists and chemical biologists in this field as well as inspire efforts to elucidate the mechanisms underlying established disease correlations, identify novel microbiota-based risk factors, and develop new therapeutic interventions.

Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers

PubMed Central

Toscos, Tammy; Carpenter, Maria; Flanagan, Mindy; Kunjan, Kislaya; Doebbeling, Bradley N.

2018-01-01

Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These “positive deviant” practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Participants: Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Methods: Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Results: Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient–provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. Conclusion: We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access. PMID:29552599

Addressing practical challenges in utility optimization of mobile wireless sensor networks

NASA Astrophysics Data System (ADS)

Eswaran, Sharanya; Misra, Archan; La Porta, Thomas; Leung, Kin

2008-04-01

This paper examines the practical challenges in the application of the distributed network utility maximization (NUM) framework to the problem of resource allocation and sensor device adaptation in a mission-centric wireless sensor network (WSN) environment. By providing rich (multi-modal), real-time information about a variety of (often inaccessible or hostile) operating environments, sensors such as video, acoustic and short-aperture radar enhance the situational awareness of many battlefield missions. Prior work on the applicability of the NUM framework to mission-centric WSNs has focused on tackling the challenges introduced by i) the definition of an individual mission's utility as a collective function of multiple sensor flows and ii) the dissemination of an individual sensor's data via a multicast tree to multiple consuming missions. However, the practical application and performance of this framework is influenced by several parameters internal to the framework and also by implementation-specific decisions. This is made further complex due to mobile nodes. In this paper, we use discrete-event simulations to study the effects of these parameters on the performance of the protocol in terms of speed of convergence, packet loss, and signaling overhead thereby addressing the challenges posed by wireless interference and node mobility in ad-hoc battlefield scenarios. This study provides better understanding of the issues involved in the practical adaptation of the NUM framework. It also helps identify potential avenues of improvement within the framework and protocol.

Ineffective Healthcare Technology Management in Benin’s Public Health Sector: The Perceptions of Key Actors and Their Ability to Address the Main Problems

PubMed Central

Houngbo, P. Thierry; De Cock Buning, Tjard; Bunders, Joske; Coleman, Harry L. S.; Medenou, Daton; Dakpanon, Laurent; Zweekhorst, Marjolein

2017-01-01

Background: Low-income countries face many contextual challenges to manage healthcare technologies effectively, as the majority are imported and resources are constrained to a greater extent. Previous healthcare technology management (HTM) policies in Benin have failed to produce better quality of care for the population and costeffectiveness for the government. This study aims to identify and assess the main problems facing HTM in Benin’s public health sector, as well as the ability of key actors within the sector to address these problems. Methods: We conducted 2 surveys in 117 selected health facilities. The first survey was based on 377 questionnaires and 259 interviews, and the second involved observation and group interviews at health facilities. The Temple-Bird Healthcare Technology Package System (TBHTPS), tailored to the context of Benin’s health system, was used as a conceptual framework. Results: The findings of the first survey show that 85% of key actors in Benin’s HTM sector characterized the system as failing in components of the TBHTPS framework. Biomedical, clinical, healthcare technology engineers and technicians perceived problems most severely, followed by users of equipment, managers and hospital directors, international organization officers, local and foreign suppliers, and finally policy-makers, planners and administrators at the Ministry of Health (MoH). The 5 most important challenges to be addressed are policy, strategic management and planning, and technology needs assessment and selection – categorized as major enabling inputs (MEI) in HTM by the TBHTPS framework – and installation and commissioning, training and skill development and procurement, which are import and use activities (IUA). The ability of each key actor to address these problems (the degree of political or administrative power they possess) was inversely proportional to their perception of the severity of the problems. Observational data gathered during site

Improving Evaluation to Address the Unintended Consequences of Health Information Technology:

PubMed Central

Ammenwerth, E.; Hyppönen, H.; de Keizer, N.; Nykänen, P.; Rigby, M.; Scott, P.; Talmon, J.; Georgiou, A.

2016-01-01

Summary Background and objectives With growing use of IT by healthcare professionals and patients, the opportunity for any unintended effects of technology to disrupt care health processes and outcomes is intensified. The objectives of this position paper by the IMIA Working Group (WG) on Technology Assessment and Quality Development are to highlight how our ongoing initiatives to enhance evaluation are also addressing the unintended consequences of health IT. Methods Review of WG initiatives Results We argue that an evidence-based approach underpinned by rigorous evaluation is fundamental to the safe and effective use of IT, and for detecting and addressing its unintended consequences in a timely manner. We provide an overview of our ongoing initiatives to strengthen study design, execution and reporting by using evaluation frameworks and guidelines which can enable better characterization and monitoring of unintended consequences, including the Good Evaluation Practice Guideline in Health Informatics (GEP-HI) and the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI). Indicators to benchmark the adoption and impact of IT can similarly be used to monitor unintended effects on healthcare structures, processes and outcome. We have also developed EvalDB, a web-based database of evaluation studies to promulgate evidence about unintended effects and are developing the content for courses to improve training in health IT evaluation. Conclusion Evaluation is an essential ingredient for the effective use of IT to improve healthcare quality and patient safety. WG resources and skills development initiatives can facilitate a proactive and evidence-based approach to detecting and addressing the unintended effects of health IT. PMID:27830232

School Nurses' Perceived Prevalence and Competence to Address Student Mental Health Problems

ERIC Educational Resources Information Center

Stephan, Sharon H.; Connors, Elizabeth H.

2013-01-01

Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their…

Next-generation clinical trials: Novel strategies to address the challenge of tumor molecular heterogeneity.

PubMed

Catenacci, Daniel V T

2015-05-01

The promise of 'personalized cancer care' with therapies toward specific molecular aberrations has potential to improve outcomes. However, there is recognized heterogeneity within any given tumor-type from patient to patient (inter-patient heterogeneity), and within an individual (intra-patient heterogeneity) as demonstrated by molecular evolution through space (primary tumor to metastasis) and time (after therapy). These issues have become hurdles to advancing cancer treatment outcomes with novel molecularly targeted agents. Classic trial design paradigms are challenged by heterogeneity, as they are unable to test targeted therapeutics against low frequency genomic 'oncogenic driver' aberrations with adequate power. Usual accrual difficulties to clinical trials are exacerbated by low frequencies of any given molecular driver. To address these challenges, there is need for innovative clinical trial designs and strategies implementing novel diagnostic biomarker technologies to account for inter-patient molecular diversity and scarce tissue for analysis. Importantly, there is also need for pre-defined treatment priority algorithms given numerous aberrations commonly observed within any one individual sample. Access to multiple available therapeutic agents simultaneously is crucial. Finally intra-patient heterogeneity through time may be addressed by serial biomarker assessment at the time of tumor progression. This report discusses various 'next-generation' biomarker-driven trial designs and their potentials and limitations to tackle these recognized molecular heterogeneity challenges. Regulatory hurdles, with respect to drug and companion diagnostic development and approval, are considered. Focus is on the 'Expansion Platform Design Types I and II', the latter demonstrated with a first example, 'PANGEA: Personalized Anti-Neoplastics for Gastro-Esophageal Adenocarcinoma'. Applying integral medium-throughput genomic and proteomic assays along with a practical

Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health.

PubMed

Paskett, Electra; Thompson, Beti; Ammerman, Alice S; Ortega, Alexander N; Marsteller, Jill; Richardson, DeJuran

2016-08-01

Multilevel interventions are those that affect at least two levels of influence-for example, the patient and the health care provider. They can be experimental designs or natural experiments caused by changes in policy, such as the implementation of the Affordable Care Act or local policies. Measuring the effects of multilevel interventions is challenging, because they allow for interaction among levels, and the impact of each intervention must be assessed and translated into practice. We discuss how two projects from the National Institutes of Health's Centers for Population Health and Health Disparities used multilevel interventions to reduce health disparities. The interventions, which focused on the uptake of the human papillomavirus vaccine and community-level dietary change, had mixed results. The design and implementation of multilevel interventions are facilitated by input from the community, and more advanced methods and measures are needed to evaluate the impact of the various levels and components of such interventions. Project HOPE—The People-to-People Health Foundation, Inc.

Characteristics of Treatment Decisions to Address Challenging Behaviors in Children with Autism Spectrum Disorder.

PubMed

Anixt, Julia S; Meinzen-Derr, Jareen; Estridge, Halley; Smith, Laura; Brinkman, William B

2018-05-01

To describe the characteristics of treatment decisions to address challenging behaviors in children with autism spectrum disorder (ASD). Parents of children aged 4 to 15 years with ASD seen in a developmental behavioral pediatric (DBP) clinic completed validated measures to characterize their child's behaviors and their own level of stress. Parents reported their treatment priority before the visit. During the visit, we assessed shared decision making (SDM) using the Observing Patient Involvement (OPTION) scale and alignment of the clinician's treatment plan with the parent's priority. Before and after the visit, parents rated their uncertainty about the treatment plan using the Decisional Conflict Scale (DCS). We calculated descriptive statistics for the measures. Fifty-four families participated. Children were a mean (SD) age of 8.8 (3.3) years, and 87% were male. Children had a variety of behavioral challenges, and parents reported high levels of stress. Commonly reported parent treatment priorities were hyperactivity, tantrums, anxiety, and poor social skills. Levels of SDM were low, with a mean (SD) OPTION score of 24.5 (9.7). Parent priorities were addressed in 65% of treatment plans. Approximately 69% of parents had elevated DCS scores before the visit. Although levels of decisional conflict were lower after the visit compared with before the visit (p < 0.03), 46% of parents continued to report high scores on the DCS. Parents leave DBP visits with feelings of uncertainty about treatment decisions and with treatment plans that do not always address their priorities. SDM interventions hold promise to improve the quality of ASD treatment decisions.

What does an e-mail address add? - Doing health and technology at home.

PubMed

Andreassen, Hege K

2011-02-01

There is increasing interest in using electronic mail and other electronic health technologies (e-health technologies) in patient follow-ups. This study sheds light on patients' reception of provider-initiated e-health in their everyday environments. In a research project carried out in Norway (2005-2007), an electronic address for a hospital dermatology ward was offered to 50 patient families for improved access to expert advice from the patients' homes. Drawing on semi-structured interviews with 12 families, this paper explores how the electronic address was integrated into everyday health practice. The research illuminates how the electronic address did not only represent changes related to treatment procedures and frequency or nature of expert contact; it was also important to other practices in the everyday lives of the families of patients with chronic illness. Once in place on the patients' computers, the electronic address was ascribed at least four different roles: it was used as the intended riverbed for a flow of information, but also as a safety alarm, as a shield to the medical gaze and as a token of competence in care and parenting. The multiplicity in use and reception of an electronic address in patient settings illustrates the need to include patients' everyday practices in current professional and political discussions of e-mail and other e-health technologies. Thus this paper argues that there is a need for research on electronic patient-provider communication that moves beyond frequency of use and questions on how technology will affect medical encounters. Social science equally needs to investigate how provider-initiated e-health technologies gets involved in patients' moral and social performance of health and illness in everyday life. Copyright © 2010 Elsevier Ltd. All rights reserved.

e-Health promises and challenges: some ethical considerations.

PubMed

Kluge, Eike-Henner W

2011-01-01

eHealth is a cost-effective and efficient way of providing health care to patients who would otherwise be excluded or underserviced. However, eHealth also presents a series of ethical and legal challenges which, if not met before its implementation, can undermine its success. Among other things, privacy, consent and liability are implicated, as are changes in the health care professional-patient relationship and in the role of health informatics professionals. Legacy systems and interoperability present further challenges, and outsourcing may pose special problems. This paper highlights some of these issues and outlines their implications.

Stigma and mental health challenges in medical students

PubMed Central

Hankir, Ahmed Khaldoon; Northall, Amy; Zaman, Rashid

2014-01-01

Despite the perception that medical students and doctors should be ‘invincible’, mental health challenges are common in this population. Medical students and doctors have low levels of help seeking for their own psychiatric problems often only presenting to mental health services once a crisis arises. Fear of exposure to stigmatisation is a crucial factor contributing to symptom concealment and is a barrier to accessing mental health services. Autobiographical narratives of the ‘Wounded Healer’ are gaining popularity among medical students and doctors with mental health challenges both as an effective form of adjunctive therapy and as a means to campaign against stigma. Indeed, the results of a randomised controlled trial to assess the efficacy of Coming Out Proud with mental illness revealed immediate positive effects on stigma stress-related variables. We provide an autobiographical narrative from a medical student who has first-hand experience with mental health challenges. PMID:25183806

Balancing the benefits and risks of public-private partnerships to address the global double burden of malnutrition.

PubMed

Kraak, Vivica I; Harrigan, Paige B; Lawrence, Mark; Harrison, Paul J; Jackson, Michaela A; Swinburn, Boyd

2012-03-01

Transnational food, beverage and restaurant companies, and their corporate foundations, may be potential collaborators to help address complex public health nutrition challenges. While UN system guidelines are available for private-sector engagement, non-governmental organizations (NGO) have limited guidelines to navigate diverse opportunities and challenges presented by partnering with these companies through public-private partnerships (PPP) to address the global double burden of malnutrition. We conducted a search of electronic databases, UN system websites and grey literature to identify resources about partnerships used to address the global double burden of malnutrition. A narrative summary provides a synthesis of the interdisciplinary literature identified. We describe partnership opportunities, benefits and challenges; and tools and approaches to help NGO engage with the private sector to address global public health nutrition challenges. PPP benefits include: raising the visibility of nutrition and health on policy agendas; mobilizing funds and advocating for research; strengthening food-system processes and delivery systems; facilitating technology transfer; and expanding access to medications, vaccines, healthy food and beverage products, and nutrition assistance during humanitarian crises. PPP challenges include: balancing private commercial interests with public health interests; managing conflicts of interest; ensuring that co-branded activities support healthy products and healthy eating environments; complying with ethical codes of conduct; assessing partnership compatibility; and evaluating partnership outcomes. NGO should adopt a systematic and transparent approach using available tools and processes to maximize benefits and minimize risks of partnering with transnational food, beverage and restaurant companies to effectively target the global double burden of malnutrition.

Ideological and organizational components of differing public health strategies for addressing the social determinants of health.

PubMed

Raphael, Dennis; Brassolotto, Julia; Baldeo, Navindra

2015-12-01

Despite a history of conceptual contributions to reducing health inequalities by addressing the social determinants of health (SDH), Canadian governmental authorities have struggled to put these concepts into action. Ontario's-Canada's most populous province-public health scene shows a similar pattern. In statements and reports, governmental ministries, professional associations and local public health units (PHUs) recognize the importance of these issues, yet there has been varying implementation of these concepts into public health activity. The purpose of this study was to gain insight into the key features responsible for differences in SDH-related activities among local PHUs. We interviewed Medical Officers of Health (MOH) and key staff members from nine local PHUs in Ontario varying in SDH activity as to their understandings of the SDH, public health's role in addressing the SDH, and their units' SDH-related activities. We also reviewed their unit's documents and their organizational structures in relation to acting on the SDH. Three clusters of PHUs are identified based on their SDH-related activities: service-delivery-oriented; intersectoral and community-based; and public policy/public education-focused. The two key factors that differentiate PHUs are specific ideological commitments held by MOHs and staff and the organizational structures established to carry out SDH-related activities. The ideological commitments and the organizational structures of the most active PHUs showed congruence with frameworks adopted by national jurisdictions known for addressing health inequalities. These include a structural analysis of the SDH and a centralized organizational structure that coordinates SDH-related activities. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments.

PubMed

Tangcharoensathien, Viroj; Srisookwatana, Orapan; Pinprateep, Poldej; Posayanonda, Tipicha; Patcharanarumol, Walaiporn

2017-05-16

Multisectoral actions for health, defined as actions undertaken by non-health sectors to protect the health of the population, are essential in the context of inter-linkages between three dimensions of sustainable development: economic, social, and environmental. These multisectoral actions can address the social and economic factors that influence the health of a population at the local, national, and global levels. This editorial identifies the challenges, opportunities and capacity development for effective multisectoral actions for health in a complex policy environment. The root causes of the challenges lie in poor governance such as entrenched political and administrative corruption, widespread clientelism, lack of citizen voice, weak social capital, lack of trust and lack of respect for human rights. This is further complicated by the lack of government effectiveness caused by poor capacity for strong public financial management and low levels of transparency and accountability which leads to corruption. The absence of or rapid changes in government policies, and low salary in relation to living standards result in migration out of qualified staff. Tobacco, alcohol and sugary drink industries are major risk factors for non-communicable diseases (NCDs) and had interfered with health policy through regulatory capture and potential law suits against the government. Opportunities still exist. Some World Health Assembly (WHA) and United Nations General Assembly (UNGA) resolutions are both considered as external driving forces for intersectoral actions for health. In addition, Thailand National Health Assembly under the National Health Act is another tool providing opportunity to form trust among stakeholders from different sectors. Capacity development at individual, institutional and system level to generate evidence and ensure it is used by multisectoral agencies is as critical as strengthening the health literacy of people and the overall good governance of a

Occupational health and safety challenges in China--focusing on township-village enterprises.

PubMed

Wang, Xiaorong; Wu, Siying; Song, Qingkun; Tse, Lap-Ah; Yu, Ignatius T S; Wong, Tze-Wai; Griffiths, Sian

2011-01-01

China has experienced dramatic industrialization, urbanization, and economic growth over the last 3 decades. The rapid transformation and dramatic prosperity of industries in rural areas have, in turn, created tremendous challenges for occupational health and safety (OHS). This article was prepared to address occupational health and safety issues in township- and village-owned enterprises (TVEs) from several aspects, including working conditions and workplace hazards, major recognized OHS problems, implications of TVE industries to environmental health, and migrant workers. Among the major recognized OHS problems, pneumoconiosis, chemical poisoning, and workplace accidents, especially in small-scale coal mines, are highlighted. It is suggested that the national polices and regulations that specifically target TVEs are indispensable and a more powerful administrative structure should be established to ensure that the pertinent polices, regulations, and OHS standards can be enforced widely and effectively in practice. Copyright © 2011 Taylor & Francis Group, LLC

The politics of knowledge: implications for understanding and addressing mental health and illness.

PubMed

Jenkins, Emily K

2014-03-01

While knowledge represents a valuable commodity, not all forms of knowledge are afforded equal status. The politics of knowledge, which entails the privileging of particular ways of knowing through linkages between the producers of knowledge and other bearers of authority or influence, represents a powerful force driving knowledge development. Within the health research and practice community, biomedical knowledge (i.e. knowledge pertaining to the biological factors influencing health) has been afforded a privileged position, shaping the health research and practice community's view of health, illness and appropriate intervention. The aim of this study is to spark critical reflection and dialogue surrounding the ways in which the politics of knowledge have constrained progress in addressing mental health and illness, one of today's leading public health issues. I argue that the hegemony of biological knowledge represents an ethical issue as it limits the breadth of knowledge available to support practitioners to 'do good' in terms of addressing mental illness. Given the power and influence inherent within the nursing community, I propose that nurses ought to engage in critical reflection and action in an effort to better situate the health research and practice community to effectively address the mental health of populations. © 2013 John Wiley & Sons Ltd.

eHealth recruitment challenges.

PubMed

Thompson, Debbe; Canada, Ashanti; Bhatt, Riddhi; Davis, Jennifer; Plesko, Lisa; Baranowski, Tom; Cullen, Karen; Zakeri, Issa

2006-11-01

Little is known about effective eHealth recruitment methods. This paper presents recruitment challenges associated with enrolling African-American girls aged 8-10 years in an eHealth obesity prevention program, their effect on the recruitment plan, and potential implications for eHealth research. Although the initial recruitment strategy was literature-informed, it failed to enroll the desired number of girls within a reasonable time period. Therefore, the recruitment strategy was reformulated to incorporate principles of social marketing and traditional marketing techniques. The resulting plan included both targeted, highly specific strategies (e.g., selected churches), and more broad-based approaches (e.g., media exposure, mass mailings, radio advertisements). The revised plan enabled recruitment goals to be attained. Media appeared to be particularly effective at reaching the intended audience. Future research should identify the most effective recruitment strategies for reaching potential eHealth audiences.

Home Health Care (HHC) Managers Perceptions About Challenges and Obstacles that Hinder HHC Services in Jordan

PubMed Central

Ajlouni, Musa T.; Dawani, Hania; Diab, Salah M.

2015-01-01

Home care aims at supporting people with various degrees of dependency to remain at home rather than use residential, long-term, or institutional-based nursing care. Demographic, epidemiological, social, and cultural trends in Jordan as in other countries are changing the traditional patterns of care with growing emphasis on home care. The purpose of this study is to highlight the most common challenges related to home health care (HHC) services in Jordan as perceived by the managers of HHC agencies. Methods: a descriptive qualitative design that depends on focus group discussions has been used to collect data from a sample of 18 managers who met the selection criteria and who are willing to participate, the study found that, the main challenges of HHC services as perceived by managers were: shortage of female staff, lack of governance and regulation, poor management, unethical practices, lack of referral systems, and low accessibility of the poor and less privileged as HHC services are not included in health insurance schemes, it concludes also that the home health care industry in Jordan is facing many challenges and problems that may have negative effects on the effectiveness, efficiency, equity and quality of services and should be addressed by health policy makers. PMID:25946949

Island health: hope and challenges for public health.

PubMed

Binns, Colin; Hokama, Tomiko; Low, Wah Yun

2010-01-01

The Asia-Pacific region is a region of small islands, perhaps 100 000 of them. The health, communication, and development problems of islands present difficult challenges for the delivery of health care. The discussions at the Okinawa Symposium centred on how health can be provided to all in the region, not only those in metropolitan areas, but also the poor in rural areas and those on living on far-flung island archipelagos. It is important to apply principles of "public health" and "primary health care" so that all island residents may have a reasonable expectation of health care. Schools of public health have a special responsibility to educate those who are responsible for the delivery and management of health care in these remote locations. The development of telehealth systems will be important to support health workers in remote locations and to deliver continuing education programs.

Addressing poverty, education, and gender equality to improve the health of women worldwide.

PubMed

Tyer-Viola, Lynda A; Cesario, Sandra K

2010-01-01

The Millennium Development Goals (MDG) that target alleviating poverty, improving primary education, and fostering gender equity are important as a foundation to promote world health. Achieving these goals will create an environment for healthy lives for women and children. Poverty, education, and gender equality, although undeniably linked, need to be addressed individually. Nurses have the capacity and political will to address MDGs and to contribute to the health and well-being of the world population. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Tracing health system challenges in post-conflict Côte d'Ivoire from 1893 to 2013.

PubMed

Gaber, Sabrina; Patel, Preeti

2013-07-01

While scholarship on health in conflict-affected countries is growing, there has been relatively little analysis of how armed conflict affects health systems in specific African countries, especially former French colonies. There is even less literature on the role of history in shaping health systems and how historical factors such as inequity may influence health impacts of armed conflict. Based on Côte d'Ivoire, this article argues that historical multidisciplinary analysis can provide valuable insight into the macro-level political, economic and social determinants of the health system over time. It explores how armed conflict has affected health services and exacerbates historically inherited challenges to the health system including unequal distribution of health services, bias towards curative care in urban areas, inadequate human resources and weak health governance. In the post-conflict period, this understanding may assist governments and other stakeholders to develop more appropriate health policies that address both urgent and long-term health needs.

The Role of Nutrition-Related Initiatives in Addressing Community Health Needs Assessments

ERIC Educational Resources Information Center

George, Daniel R.; Rovniak, Liza S.; Dillon, Judy; Snyder, Gail

2017-01-01

Academic Health Centers and nonprofit hospitals are exploring strategies to meet Affordable Care Act mandates requiring tax-exempt institutions to address community health needs, which commonly include major chronic illnesses. We explore the implications of this regulatory landscape, describing methods that nonprofit health care institutions are…