A 5-Year Update on the Uneven Distribution of Women in Orthopaedic Surgery Residency Training Programs in the United States.

PubMed

Van Heest, Ann E; Fishman, Felicity; Agel, Julie

2016-08-03

This study was undertaken to update our report from academic years 2004-2005 through 2008-2009, to include 5 additional years of the Association of American Medical Colleges GME Track data. This study will test the hypothesis that, when compared with the data from 2004-2005 through 2008-2009, there were no substantial changes from 2009-2010 through 2013-2014 in the distribution of orthopaedic surgery residency programs that train female residents and have been accredited by the Accreditation Council for Graduate Medical Education (ACGME). Data for all ACGME-accredited orthopaedic surgery residency training programs in the United States were analyzed for 2009-2010 through 2013-2014, in the same manner as our previous report analyzed data for 2004-2005 through 2008-2009. Programs were classified as having 0, 1, 2, or >2 women in training (i.e., for postgraduate year [PGY]-1 through PGY-5) for each of the 5 academic years. Programs were also analyzed for the percentage of female residents in training and were classified as being above the national average (>20%), similar to the national average (between 10% and 20%), or below the national average (<10%) for each of the 5 academic years. During the time period of 2004 to 2009, the mean percentage of female trainees in U.S. orthopaedic surgery residency programs was 11.6%, and during the time period of 2009 to 2014, this mean percentage increased to 12.6%. Residency programs in the United States do not train women at an equal rate. In the 5 years examined (2009 to 2014), 30 programs had no female trainees and 49 programs had >20% women enrolled in at least 1 of the 5 years, 8 programs had no female trainees enrolled in any of the 5 years, and 9 programs had >20% women enrolled in each of the 5 years. Female medical students continue to pursue orthopaedic surgery as a career at rates lagging behind all other surgical specialties. Not all residency programs train women at equal rates. The period of 2009-2010 through 2013-2014 showed a greater percentage of programs (68%) training ≥2 women than the period of 2004-2005 through 2008-2009 (61%). Obstacles to attracting women to orthopaedic surgery should continue to be identified and to be addressed. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Standards of care for occupational asthma: an update.

PubMed

Fishwick, David; Barber, Christopher Michael; Bradshaw, Lisa M; Ayres, Jon G; Barraclough, Richard; Burge, Sherwood; Corne, Jonathan M; Cullinan, Paul; Frank, Timothy Laszlo; Hendrick, David; Hoyle, Jennifer; Curran, Andrew D; Niven, Robert; Pickering, Tony; Reid, Peter; Robertson, Alastair; Stenton, Chris; Warburton, Christopher J; Nicholson, Paul J

2012-03-01

The British Thoracic Society (BTS) Standards of Care (SoC) Committee produced a standard of care for occupational asthma (OA) in 2008, based on a systematic evidence review performed in 2004 by the British Occupational Health Research Foundation (BOHRF). BOHRF updated the evidence base from 2004-2009 in 2010. This article summarises the changes in evidence and is aimed at physicians, nurses and other healthcare professionals in primary and secondary care, occupational health and public health and at employers, workers and their health, safety and other representatives. Various recommendations and evidence ratings have changed in the management of asthma that may have an occupational cause.

Effect of Improved access to Antiretroviral Therapy on clinical characteristics of patients enrolled in the HIV care and treatment clinic, at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania

PubMed Central

2010-01-01

Background Sub-Saharan Africa has been severely affected by the HIV and AIDS pandemic. Global efforts at improving care and treatment has included scaling up use of antiretroviral therapy (ART). In Tanzania, HIV care and treatment program, including the provision of free ART started in 2004 with a pilot program at Muhimbili National Hospital in Dar es Salaam. This study describes the socio-demographic and clinical features of patients enrolled at the care and treatment clinic at MNH, Dar es Salaam, Tanzania. Methods A cross-sectional study looking at baseline characteristics of patients enrolled at the HIV clinic at MNH between June 2004 - Dec 2005 compared to those enrolled between 2006 and September 2008. Results Of all enrolled patients, 2408 (58.5%) were used for analysis. More females than males were attending the clinic. Their baseline median CD4 cell count was low (136 cells/μl) with 65.7% having below 200 cells/μl. Females had higher CD4 cell counts (150 cells/μl) than males (109 cells/μl) p < 0.001). The most common presenting features were skin rash and/or itching (51.6%); progressive weight loss (32.7%) and fever (23.4). Patients enrolled earlier at the clinic (2004-5) were significantly more symptomatic and had significantly lower CD4 cell count (127 cells/μl) compared to CD4 of 167 cells/μl in those seen later (2006-8) (p < 0.001). Conclusion Patients enrolled to the MNH HIV clinic were predominantly females, and presented with advanced immune-deficiency. Improved access to HIV care and treatment services seems to be associated with patients' early presentation to the clinics in the course of HIV disease. PMID:20509892

[Effects of performance-volume limit on the institutional financing of the Clinical Centre of the University of Pécs, Hungary].

PubMed

Endrei, Dóra; Kollár, Lajos; Bódis, József; Imhof, Gábor; Zemplényi, Antal; Vas, Gábor; Boncz, Imre

2010-08-01

The aim of our study is to demonstrate the effects of performance-volume limit (PVL) on the institutional financing of the Clinical Centre of the University of Pécs (CC UP). The data involved in the analysis are based on the reports towards the National Health Insurance Fund Administration (NHIFA), concerning the active inpatient care by specialist in the period between 2004 and 2008. We determined the real NHIFA reimbursement per weighted case number and the financial loss caused by the PVL. We analyzed the proportion of local health care obligation and urgency cases in comparison of various clinics. The reimbursement per weighted case number of CC UP has been less than the pre-announced NHIFA amounts after the installation of PVL. During the examined 5 years, i.e. 2004-2008, the loss in case of CC UP has been up to 3.256 million HUF due to the PVL. Concerning the whole of CC UP it means that 25.3 % of the treated cases and 24.5 % of the executed weighted case number has been out of local health care obligation. Studying the ratio of urgency cases inside the total volume of medical attendance, it is represented that 31.5 % of the cases and 36.1 % of the weighted case numbers came from the treatment of urgency cases. The introduction of performance-volume limit considerably reduced the health insurance financing of CC UP between 2004 and 2008.

The YMCA/Steps Community Collaboratives, 2004-2008.

PubMed

Adamson, Katie; Shepard, Dennis; Easton, Alyssa; Jones, Ellen S

2009-07-01

Since the YMCA/Steps National Partnership began in 2004, the collaborative approach has built local synergy, linked content experts, and engaged national partners to concentrate on some of the most pressing health issues in the United States. Together, national and local partners used evidence-based public health programs to address risk factors such as poor nutrition, physical inactivity, and tobacco use. This article describes the YMCA/Steps National Partnership and focuses on the experiences and achievements of the YMCA/Steps Community Collaboratives, conducted with technical assistance from the National Association of Chronic Disease Directors between 2004 and 2008. We introduce some of the fundamental concepts underlying the partnership's success and share evaluation results.

Trends in pesticide concentrations in urban streams in the United States, 1992-2008

USGS Publications Warehouse

Ryberg, Karen R.; Vecchia, Aldo V.; Martin, Jeffrey D.; Gilliom, Robert J.

2010-01-01

Pesticide concentration trends in streams dominated by urban land use were assessed using data from 27 urban streams sampled as part of the U.S. Geological Survey National Water-Quality Assessment Program. The sites were divided into four regions, Northeast, South, Midwest, and West, to examine possible regional patterns. Three partially overlapping 9-year periods (1992-2000, 1996-2004, and 2000-2008) were examined for eight herbicides and one degradation product (simazine, prometon, atrazine, deethylatrazine, metolachlor, trifluralin, pendimethalin, tebuthiuron, and Dacthal), and five insecticides and two degradation products (chlorpyrifos, malathion, diazinon, fipronil, fipronil sulfide, desulfinylfipronil, and carbaryl). The data were analyzed for trends in concentration using a parametric regression model with seasonality, flow-related variability, and trend, called SEAWAVE-Q. The SEAWAVE-Q model also was used to generate estimated daily concentration percentiles for each analysis period to provide a summary of concentration magnitudes. For herbicides, the largest 90th percentiles of estimated concentrations for simazine were in the South, prometon at some sites in all of the regions, atrazine and deethylatrazine in the South and Midwest, metolachlor in the Midwest and a few sites in the South, pendimethalin at scattered sites in all of the regions, and tebuthiuron in the South and a few sites in the Midwest and West. For insecticides, the largest 90th percentiles of estimated concentrations for diazinon and carbaryl were distributed among various sites in all regions (especially during 1996-2004), and fipronil at isolated sites in all of the regions during 2000-2008. Trend analysis results for the herbicides indicated many significant trends, both upward and downward, with varying patterns depending on period, region, and herbicide. Overall, deethylatrazine showed the most consistent pattern of upward trends, especially in the Northeast (2000-2008), South (1996-2004 and 2000-2008), and Midwest (1996-2004 and 2000-2008). Other herbicides showed less consistent upward trends, including simazine in the South (1996-2004), prometon in the Midwest (2000-2008), and atrazine in the South (1996-2004). The most consistent downward trends were for simazine in the Northeast and Midwest (1996-2004), prometon in the Northeast and Midwest (1996-2004) and West (1996-2004 and 2000-2008), and tebuthiuron in the South (1996-2004 and 2000-2008) and West (2000-2008). Strong similarity existed between the trends for atrazine and deethylatrazine during 1996-2004. During 2000-2008, however, there were mixed upward and downward trends in atrazine and predominantly upward trends in deethylatrazine. Ten sites with a downward trend in atrazine were paired with an upward trend in deethylatrazine and for three of these sites (1 in the South and 2 in the Midwest) both opposing trends were significant. Opposing trends showing a decrease in atrazine and an increase in deethylatrazine may indicate that decreases in atrazine from surface runoff are being offset in some cases by increases in deethylatrazine from groundwater for the latter analysis period. Trend results for insecticides indicated widespread significant downward trends for chlorpyrifos (especially 1996-2004), diazinon (1996-2004 and 2000-2008), and malathion (especially 1996-2004); widespread significant upward trends for fipronil and its degradation products (2000-2008); and mostly nonsignificant trends for carbaryl (1996-2004 and 2000-2008). The downward trends for chlorpyrifos and diazinon were consistent with the regulatory phaseout of residential uses of these insecticides and the upward trends for fipronil and its degradation products were consistent with its introduction in 1996 and subsequent increasing use as a possible substitute for chlorpyrifos and diazinon. The downward trends in malathion may be caused by voluntary substitution of pyrethroids or fipronil for malathio

Job mobility among parents of children with chronic health conditions: Early effects of the 2010 Affordable Care Act.

PubMed

Chatterji, Pinka; Brandon, Peter; Markowitz, Sara

2016-07-01

We examine the effects of the 2010 Patient Protection and Affordable Care Act's (ACA) prohibition of preexisting conditions exclusions for children on job mobility among parents. We use a difference-in-difference approach, comparing pre-post policy changes in job mobility among privately-insured parents of children with chronic health conditions vs. privately-insured parents of healthy children. Data come from the 2004 and 2008 Survey of Income and Program Participation (SIPP). Among married fathers, the policy change is associated with about a 0.7 percentage point, or 35 percent increase, in the likelihood of leaving an employer voluntarily. We find no evidence that the policy change affected job mobility among married and unmarried mothers. Copyright © 2016 Elsevier B.V. All rights reserved.

Diversity in the Emerging Critical Care Workforce: Analysis of Demographic Trends in Critical Care Fellows From 2004 to 2014.

PubMed

Lane-Fall, Meghan B; Miano, Todd A; Aysola, Jaya; Augoustides, John G T

2017-05-01

Diversity in the physician workforce is essential to providing culturally effective care. In critical care, despite the high stakes and frequency with which cultural concerns arise, it is unknown whether physician diversity reflects that of critically ill patients. We sought to characterize demographic trends in critical care fellows, who represent the emerging intensivist workforce. We used published data to create logistic regression models comparing annual trends in the representation of women and racial/ethnic groups across critical care fellowship types. United States Accreditation Council on Graduate Medical Education-approved residency and fellowship training programs. Residents and fellows employed by Accreditation Council on Graduate Medical Education-accredited training programs from 2004 to 2014. None. From 2004 to 2014, the number of critical care fellows increased annually, up 54.1% from 1,606 in 2004-2005 to 2,475 in 2013-2014. The proportion of female critical care fellows increased from 29.5% (2004-2005) to 38.3% (2013-2014) (p < 0.001). The absolute number of black fellows increased each year but the percentage change was not statistically significantly different (5.1% in 2004-2005 vs 3.9% in 2013-2014; p = 0.92). Hispanic fellows increased in number from 124 (7.7%) in 2004-2005 to 216 (8.4%) in 2013-2014 (p = 0.015). The number of American Indian/Alaskan Native/Native Hawaiian/Pacific Islander fellows decreased from 15 (1.0%) to seven (0.3%) (p < 0.001). When compared with population estimates, female critical care fellows and those from racial/ethnic minorities were underrepresented in all years. The demographics of the emerging critical care physician workforce reflect underrepresentation of women and racial/ethnic minorities. Trends highlight increases in women and Hispanics and stable or decreasing representation of non-Hispanic underrepresented minority critical care fellows. Further research is needed to elucidate the reasons underlying persistent underrepresentation of racial and ethnic minorities in critical care fellowship programs.

The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

PubMed Central

Ryan, Andrew M; Blustein, Jan

2011-01-01

Objective To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N = 62) and other states (N = 3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (−0.67 percentage points, p>.10) and SIP (−0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation. PMID:21210796

“If We Build It, Will It Stay?” A Case Study of the Sustainability of Whole-System Change in London

PubMed Central

Greenhalgh, Trisha; Macfarlane, Fraser; Barton-Sweeney, Catherine; Woodard, Fran

2012-01-01

Context The long-term sustainability of whole-system change programs is rarely studied, and when it is, it is inevitably undertaken in a shifting context, thereby raising epistemological and methodological questions. This article describes a transferable methodology that was developed to guide the evaluation of a three-year follow-up of a large health care change program in London, which took place during a period of economic turbulence and rapid policy change. Method Using a mixed-method organizational case study design, we studied three services (stroke, kidney, and sexual health) across primary and secondary care. Each had received £5 million (US$7.8 million) in modernization funding in 2004. In 2010/2011, we gathered data on the services and compared them with data from 2004 to 2008. The new data set contained quantitative statistics (access, process, and outcome metrics), qualitative interviews with staff and patients, documents, and field notes. Our data analysis was informed by two complementary models of sustainability: intervention-focused (guided by the question, What, if anything, of the original program has been sustained?) and system-dynamic (guided by the question, How and why did change unfold as it did in this complex system?). Findings Some but not all services introduced in the original transformation effort of 2004–2008 were still running; others had ceased or been altered substantially to accommodate contextual changes (e.g., in case mix, commissioning priorities, or national policies). Key cultural changes (e.g., quality improvement, patient centeredness) largely persisted, and innovative ideas and practices had spread elsewhere. To draw causal links between the original program and current activities and outcomes, it was necessary to weave a narrative thread with multiple intervening influences. In particular, against a background of continuous change in the local health system, the sustainability of the original vision and capacity for quality improvement was strongly influenced by (1) stakeholders’ conflicting and changing interpretations of the targeted health need; (2) changes in how the quality cycle was implemented and monitored; and (3) conflicts in stakeholders’ values and what each stood to gain or lose. Conclusions The sustainability of whole-system change embodies a tension between the persistence of past practice and the adaptation to a changing context. Although the intervention-focused question, What has persisted from the original program? (addressed via a conventional logic model), may be appropriate, evaluators should qualify their findings by also considering the system-dynamic question, What has changed, and why? (addressed by producing a meaningful narrative). PMID:22985280

Maryland's forest resources, 2008

Treesearch

T.W. Lister; J. Perdue; B. Butler; C. Barnett; B. O' Connell

2010-01-01

This publication provides an overview of forest resource attributes for Maryland based on an annual inventory (2004-2008) conducted by the Forest Inventory and Analysis (FIA) program at the Northern Research Station of the U.S. Forest Service. These estimates, along with web-posted core tables, will be updated annually. For more information please refer to the last...

Trends of HIV and sexually transmitted infections, estimated HIV incidence, and risky sexual behaviors among gay bathhouse attendees in Taiwan: 2004-2008.

PubMed

Ko, Nai-Ying; Lee, Hsin-Chun; Hung, Chien-Ching; Tseng, Fan-Chen; Chang, Jui-Ling; Lee, Nan-Yao; Chang, Chia-Ming; Lee, Meng-Ping; Chen, Bo-Jie; Wang, Shainn-Wei; Ko, Wen-Chien

2011-02-01

Five serial cross-sectional surveys were done at eight gay bathhouses in Taiwan to investigate the trends of HIV and sexually transmitted infections (STIs) and estimated HIV incidence between 2004 and 2008. Bathhouse attendees completed a questionnaire and tests for HIV, syphilis, hepatitis C virus, and amoebiasis. Twenty-nine (38.6%) were identified as having recent HIV-1 infections. There was a significant increase in HIV incidence, from 7.8% in 2004 to 15% in 2007 (χ(2) = 17.59, P-trend <0.001). Recreational drug use is the primary risk behavior. Comprehensive screening programs in gay bathhouses for early detection of HIV and STIs are important.

An investigation of prescription and over-the-counter supply of ophthalmic chloramphenicol in Wales in the 5 years following reclassification.

PubMed

Du, Hank C T; John, Dai N; Walker, Roger

2014-02-01

The aims of the study were to (i) quantify the sales of over-the-counter (OTC) ophthalmic chloramphenicol from all community pharmacies in Wales and investigate the impact on primary care prescriptions up to 5 years after reclassification and (ii) investigate the temporal relationship between items supplied OTC and on NHS primary care prescriptions. Primary care prescription data (2004-2010) and OTC sales data (2005-2010) for ophthalmic chloramphenicol were obtained. The quantity sold OTC was calculated from pharmacy wholesale records and sales data from a large pharmacy multiple. Spearman's rank correlation for prescription and OTC supplies of ophthalmic chloramphenicol was calculated for data from January 2008 to December 2010. OTC supply of chloramphenicol eye drops and ointment were both highest in 2007-2008 and represented 68% (57,708/84,304) and 48% (22,875/47,192) of the corresponding prescription volume, respectively. There was a steady year-on-year increase in the combined supply of OTC ophthalmic chloramphenicol and that dispensed on prescription from 144,367 items in 2004-2005 to 210,589 in 2007-2008 before stabilising in 2008-2009 and 2009-2010. A significant positive correlation was observed between prescription items and OTC sales of chloramphenicol eye drops and ointment combined (r=0.7, P<0.001). OTC availability increased the total quantity of ophthalmic chloramphenicol supplied in primary care compared to that seen prior to reclassification. Although growth in the sales of ophthalmic chloramphenicol OTC has stabilised and the supply pattern mirrors primary care prescribers, further work is required to investigate whether use is appropriate and whether the publication of updated practice guidance has changed this. © 2013 The Authors. IJPP © 2013 Royal Pharmaceutical Society.

Reduction of feral cat (Felis catus Linnaeus 1758) colony size following hysterectomy of adult female cats.

PubMed

Mendes-de-Almeida, Flavya; Remy, Gabriella L; Gershony, Liza C; Rodrigues, Daniela P; Chame, Marcia; Labarthe, Norma V

2011-06-01

The size of urban cat colonies is limited only by the availability of food and shelter; therefore, their population growth challenges all known population control programs. To test a new population control method, a free-roaming feral cat colony at the Zoological Park in the city of Rio de Janeiro was studied, beginning in 2001. The novel method consisted of performing a hysterectomy on all captured female cats over 6 months of age. To estimate the size of the colony and compare population from year to year, a method of capture-mark-release-recapture was used. The aim was to capture as many individuals as possible, including cats of all ages and gender to estimate numbers of cats in all population categories. Results indicated that the feral cat population remained constant from 2001 to 2004. From 2004 to 2008, the hysterectomy program and population estimates were performed every other year (2006 and 2008). The population was estimated to be 40 cats in 2004, 26 in 2006, and 17 cats in 2008. Although pathogens tend to infect more individuals as the population grows older and maintains natural behavior, these results show that free-roaming feral cat colonies could have their population controlled by a biannual program that focuses on hysterectomy of sexually active female cats. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

Reformatted data sets used in the Cooperative LACSD/USGS Palos Verdes Flow Study, 2000--2008

USGS Publications Warehouse

Anderson, Todd; Rosenberger, Kurt J.; Gartner, Anne L.

2012-01-01

Beginning in 1997, the Environmental Protection Agency (EPA) defined a contaminated section of the Palos Verdes shelf in southern California as a Superfund site, initiating a continuing investigation of this area. A number of agencies, including the EPA, U.S. Geological Survey (USGS), and Science Applications International Corporation (SAIC), conducted two oceanographic measurement programs in 2004 and 2007-2008 (SAIC, 2004, 2005; Rosenberger and others, 2010; Sherwood and others, unpublished data) to improve our understanding of the natural processes that resuspend and transport sediment in the area, especially in the region southeast of the Whites Point ocean outfall where earlier measurements were thought to be deficient. Los Angeles County Sanitation Districts (LACSD) deployed a simpler but much broader array of instruments on the Palos Verdes shelf and within the northern reaches of San Pedro Bay from 2000 to 2008 in order to characterize the current and temperature patterns within these regions. This program overlapped the two programs run by USGS and other agencies in 2004 and 2007. The LACSD data were made available to the USGS and the EPA in order to support their joint efforts to model the transport of the contaminated sediments in the region. This report describes the LACSD data sets, the instruments and data-processing procedures used, and the archive that contains the data sets that have passed our quality-assurance procedures.

Effects of red light camera enforcement on fatal crashes in large U.S. cities.

PubMed

Hu, Wen; McCartt, Anne T; Teoh, Eric R

2011-08-01

To estimate the effects of red light camera enforcement on per capita fatal crash rates at intersections with signal lights. From the 99 large U.S. cities with more than 200,000 residents in 2008, 14 cities were identified with red light camera enforcement programs for all of 2004-2008 but not at any time during 1992-1996, and 48 cities were identified without camera programs during either period. Analyses compared the citywide per capita rate of fatal red light running crashes and the citywide per capita rate of all fatal crashes at signalized intersections during the two study periods, and rate changes then were compared for cities with and without cameras programs. Poisson regression was used to model crash rates as a function of red light camera enforcement, land area, and population density. The average annual rate of fatal red light running crashes declined for both study groups, but the decline was larger for cities with red light camera enforcement programs than for cities without camera programs (35% vs. 14%). The average annual rate of all fatal crashes at signalized intersections decreased by 14% for cities with camera programs and increased slightly (2%) for cities without cameras. After controlling for population density and land area, the rate of fatal red light running crashes during 2004-2008 for cities with camera programs was an estimated 24% lower than what would have been expected without cameras. The rate of all fatal crashes at signalized intersections during 2004-2008 for cities with camera programs was an estimated 17% lower than what would have been expected without cameras. Red light camera enforcement programs were associated with a statistically significant reduction in the citywide rate of fatal red light running crashes and a smaller but still significant reduction in the rate of all fatal crashes at signalized intersections. The study adds to the large body of evidence that red light camera enforcement can prevent the most serious crashes. Communities seeking to reduce crashes at intersections should consider this evidence. Copyright © 2011 Elsevier Ltd. All rights reserved.

Interaction Challenges in Human-Robot Space Exploration

NASA Technical Reports Server (NTRS)

Fong, Terrence; Nourbakhsh, Illah

2005-01-01

In January 2004, NASA established a new, long-term exploration program to fulfill the President's Vision for U.S. Space Exploration. The primary goal of this program is to establish a sustained human presence in space, beginning with robotic missions to the Moon in 2008, followed by extended human expeditions to the Moon as early as 2015. In addition, the program places significant emphasis on the development of joint human-robot systems. A key difference from previous exploration efforts is that future space exploration activities must be sustainable over the long-term. Experience with the space station has shown that cost pressures will keep astronaut teams small. Consequently, care must be taken to extend the effectiveness of these astronauts well beyond their individual human capacity. Thus, in order to reduce human workload, costs, and fatigue-driven error and risk, intelligent robots will have to be an integral part of mission design.

Profile of children placed in residential psychiatric program: Association with delinquency, involuntary mental health commitment, and reentry into care.

PubMed

Yampolskaya, Svetlana; Mowery, Debra; Dollard, Norín

2014-05-01

This study examined characteristics and profiles of youth receiving services in 1 of Florida's Medicaid-funded residential mental health treatment programs--State Inpatient Psychiatric Program (SIPP)--between July 1, 2004, and June 30, 2008 (N=1,432). Latent class analysis (LCA) was used to classify youth, and 3 classes were identified: Children With Multiple Needs, Children With No Caregivers, and Abused Children With Substantial Maltreatment History. The results of LCA showed that Children With Multiple Needs experienced the greatest risk for adverse outcomes. Compared with youth in the other 2 classes, these children were more likely to get readmitted to SIPP, more likely to become involved with the juvenile justice system, and more likely to experience involuntary mental health assessments. Implications of the findings are discussed. PsycINFO Database Record (c) 2014 APA, all rights reserved

75 FR 6404 - Regulatory Site Visit Training Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2008-N-0045] (formerly Docket No. 2004N-0408) Regulatory Site Visit Training Program AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration's (FDA's) Center for Biologics...

OHD/SRC - Collaborative Research Projects

Science.gov Websites

Collaborative Research Program Current Announcement Past Announcements Collaborative Research Projects General services. Collaborative Research Projects Fiscal Year 2004 Fiscal Year 2007 Fiscal Year 2008 Fiscal Year

78 FR 38162 - Endangered and Threatened Wildlife and Plants; Listing One Distinct Population Segment of Broad...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-25

... of Nature (IUCN) Crocodile Specialist Group (CSG), which provided information on the conservation... wetlands on which caimans depend (Larriera et al. 2008a, pp. 143-145). As of 2008, four ranching programs... CITES by the IUCN Crocodile Specialist Group (CSG) in 2004 found that only three Parties (one of which...

Factors Associated with HIV Discussion and Condom Use with Sexual Partners in an Underserved Community in South Africa

PubMed Central

Conserve, Donaldson F.; Middelkoop, Keren; King, Gary; Bekker, Linda-Gail

2016-01-01

We examined factors associated with discussing HIV and condom use with a sexual partner. Two cross-sectional surveys were conducted in 2004 prior to the implementation of an HIV awareness campaign in a South African community and in 2008 after a three-year education program. Overall, the proportion of individuals who had discussed HIV with a sexual partner increased from 76% in 2004 to 89% in 2008 (p < .001). Among respondents who had sex six months before completing the surveys, condom use significantly increased from 64% in 2004 to 79% in 2008 (p < .05). Respondents who discussed HIV with a sexual partner were more likely to use condoms than respondents who had not discussed HIV with a sexual partner (OR=2.08, 95% CI=1.16, 3.72). These findings indicate the importance of interventions aimed at promoting HIV awareness and discussion of HIV in communities with individuals at risk of acquiring HIV. PMID:27698549

Configuring balanced scorecards for measuring health system performance: evidence from 5 years' evaluation in Afghanistan.

PubMed

Edward, Anbrasi; Kumar, Binay; Kakar, Faizullah; Salehi, Ahmad Shah; Burnham, Gilbert; Peters, David H

2011-07-01

In 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE) models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0-100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3-84.5, p<0.0001); provider satisfaction (65.4-79.2, p<0.01); capacity for service provision (47.4-76.4, p<0.0001); quality of services (40.5-67.4, p<0.0001); and overall vision for pro-poor and pro-female health services (52.0-52.6). The financial domain also showed improvement until 2007 (84.4-95.7, p<0.01), after which user fees were eliminated. By 2008, all provinces achieved the upper benchmark of national median set in 2004. The BSC has been successfully employed to assess and improve health service capacity and service delivery using performance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary.

Asian longhorned beetle (ALB) Anoplophora gabripennis: advancements in the eradication program

Treesearch

Christine Markham; Joe Gittleman; Tom Denholm; Clint McFarland

2011-01-01

Current detections of Asian longhorned beetle (ALB): August 1996--Brooklyn, NY, later detected on Long Island and in other parts of New York City; July 1998--Chicago, IL; October 2002--Jersey City, NJ; August 2004--Carteret, NJ; August 2008--Worcester, MA. Declared eradication of ALB infestations: April 2008--Chicago, IL, and Jersey City, NJ. Currently regulated for...

The US Air Force suicide prevention program: implications for public health policy.

PubMed

Knox, Kerry L; Pflanz, Steven; Talcott, Gerald W; Campise, Rick L; Lavigne, Jill E; Bajorska, Alina; Tu, Xin; Caine, Eric D

2010-12-01

We evaluated the effectiveness of the US Air Force Suicide Prevention Program (AFSPP) in reducing suicide, and we measured the extent to which air force installations implemented the program. We determined the AFSPP's impact on suicide rates in the air force by applying an intervention regression model to data from 1981 through 2008, providing 16 years of data before the program's 1997 launch and 11 years of data after launch. Also, we measured implementation of program components at 2 points in time: during a 2004 increase in suicide rates, and 2 years afterward. Suicide rates in the air force were significantly lower after the AFSPP was launched than before, except during 2004. We also determined that the program was being implemented less rigorously in 2004. The AFSPP effectively prevented suicides in the US Air Force. The long-term effectiveness of this program depends upon extensive implementation and effective monitoring of implementation. Suicides can be reduced through a multilayered, overlapping approach that encompasses key prevention domains and tracks implementation of program activities.

Hospital Performance Trends on National Quality Measures and the Association With Joint Commission Accreditation

PubMed Central

Schmaltz, Stephen P; Williams, Scott C; Chassin, Mark R; Loeb, Jerod M; Wachter, Robert M

2011-01-01

BACKGROUND Evaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS). OBJECTIVES To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases. DESIGN, SETTING, AND PATIENTS Performance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data. MEASUREMENTS Changes in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores. RESULTS Hospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores. CONCLUSIONS While Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458–465. © 2011 Society of Hospital Medicine PMID:21990175

Annual expenditures for nursing home care: Private and public payer price growth, 1977–2004

PubMed Central

Stewart, Kate A.; Grabowski, David C.; Lakdawalla, Darius N.

2009-01-01

Background Long-term nursing home care is primarily funded by out-of-pocket payments and public Medicaid programs. Few studies have explored price growth in nursing home care, particularly trends in the real cost of a year spent in a nursing home. Objectives To evaluate changes in private and public prices for annual nursing home care from 1977 to 2004, and to compare nursing home price growth to overall price growth and growth in the price of medical care. Research Design We estimated annual private prices for nursing home care between 1977 and 2004 using data from the National Nursing Home Survey. We compared private nursing home price growth to public prices obtained from surveys of state Medicaid offices, and evaluated the Bureau of Labor Statistics Consumer Price Indexes to compare prices for nursing homes, medical care, and general goods and services over time. Results Annual private pay nursing homes prices grew by 7.5% annually from $8,645 in 1977 to $60,249 in 2004. Medicaid prices grew by 6.7% annually from $9,491 in 1979 to $48,056 in 2004. Annual price growth for private pay nursing home care outpaced medical care and other goods and services (7.5% vs. 6.6% and 4.4%, respectively) between 1977 and 2004. Conclusions The recent rapid growth in nursing home prices is likely to persist, due to an aging population and greater disability among the near-elderly. The result will place increasing financial pressure on Medicaid programs. Better data on nursing prices are critical for policy-makers and researchers. PMID:19194339

Flexible Display and Integrated Communication Devices (FDICD) Technology. Volume 2

DTIC Science & Technology

2008-06-01

AFRL-RH-WP-TR-2008-0072 Flexible Display and Integrated Communication Devices (FDICD) Technology, Volume II David Huffman Keith Tognoni...14 April 2004 – 20 June 2008 4. TITLE AND SUBTITLE Flexible Display and Integrated Communication Devices (FDICD) Technology, Volume II 5a...14. ABSTRACT This flexible display and integrated communication devices (FDICD) technology program sought to create a family of powerful

Building Evaluation Capacity in Local Programs for Multisite Nutrition Education Interventions

ERIC Educational Resources Information Center

Fourney, Andrew; Gregson, Jennifer; Sugerman, Sharon; Bellow, Andrew

2011-01-01

From 2004-2008, capacity to conduct program evaluation was built among the "Network for a Healthy California's" 48 largest local partners. Capacity building was done within a framework of Empowerment Evaluation and Utility-Focused evaluation. Tools included: a Scope of Work template, a handbook, a compendium of surveys, an evaluation…

Beginning Teachers' Perceptions of the California Teaching Performance Assessment (TPA)

ERIC Educational Resources Information Center

Campbell, Conni; Ayala, Carlos Cuauhtémoc; Railsback, Gary; Freking, Frederick W.; McKenna, Corey; Lausch, David

2016-01-01

The teaching performance assessment (TPA) seeks to measure the knowledge, skills, and competencies of teachers during the credential phase of their training. The TPA was introduced in California in 2004 with programs piloting it and then became mandatory for candidates enrolling in preliminary programs in 2008. Although California has multiple…

CORE Knowledge Domain C.4 Employment and Career Development: Application for Rehabilitation Counselor Educators

ERIC Educational Resources Information Center

McGuire-Kuletz, Maureen; Hergenrather, Kenneth C.

2008-01-01

The Council on Rehabilitation Education (CORE) CORE revised the standards for rehabilitation counseling master's degree program accreditation in 2004. These standards seek to promote effective rehabilitation services to persons with disabilities in both private and public programs (CORE, 2008). This article focuses on the new CORE standard…

Perceived discrimination, psychological distress, and current smoking status: results from the Behavioral Risk Factor Surveillance System Reactions to Race module, 2004-2008.

PubMed

Purnell, Jason Q; Peppone, Luke J; Alcaraz, Kassandra; McQueen, Amy; Guido, Joseph J; Carroll, Jennifer K; Shacham, Enbal; Morrow, Gary R

2012-05-01

We examined the association between perceived discrimination and smoking status and whether psychological distress mediated this relationship in a large, multiethnic sample. We used 2004 through 2008 data from the Behavioral Risk Factor Surveillance System Reactions to Race module to conduct multivariate logistic regression analyses and tests of mediation examining associations between perceived discrimination in health care and workplace settings, psychological distress, and current smoking status. Regardless of race/ethnicity, perceived discrimination was associated with increased odds of current smoking. Psychological distress was also a significant mediator of the discrimination-smoking association. Our results indicate that individuals who report discriminatory treatment in multiple domains may be more likely to smoke, in part, because of the psychological distress associated with such treatment.

The effectiveness of a health promotion program after 3 years: evidence from the University of Minnesota.

PubMed

Nyman, John A; Abraham, Jean M; Jeffery, Molly Moore; Barleen, Nathan A

2012-09-01

Health promotion programs for the workplace are often sold to employers with the promise that they will pay for themselves with lowered health care expenditures and reduced absenteeism. In a recent review of the literature, it was noted that analysts often caution not to expect a positive return on investment until the third year of operation. This study investigates whether a positive return on investment was generated in the third year for the health promotion program used by the University of Minnesota. It further investigates what it is about the third year that would explain such a phenomenon. The study uses health care expenditure data and absenteeism data from 2004 to 2008 to investigate the effect of the University's lifestyle and disease management programs. It also investigates the effectiveness of participation in Minnesota's 10,000 Steps walking program and Miavita self-help programs. A differences-in-differences equations approach is used to address potential selection bias. Possible regression to the mean is dealt with by using only those who were eligible to participate as control observations. Propensity score weighting was used to balance the sample on observable characteristics and reduce bias due to omitted variables. The study finds that a 1.76 return on investment occurs in the third year of operation that is generated solely by the effect of disease management program participation in reducing health care expenditures. However, neither of the explanations for a third-year effect we tested seemed to be able to explain this phenomenon.

The US Air Force Suicide Prevention Program: Implications for Public Health Policy

PubMed Central

Pflanz, Steven; Talcott, Gerald W.; Campise, Rick L.; Lavigne, Jill E.; Bajorska, Alina; Tu, Xin; Caine, Eric D.

2010-01-01

Objectives. We evaluated the effectiveness of the US Air Force Suicide Prevention Program (AFSPP) in reducing suicide, and we measured the extent to which air force installations implemented the program. Methods. We determined the AFSPP's impact on suicide rates in the air force by applying an intervention regression model to data from 1981 through 2008, providing 16 years of data before the program's 1997 launch and 11 years of data after launch. Also, we measured implementation of program components at 2 points in time: during a 2004 increase in suicide rates, and 2 years afterward. Results. Suicide rates in the air force were significantly lower after the AFSPP was launched than before, except during 2004. We also determined that the program was being implemented less rigorously in 2004. Conclusions. The AFSPP effectively prevented suicides in the US Air Force. The long-term effectiveness of this program depends upon extensive implementation and effective monitoring of implementation. Suicides can be reduced through a multilayered, overlapping approach that encompasses key prevention domains and tracks implementation of program activities. PMID:20466973

The Impact of Child Care Subsidy Use on Child Care Quality

ERIC Educational Resources Information Center

Ryan, Rebecca M.; Johnson, Anna; Rigby, Elizabeth; Brooks-Gunn, Jeanne

2011-01-01

In 2008, the federal government allotted $7 billion in child care subsidies to low-income families through the state-administered Child Care and Development Fund (CCDF), now the government's largest child care program (US DHHS, 2008). Although subsidies reduce costs for families and facilitate parental employment, it is unclear how they impact the…

78 FR 50114 - Distribution of 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, and 2009 Satellite...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-16

... categories of copyrightable content (e.g., movies, music, and sports programming). At Phase II, the royalties... electronic copy in Portable Document Format (PDF) on a Compact Disc, along with the $150 filing fee, to the... request are: Joint Sports Claimants (JSC), Program Suppliers, Devotional Claimants, [[Page 50115...

[§ 116b SGB V (social insurance code, book five) for rheumatology patients. An empirical assessment on the basis of administrative data].

PubMed

Rath, T; Bokern, E; Sefo-Bukow, E; Büscher, G; Lüngen, M; Rubbert-Roth, A

2011-01-01

The choice between outpatient and inpatient care is currently undergoing major changes within the German health care system with the amendment of § 116b SGB V. This study investigates what proportion of hitherto inpatient rheumatologic care could potentially be given on an outpatient basis. The analysis is based on administrative inpatient data from 2004 to 2008 covering approximately 23.6 million private health insurance insurants. The selection of patients with rheumatological diseases was based on diagnosis according to ICD-10 of § 116b SGB V. From 2004 to 2008 the number of all rheumatologic cases increased by 13.9%, while the average length of hospital stay decreased from 9.46 days to 8.08 days and the number of attending hospitals declined by 3.1%. The number of rheumatologic cases with a short inpatient stay (≤2 days) increased by 32.3%. We define the ambulatory potential as the proportion of patients with a short length of stay to the total of inpatient rheumatologic cases; this increased from 25.7% to 29.9%. Not all patients with a short inpatient stay can be transferred problem-free to ambulatory care. No channeling of patients to specialized centres has taken place thus far in Germany. Quality of care at the hospitals studied has not been considered. Further data are needed to link administrative data with quality care data.

Child Care Work Environments: The Relationship with Learning Environments

ERIC Educational Resources Information Center

Lower, Joanna K.; Cassidy, Deborah J.

2007-01-01

The study explores the relationship between child care program administration, organizational climate, and global quality. The recently developed Program Administration Scale (PAS; Talan & Bloom, 2004) was utilized in the study. Both program administration and organizational climate were found to be positively correlated with preschool…

Trends in reported sun bed use, sunburn, and sun care knowledge and attitudes in a U.K. region: results of a survey of the Northern Ireland population.

PubMed

Boyle, R; O'Hagan, A H; Donnelly, D; Donnelly, C; Gordon, S; McElwee, G; Gavin, A

2010-12-01

Sunburn and sun bed use increase risk of malignant melanoma, the incidence of which continues to rise. To document trends in reported sun bed use, sunburn, and sun care knowledge and attitudes in a U.K. region where there have been 20 years of sun-related health promotion campaigns. In 2000, 2004 and 2008, a 'care in the sun' module was included in the Northern Ireland (NI) Omnibus survey. Each year 2200 subjects aged 16 years and over were randomly selected and invited to complete a sun-related questionnaire. Proportions of respondents were analysed by demographic and socioeconomic factors, with differences tested using z-tests and the χ(2) -squared test. In total, 3623 persons responded (response rate 50-59%). Skin cancer knowledge in 2008 was high at 97%. Skin type reporting was inaccurate and since 2000 has become weighted towards the darker Fitzpatrick skin types IV and V (χ(2) = 21·5, P = 0·006). Reported sunburn rose over the 8-year period to 60% in 2008, with 39% of those aged 16-24 years reporting sunburn at least once in the previous year. Twenty per cent reported sun bed use in 2008, a fall from 28% in 2004 (P = 0·01), with greater reported use among those aged 16-24 years (24%) and among women (31% vs. 9% men, P < 0·001). Tanning was reported to make respondents feel healthier (42%) and more attractive (47%), with these attitudes more likely among young women. Skin cancer and sun care knowledge is good among the NI population but reported behaviours of sun bed use and sunburn pose risks for further rises in skin cancer. Barriers for future sun care campaigns to address include poorer sun care knowledge among men, poor skin type awareness, and women's attitudes regarding the health and attractiveness of tanning. Sun bed use, although high, has fallen, possibly in response to recent campaigns. © 2010 The Authors. BJD © 2010 British Association of Dermatologists.

Grandparenting Roles and Volunteer Activity

PubMed Central

Jendrek, Margaret Platt

2016-01-01

Objectives. We examine whether grandparenting roles are related to formal volunteering among older adults. Method. Logistic regression is used to examine the likelihood of volunteering based on grandchild care using data from the 2004 wave of the Health and Retirement Study (n = 13,785). Longitudinal analyses utilize treatment effects models to examine changes in volunteering for grandparents who begin nonresidential grandchild care between the 2004 and 2008 waves (n = 10,811). Results. Results show that grandparents raising coresidential grandchildren have lower odds of volunteering than grandparents providing no regular grandchild care. However, grandparents who provide nonresidential grandchild care are more likely to volunteer than grandparents not providing grandchild care and those raising a coresidential grandchild. Grandparents who provide nonresidential care for grandchildren engage in more volunteering before assuming grandchild care, and their volunteerism increases after becoming a caregiver for a grandchild. Discussion. Consistent with resource theory and the accumulation of roles, providing nonresidential grandchild care may draw grandparents into formal volunteer activity. The lower human capital resources evidenced by grandparents raising coresidential grandchildren may play a role in their lower likelihood of formal volunteering. PMID:24721748

Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys.

PubMed

Sonik, Rajan A; Parish, Susan L; Akobirshoev, Ilhom; Son, Esther; Rosenthal, Eliana

2017-10-05

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population. We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation. Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%-56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%-22% experiencing food insecurity, compared to 11%-14% of their peers without any indications of speech-language difficulties). We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

Perceived Discrimination, Psychological Distress, and Current Smoking Status: Results From the Behavioral Risk Factor Surveillance System Reactions to Race Module, 2004–2008

PubMed Central

Peppone, Luke J.; Alcaraz, Kassandra; McQueen, Amy; Guido, Joseph J.; Carroll, Jennifer K.; Shacham, Enbal; Morrow, Gary R.

2012-01-01

Objectives. We examined the association between perceived discrimination and smoking status and whether psychological distress mediated this relationship in a large, multiethnic sample. Methods. We used 2004 through 2008 data from the Behavioral Risk Factor Surveillance System Reactions to Race module to conduct multivariate logistic regression analyses and tests of mediation examining associations between perceived discrimination in health care and workplace settings, psychological distress, and current smoking status. Results. Regardless of race/ethnicity, perceived discrimination was associated with increased odds of current smoking. Psychological distress was also a significant mediator of the discrimination–smoking association. Conclusions. Our results indicate that individuals who report discriminatory treatment in multiple domains may be more likely to smoke, in part, because of the psychological distress associated with such treatment. PMID:22420821

Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan

PubMed Central

Edward, Anbrasi; Kumar, Binay; Kakar, Faizullah; Salehi, Ahmad Shah; Burnham, Gilbert; Peters, David H.

2011-01-01

Background In 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. Methods and Findings Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE) models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0–100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3–84.5, p<0.0001); provider satisfaction (65.4–79.2, p<0.01); capacity for service provision (47.4–76.4, p<0.0001); quality of services (40.5–67.4, p<0.0001); and overall vision for pro-poor and pro-female health services (52.0–52.6). The financial domain also showed improvement until 2007 (84.4–95.7, p<0.01), after which user fees were eliminated. By 2008, all provinces achieved the upper benchmark of national median set in 2004. Conclusions The BSC has been successfully employed to assess and improve health service capacity and service delivery using performance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary PMID:21814499

Do the Medicaid and Medicare programs compete for access to health care services? A longitudinal analysis of physician fees, 1998-2004.

PubMed

Howard, Larry L

2014-09-01

As the demand for publicly funded health care continues to rise in the U.S., there is increasing pressure on state governments to ensure patient access through adjustments in provider compensation policies. This paper longitudinally examines the fees that states paid physicians for services covered by the Medicaid program over the period 1998-2004. Controlling for an extensive set of economic and health care industry characteristics, the elasticity of states' Medicaid fees, with respect to Medicare fees, is estimated to be in the range of 0.2-0.7 depending on the type of physician service examined. The findings indicate a significant degree of price competition between the Medicaid and Medicare programs for physician services that is more pronounced for cardiology and critical care, but not hospital care. The results also suggest several policy levers that work to either increase patient access or reduce total program costs through changes in fees.

[Impact of vaccination on admissions for Haemophilus influenzae b meningitis from 2004 to 2008 in Bobo Dioulasso, Burkina Faso].

PubMed

Kaboré, N F; Poda, G E A; Barro, M; Cessouma, R; Héma, A; Ouedraogo, A S; Sawadogo, A B; Nacro, B

2012-01-01

Vaccination against Haemophilus influenzae type b was introduced in Burkina Faso on 1st January 2006. This study thus sought to determine the impact of the first 30 months of vaccination on admissions for Hib meningitis in the department of pediatrics at the Sourô-Sanou University Hospital in Bobo Dioulasso. Retrospective study of children aged zero to 14 years hospitalized from 1st January 2004 to 30th June 2008 for acute bacterial meningitis (laboratory-confirmed). During the study period, 416 children were admitted for acute bacterial meningitis. The bacterium isolated was identified in 386 cases and unidentified in 30 cases. Hib meningitis accounted for 42.3 % of the cases of identified bacterial meningitis before the introduction of the vaccine (2004 to 2005). This rate declined to 11.8 % for the first 30 months of vaccination (p < 0.001). No cases of Hib meningitis have been reported in the first half of 2008. Admissions for Hib meningitis in the Department of Pediatrics have practically disappeared two years after the introduction of the Hib vaccine into Burkina Faso's expanded program on immunization.

The Polish National Registry for Fetal Cardiac Pathology: organization, diagnoses, management, educational aspects and telemedicine endeavors.

PubMed

Slodki, Maciej; Szymkiewicz-Dangel, Joanna; Tobota, Zdzislaw; Seligman, Neil S; Weiner, Stuart; Respondek-Liberska, Maria

2012-05-01

We describe the National Registry for Fetal Cardiac Pathology, a program under the Polish Ministry of Health aimed at improving the prenatal diagnosis, care, and management of congenital heart disease (CHD). An online database was created to prospectively record diagnosis, prenatal care, delivery, follow-up, and still images and video for fetuses with CHD. A certification program in fetal cardiac ultrasound was also implemented. Optimal screening and referral centers were identified by number of fetuses entered in the Registry yearly by each center. From 2004 to 2009, 2910 fetuses with CHD were registered (2473 structural, 437 functional anomalies). The most common reasons for referral for fetal echocardiography were abnormal four-chamber view (56.0%) and extra-cardiac anomalies (8.2% ), while the most common diagnoses were atrioventricular septal defects (10.2%) and hypoplastic left heart syndrome (9.7%). Prenatal diagnosis increased yearly, from 10.0% of neonatal diagnoses in 2003 to 38.0% in 2008. From inception of the registry up to 2009 there has been a fourfold increase in the number of neonates referred for cardiac surgery in whom the condition was prenatally diagnosed. Equally important achievements include the establishment of a certification program for fetal echocardiography and the organization of prenatal and neonatal management. © 2012 John Wiley & Sons, Ltd.

Improved knowledge of and difficulties in palliative care among physicians during 2008 and 2015 in Japan: Association with a nationwide palliative care education program.

PubMed

Nakazawa, Yoko; Yamamoto, Ryo; Kato, Masashi; Miyashita, Mitsunori; Kizawa, Yoshiyuki; Morita, Tatsuya

2018-02-01

Palliative care education for health care professionals is a key element in improving access to quality palliative care. The Palliative Care Emphasis Program on Symptom Management and Assessment for Continuous Medical Education (PEACE) was designed to provide educational opportunities for all physicians in Japan. As of 2015, 57,764 physicians had completed it. The objective of this study was to estimate the effects of the program. This study was an analysis of 2 nationwide observational studies from 2008 and 2015. We conducted 2 questionnaire surveys for representative samples of physicians. The measurements used were the Palliative Care Knowledge Test (range, 0-100) and the Palliative Care Difficulties Scale (range, 1-4). Comparisons were made with the unpaired Student t test and with a multivariate linear regression model using 2 cohorts and a propensity score-matched sample. This study analyzed a total of 48,487 physicians in 2008 and a total of 2720 physicians in 2015. Between 2008 and 2015, physicians' knowledge and difficulties significantly improved on the Palliative Care Knowledge Test with total scores of 68 and 78, respectively (P < .001; effect size, 0.40) and on the Palliative Care Difficulties Scale with total scores of 2.65 and 2.49, respectively (P < .001; effect size, 0.29). Propensity-score matching resulted in 619 untrained physicians matched to 619 trained physicians, and physicians who trained with the PEACE program had a higher knowledge score (74 vs 86; P < .001; effect size, 0.64) and a lower difficulties score (2.6 vs 2.3; P < .001; effect size, 0.42). Physicians' knowledge of and difficulties with palliative care improved on a national level. The PEACE program may have contributed to these improvements. Cancer 2018;124:626-35. © 2017 American Cancer Society. © 2017 American Cancer Society.

Carotid endarterectomy: the change in practice over 11 years in a stroke centre.

PubMed

Tse, Gabrielle T W; Kilkenny, Monique F; Bladin, Chris; Grigg, Michael; Dewey, Helen M

2017-11-13

Recent research evidence has impacted the practice of carotid endarterectomy (CEA). We aim to characterize changes in the practice and outcome of CEA over time in a single large-volume stroke centre. All patients who underwent CEA from 2004 to 2014 and carotid angioplasty and stenting (CAS) from 2003 to 2008 at an Australian metropolitan tertiary stroke centre hospital were included. Clinical data were analysed to identify time trends in choice of intervention, patient selection, preoperative imaging utilization, surgical timing and outcome. There were 510 CEAs performed during 2004-2014 and 95 CASs during 2003-2008. The proportion of patients undergoing CEA compared to CAS increased from 60% to 90% from 2004 to 2008 (P < 0.001). CAS patients were more likely to have cardiac co-morbidities. From 2004 to 2014, the proportion of CEA patients aged ≥80 years increased (P = 0.001) and the proportion of asymptomatic patients decreased (P = 0.003) over time. Median time from symptom onset to surgery decreased from 52 days (Q1: 25, Q3: 74) in 2004 to 8 days (Q1: 5, Q3: 37) in 2014 (P < 0.001). Use of preoperative ultrasonography decreased whilst CT angiography and the number of imaging modalities applied to each patient increased over time (P < 0.001). Overall, 5.9% of CEAs were complicated by death, stroke or acute myocardial infarction with no significant change over time. The trends in CEA practice at our centre align with international trends and guidelines. This study provides a representative indicator of Australian hospital practice, and illustrates how evidence from research is translated into clinical care. © 2017 Royal Australasian College of Surgeons.

Five years' experience of classical swine fever polymerase chain reaction ring trials in France.

PubMed

Po, F; Le Dimna, M; Le Potier, M F

2011-12-01

Since 2004, the French National Reference Laboratory for classical swine fever (CSF) has conducted an annual proficiency test (PT) to evaluate the ability of local veterinary laboratories to perform real-time polymerase chain reaction (PCR) for CSF virus. The results of five years of testing (2004-2008) are described here. The PT was conducted under blind conditions on 20 samples. The same batch of samples was used for all five years. The number of laboratories that analysed the samples increased from four in 2004 to 13 in 2008. The results of the PT showed the following: cross-contamination between samples and deficiencies in RNA preparation can occur even in experienced laboratories; sample homogeneity should be checked carefully before selection; samples stored at-80 degrees C for several years remain stable; and poor shipment conditions do not damage the samples with regard to detection of CSF virus genome. These results will enable redesign of the panel to improve the overall quality of the PT, which will encourage laboratories to check and improve their PCR procedures and expertise. This is an excellent way to determine laboratory performance.

El Salvador: Political, Economic, and Social Conditions and U.S. Relations

DTIC Science & Technology

2008-11-18

Ever,” Latin American Weekly Report, February 7, 2008; United Nations Development Program (UNDP), “Maras y Pandillas: Comunidad y Policia en ...to 60% of homicides, but CRS-4 6 “2,576 Homicidios en el 2004 en El Salvador,” Agence France Presse, January 5, 2004; United Nations Office on Drugs...El Salvador, along with Ecuador , Aruba, and the Netherlands Antilles, serves as a Forward Operating Location (FOL) for U.S. anti- drug forces. In 2007

Health care use and costs for participants in a diabetes disease management program, United States, 2007-2008.

PubMed

Dall, Timothy M; Roary, Mary; Yang, Wenya; Zhang, Shiping; Chen, Yaozhu J; Arday, David R; Gantt, Cynthia J; Zhang, Yiduo

2011-05-01

The Disease Management Association of America identifies diabetes as one of the chronic conditions with the greatest potential for management. TRICARE Management Activity, which administers health care benefits for US military service personnel, retirees, and their dependents, created a disease management program for beneficiaries with diabetes. The objective of this study was to determine whether participation intensity and prior indication of uncontrolled diabetes were associated with health care use and costs for participants enrolled in TRICARE's diabetes management program. This ongoing, opt-out study used a quasi-experimental approach to assess program impact for beneficiaries (n = 37,370) aged 18 to 64 living in the United States. Inclusion criteria were any diabetes-related emergency department visits or hospitalizations, more than 10 diabetes-related ambulatory visits, or more than twenty 30-day prescriptions for diabetes drugs in the previous year. Beginning in June 2007, all participants received educational mailings. Participants who agreed to receive a baseline telephone assessment and telephone counseling once per month in addition to educational mailings were considered active, and those who did not complete at least the baseline telephone assessment were considered passive. We categorized the diabetes status of each participant as "uncontrolled" or "controlled" on the basis of medical claims containing diagnosis codes for uncontrolled diabetes in the year preceding program eligibility. We compared observed outcomes to outcomes predicted in the absence of diabetes management. Prediction equations were based on regression analysis of medical claims for a historical control group (n = 23,818) that in October 2004 met the eligibility criteria for TRICARE's program implemented June 2007. We conducted regression analysis comparing historical control group patient outcomes after October 2004 with these baseline characteristics. Per-person total annual medical savings for program participants, calculated as the difference between observed and predicted outcomes, averaged $783. Active participants had larger reductions in inpatient days and emergency department visits, larger increases in ambulatory visits, and larger increases in receiving retinal examinations, hemoglobin A1c tests, and urine microalbumin tests compared with passive participants. Participants with prior indication of uncontrolled diabetes had higher per-person total annual medical savings, larger reduction in inpatient days, and larger increases in ambulatory visits than did participants with controlled diabetes. Greater intensity of participation in TRICARE's diabetes management program was associated with lower medical costs and improved receipt of recommended testing. That patients who were categorized as having uncontrolled diabetes realized greater program benefits suggests diabetes management programs should consider indication of uncontrolled diabetes in their program candidate identification criteria.

VizieR Online Data Catalog: Spitzer h and {chi} Persei candidate members (Cloutier+, 2014)

NASA Astrophysics Data System (ADS)

Cloutier, R.; Currie, T.; Rieke, G. H.; Kenyon, S. J.; Balog, Z.; Jayawardhana, R.

2017-08-01

The IRAC (Fazio et al. 2004ApJS..154...39F) observed h and {chi} Persei on October 30, 2008 (AOR IDs 2182740, 21828608, 21828096, 21828864, 21828352, and 2182912). Solar activity was normal to below average. Zodical emission ranged between ~0.02 and 2 MJy/sr from 3.6 um to 8 um. Image processing and photometry were performed separately for the short-exposure and long-exposure frames. The MIPS (Rieke et al. 2004ApJS..154...25R) imaged h and {chi} Persei on 2008 March 15-16, 2008 October 25-26, and 2009 March 26 and 29 as a part of General Observation Programs 40690 and 50664 (PI: Scott Kenyon). To identify and characterize disks surrounding h and {chi} Persei stars, we combine Spitzer data with optical/near-IR data for likely cluster members, updating the list from Currie et al. (2010, J/ApJS/186/191) with a more accurate one of 13956 stars (Table 1). (3 data files).

Department of Defense HIV/AIDS Prevention Program: Annual Report 2015

DTIC Science & Technology

2016-05-12

Angola, which has an estimated literacy rate of 71.1%, with a higher rate among men than women. Oil production and its supporting activities account...for about 50% of the GDP. Increased oil production supported growth averaging more than 17% per year from 2004 to 2008. During the global recession...that started in 2008, the GDP dropped by 2.4%, but steadily rose by 8.4% in 2012. A significant drop in international oil prices has caused the 2015

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 17, Number 5. September-October 2004

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Guralnick, Eva, Ed.; Calder, Judy, Ed.; Lucich, Mardi, Ed.; Walsh, Eileen, Ed.

2004-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 17, Number 4. July-August 2004

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Guralnick, Eva, Ed.; Calder, Judy, Ed.; Kunitz, Judith Ed.; Lucich, Mardi, Ed.; Walsh, Eileen, Ed.

2004-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 17, Number 3. May-June 2004

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Guralnick, Eva, Ed.; Calder, Judy, Ed.; Kunitz, Judith, Ed.; Lucich, Mardi, Ed.

2004-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 17, Number 1. January-February 2004

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Guralnick, Eva, Ed.; Lucich, Mardi, Ed.

2004-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 17, Number 2. March-April 2004

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Guralnick, Eva, Ed.; Lucich, Mardi, Ed.

2004-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 17, Number 6. November-December 2004

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Guralnick, Eva, Ed.; Calder, Judy, Ed.; Lucich, Mardi, Ed.; Walsh, Eileen, Ed.

2004-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Special Milk Program

ERIC Educational Resources Information Center

US Department of Agriculture, 2009

2009-01-01

The Special Milk Program provides milk to children in schools, child care institutions and eligible camps that do not participate in other Federal child nutrition meal service programs. The program reimburses schools and institutions for the milk they serve. In 2008, 4,676 schools and residential child care institutions participated, along with…

Energy and Obesity--The 2008 Keystone Youth Policy Summits

ERIC Educational Resources Information Center

NCSSSMST Journal, 2009

2009-01-01

Keystone Science School and Keystone Center for Science and Public Policy programs blend learning in the natural world with developing mediation and conflict resolution skills. Since 2004, these two divisions of The Keystone Center in Colorado have partnered with the National Consortium for Specialized Secondary Schools of Mathematics, Science and…

Perceived Impact of an Outdoor Orientation Program for First-Year University Students

ERIC Educational Resources Information Center

Wolfe, Brent D.; Kay, Gregor

2011-01-01

Colleges and universities across the United States are struggling with student retention and attrition (Derby & Smith, 2004; Jacobs & Archie, 2008; Tinto, 1993). As a result, theoretically supported interventions designed to encourage retention and persistence are needed. The purpose of this study was twofold: (a) to intentionally create…

Marriage and outcomes of people with schizophrenia in rural China: 14-year follow-up study.

PubMed

Ran, Mao-Sheng; Wong, Yin-Ling Irene; Yang, Shu-Yan; Ho, Petula S Y; Mao, Wen-Jun; Li, Jie; Chan, Cecilia Lai-Wan

2017-04-01

The influence of marriage on the long-term outcomes of schizophrenia is largely unknown. This study was to examine the impact of marriage on the 14-year outcomes and identify the correlates of marriage among persons with schizophrenia in rural community. All study participants with schizophrenia (n=510) were identified in 1994 in an epidemiological investigation of 123,572 people aged 15years and older and followed up in 2004 and 2008 in Xinjin County, Chengdu, China. The Patients Follow-up Schedule (PFS) was used in 2004 and 2008. The rate of follow-up in 2008 was 95.9%. Unmarried individuals in 1994 had higher rates of homelessness and suicide, and lower rate of survival in 2004 and 2008 than those married. In 14-year follow-up, unmarried individuals were more likely to be male, to have higher level of psychiatric symptoms and lower rate of full remission of illness, and to report lower level of work functioning, as well as with fewer family members and caregiver, and lower family economic status. The predictors of being married in 2008 included being married in 1994, shorter duration of illness, being female, and lower level of education. Being married is predictive of more favorable 14-year outcomes of persons with schizophrenia in the rural community. Given that marriage can be instrumental for enhancing family-based support and caregiving, as well as improving the community tenure of persons with schizophrenia, it is important to develop programs to enhance opportunity for persons with schizophrenia to get and stay married. Copyright © 2016 Elsevier B.V. All rights reserved.

Ten-Year Time Trends in Emotional and Behavioral Problems of Dutch Children Referred for Youth Care

ERIC Educational Resources Information Center

Veerman, Jan Willem; De Meyer, Ronald

2012-01-01

Emotional and behavioral problems assessed with the "Child Behavior Checklist" (CBCL) were analyzed from 2,739 Dutch children referred to Families First (FF) or Intensive Family Treatment (IFT) from 1999 to 2008, to examine time trends. From the year 2004 onward, six of the eight CBCL-syndrome scales yielded significant decreases from the…

Finnish Media Literacy Education Policies and Best Practices in Early Childhood Education and Care since 2004

ERIC Educational Resources Information Center

Rantala, Leena

2011-01-01

The purpose of the article is to describe Finnish media literacy policies and good media education practices in early childhood education and care. This article will focus on describing two central action lines related to the Children and Media Program, initiated by the Division for Cultural Policy of the Ministry of Education and Culture in 2004.…

Medicaid and Children's Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children's Health Insurance Program (CHIP), and Alternative Benefit Plans. Final rule.

PubMed

2016-03-30

This final rule will address the application of certain requirements set forth in the Public Health Service Act, as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, to coverage offered by Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and Children’s Health Insurance Programs.

Community woodstove changeout and impact on ambient concentrations of polycyclic aromatic hydrocarbons and phenolics.

PubMed

Ward, Tony J; Palmer, Christopher P; Houck, James E; Navidi, William C; Geinitz, Steve; Noonan, Curtis W

2009-07-15

A large woodstove changeout program was carried out in Libby, Montana, with the goal of reducing ambient levels of PM2.5. This provided researchers the opportunity to measure ambient concentrations of phenolic and polycyclic aromatic hydrocarbons (PAHs) before, during, and after the changeout of nearly 1200 stoves to evaluate the effectiveness of the intervention. Starting in the heating season of 2004/2005 and ending in the heating season of 2007/2008, 19 compounds were measured every three days using a high-volume polyurethane foam (PUF) sampler followed by gas chromatography and mass spectrometry analysis. Some of the organic species with the highest measured concentrations were also signature chemical markers for wood combustion. When comparing the measurements conducted during the heating season of 2004/2005 (prechangeout) to those of the heating season of 2007/2008 (postchangeout), there was a 64% average reduction in the measured concentrations of phenolics and PAHs, while the PM2.5 mass dropped by only 20% over the same time period. The results of this four year sampling program suggest that the Libby woodstove changeout program was successful in reducing overall concentrations of the measured phenolic and PAH compounds.

Learning from research on the information behaviour of healthcare professionals: a review of the literature 2004-2008 with a focus on emotion.

PubMed

Fourie, Ina

2009-09-01

A review, focusing on emotion, was conducted of reported studies on the information behaviour of healthcare professionals (2004-2008). Findings were intended to offer guidelines on information services and information literacy training, to note gaps in research and to raise research interest. Databases were searched for literature published from January 2004 to December 2008 and indexed on eric, Library and Information Science Abstracts, medline, PsycINFO, Social Services Abstracts, Sociological Abstracts, Health Source: Nursing/Academic Edition; Library, Information Science & Technology Abstracts; Psychology and Behavioral Sciences Collection; Social Work Abstracts; SocINDEX with Full Text; SPORTDiscus; cinhal; and the ISI Web of Knowledge databases. Key journals were manually scanned and citations followed. Literature was included if reporting on issues concerning emotion. Emotion in information behaviour in healthcare contexts is scantily addressed. This review, however, offers some insight into the difficulty in identifying and expressing information needs; sense making and the need to fill knowledge gaps; uncertainty; personality and coping skills; motivation to seeking information; emotional experiences during information seeking; self-confidence and attitude; emotional factors in the selection of information channels; and seeking information for psychological or emotional reasons. Suggestions following findings, address information literacy programs, information services and research gaps.

Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008.

PubMed

Yokota, Renata T C; Nusselder, Willma J; Robine, Jean-Marie; Tafforeau, Jean; Renard, Françoise; Deboosere, Patrick; Van Oyen, Herman

2018-06-15

We aimed to investigate the contribution of chronic conditions to gender differences in disability-free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008. Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED. Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross-sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic respiratory diseases. To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.

Rapid increase of health care utilization and cost due to benign prostatic hyperplasia in Korean men: retrospective population-based analysis using the Health Insurance Review and Assessment service data.

PubMed

Son, Hwancheol; Park, Juhyun; Song, Sang Hoon; Kang, Jung Yoon; Hong, Sung Kyu; Lee, Hyun Moo; Kim, Sun-Hee; Park, Byung-Joo; Lee, Hyung-Lae; Lee, Kyung Seop

2015-02-01

Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.

Beyond robotics: a new proactive research initiative from the EU IST program.

PubMed

Karp, Pekka

2005-01-01

A research initiative on embodied artificial intelligence has been launched in 2004 by the Future and Emerging Technologies (FET) arm of the Information Society Technologies (IST) programme of the European Union. The initiative is called "Beyond Robotics" to emphasize that the research projects funded are required to set ambitious objectives and to aim at breakthroughs going well beyond the state of the art. Four projects worth 20 M E of EC funding were selected for 2004-2008 to address the objectives of the initiative.

Using Earned Value Information to Predict Program Cancellation

DTIC Science & Technology

2014-09-02

models is that when there is high cost growth in the EAC reported by the contractor, programs run far larger risks of cancellation. We find less robust...for MDAPs. Our most significant finding across models is that when there is high cost growth in the EAC reported by the contractor, programs run far...professor and received a BA in anthropology and a BA and MA in economics (2004) and a PhD in political economy and public policy (2008) from the

Lessons Learned From a 5-Year Experience With a 4-Week Experiential Quality Improvement Curriculum in a Preventive Medicine Fellowship

PubMed Central

Varkey, Prathibha; Karlapudi, Sudhakar Prakash

2009-01-01

Background Competency in practice-based learning and improvement (PBLI) and systems-based practice (SBP) empowers learners with the skills to plan, lead, and execute health care systems improvement efforts. Experiences from several graduate medical education programs describe the implementation of PBLI and SBP curricula as challenging because of lack of adequate curricular time and faculty resources, as well as a perception that PBLI and SBP are not relevant to future careers. A dedicated experiential rotation that requires fellow participation in a specialty-specific quality improvement project (QIP) may address some of these challenges. Method We describe a retrospective analysis of our 5-year experience with a dedicated 3-week PBLI-SBP experiential curriculum in a preventive medicine fellowship program at Mayo Clinic, Rochester, Minnesota. Results Between 2004 and 2008, 19 learners including 7 preventive medicine fellows participated in the rotation. Using just-in-time learning, fellows work together on a relatively complex QIP of community or institutional significance. Since 2004, all 19 learners (100%) participating in this rotation have consistently demonstrated statistically significant increase in their quality improvement knowledge application tool (QIKAT) scores at the end of the rotation. At the end of the rotation, all 19 learners stated that they were either confident or very confident of making a change to improve health care in a local setting. Most of the QIPs resulted in sustainable practice improvements, and resultant solutions have been disseminated beyond the location of the original QIP. Conclusion A dedicated experiential rotation that requires learner participation in a QIP is one of the effective methods to address the needs of the SBP and PBLI competencies. PMID:21975713

Source mechanisms of persistent shallow earthquakes during eruptive and non-eruptive periods between 1981 and 2011 at Mount St. Helens, Washington

USGS Publications Warehouse

Lehto, Heather L.; Roman, Diana C.; Moran, Seth C.

2013-01-01

Shallow seismicity between 0 and 3-km depth has persisted at Mount St. Helens, Washington (MSH) during both eruptive and non-eruptive periods for at least the past thirty years. In this study we investigate the source mechanisms of shallow volcano-tectonic (VT) earthquakes at MSH by calculating high-quality hypocenter locations and fault plane solutions (FPS) for all VT events recorded during two eruptive periods (1981–1986 and 2004–2008) and two non-eruptive periods (1987–2004 and 2008–2011). FPS show a mixture of normal, reverse, and strike-slip faulting during all periods, with a sharp increase in strike-slip faulting observed in 1987–1997 and an increase in normal faulting in 1998–2004. FPS P-axis orientations show a ~ 90° rotation with respect to regional σ1 (N23°E) during 1981–1986 and 2004–2008, bimodal orientations (~ N-S and ~ E-W) during 1987–2004, and bimodal orientations at ~ N-E and ~ S-W from 2008–2011. We interpret these orientations to likely be due to pressurization accompanying the shallow intrusion and subsequent eruption of magma as domes during 1981–1986 and 2004–2008 and the buildup of pore pressure beneath a seismogenic volume (located at 0–1 km) with a smaller component due to the buildup of tectonic forces during 1987–2004 and 2008–2011.

Evaluating the McDonald's business model for HIV prevention among truckers to improve program coverage and service utilization in India, 2004-2010.

PubMed

Rao, Vasudha Tirumalasetti; Mahapatra, Bidhubhusan; Juneja, Sachin; Singh, Indra R

2013-01-01

This study describes the experiences and results of a large-scale human immunodeficiency virus (HIV) prevention intervention for long-distance truck drivers operating on the national highways of India. The intervention for long-distance truckers started in 2004 across 34 trans-shipment locations. However, due to poor coverage and utilization of services by truckers in the initial 18-month period, the intervention was redesigned to focus on only 17 trans-shipment locations. The redesigned intervention model was based on the McDonald's business franchise model where the focus is on optimal placement of services, supported with branding and standardization of services offered, and a surround sound communication approach. Program output indicators were assessed using program monitoring data over 7 years (2004-2010) and two rounds of cross-sectional behavioral surveys conducted in January 2008 (n = 1402) and July 2009 (n = 1407). The number of truckers contacted per month per site increased from 374 in 2004 to 4327 in 2010. Analysis of survey data showed a seven-fold increase in clinic visits in the past 12 months from 2008 to 2009 (21% versus 63%, P < 0.001). A significant increase was also observed in the percentage of truckers who watched street plays (10% to 56%, P < 0.001), and participated in health exhibitions (6% to 35%, P < 0.001). Furthermore, an increase from round 1 to round 2 was observed in the percentage who received condoms (13% to 22%, P < 0.001), and attended one-one counseling (15% to 21%, P < 0.01). Treatment-seeking from program clinics for symptoms related to sexually transmitted infections increased six-fold during this period (16% versus 50%, P < 0.001). Adoption of a business model for HIV prevention helped to increase program coverage and service utilization among long-distance truckers. Implementing HIV prevention programs in a highly mobile population such as truckers, in a limited number of high-impact locations, supported by branding of services, could help in saturating coverage and optimum utilization of available resources.

Evaluating the McDonald’s business model for HIV prevention among truckers to improve program coverage and service utilization in India, 2004–2010

PubMed Central

Rao, Vasudha Tirumalasetti; Mahapatra, Bidhubhusan; Juneja, Sachin; Singh, Indra R

2013-01-01

Background This study describes the experiences and results of a large-scale human immunodeficiency virus (HIV) prevention intervention for long-distance truck drivers operating on the national highways of India. Methods The intervention for long-distance truckers started in 2004 across 34 trans-shipment locations. However, due to poor coverage and utilization of services by truckers in the initial 18-month period, the intervention was redesigned to focus on only 17 trans-shipment locations. The redesigned intervention model was based on the McDonald’s business franchise model where the focus is on optimal placement of services, supported with branding and standardization of services offered, and a surround sound communication approach. Program output indicators were assessed using program monitoring data over 7 years (2004–2010) and two rounds of cross-sectional behavioral surveys conducted in January 2008 (n = 1402) and July 2009 (n = 1407). Results The number of truckers contacted per month per site increased from 374 in 2004 to 4327 in 2010. Analysis of survey data showed a seven-fold increase in clinic visits in the past 12 months from 2008 to 2009 (21% versus 63%, P < 0.001). A significant increase was also observed in the percentage of truckers who watched street plays (10% to 56%, P < 0.001), and participated in health exhibitions (6% to 35%, P < 0.001). Furthermore, an increase from round 1 to round 2 was observed in the percentage who received condoms (13% to 22%, P < 0.001), and attended one-one counseling (15% to 21%, P < 0.01). Treatment-seeking from program clinics for symptoms related to sexually transmitted infections increased six-fold during this period (16% versus 50%, P < 0.001). Conclusion Adoption of a business model for HIV prevention helped to increase program coverage and service utilization among long-distance truckers. Implementing HIV prevention programs in a highly mobile population such as truckers, in a limited number of high-impact locations, supported by branding of services, could help in saturating coverage and optimum utilization of available resources. PMID:23439724

Food Insecurity in U.S. Households That Include Children with Disabilities

ERIC Educational Resources Information Center

Sonik, Rajan; Parish, Susan L.; Ghosh, Subharati; Igdalsky, Leah

2016-01-01

The authors examined food insecurity in households including children with disabilities, analyzing data from the 2004 and 2008 panels of the Survey of Income and Program Participation, which included 24,729 households with children, 3,948 of which had children with disabilities. Logistic regression models were used to estimate the likelihood of…

Head circumference growth among extremely preterm infants in Denmark has improved during the past two decades.

PubMed

Zachariassen, Gitte; Hansen, Bo Mølholm

2015-07-01

Treatment of extremely preterm and low birth weight infants is still evolving and improving. In this study, we evaluated if growth has improved from birth to two years of corrected age (CA) among extremely low birth weight (BW) and preterm born infants in Denmark. This was an observational study with comparison of head circumference (HC), weight and length growth in two Danish cohorts of extremely preterm (gestational age (GA) < 28 weeks) and extremely low birth weight (ELBW with a BW < 1,000 g) infants (A: 1994-1995 and B: 2004-2008). Infants in cohort A (n = 198) and B (n = 64) had a median GA and BW of 27 + 2 weeks and 948 g in A, and 27 + 3 weeks and 934 g in B. At discharge, infants in B compared with A had increased more in HC (p = 0.000), length (p = 0.008) and weight (p = 0.000). At two years CA, HC was still significantly larger in cohort B than A (p = 0.03), while no significant difference was recorded for length or weight. Growth during hospitalisation seems to have improved among extremely preterm and low birth weight infants from 1994-1995 to 2004-2008. This may be a result of improved nutrition in combination with improved intensive care during hospitalisation. Collection of data in the 2004-2008 cohort was supported by the Institute of Regional Health Services Research, the Egmont Foundation and the University of Southern Denmark. Collection of data from birth to two years of age in the 1994-1995 cohort was without financial support. For the 1994-1995 study, all eight regional Research Ethics Committees in Denmark at that time approved the study. The 2004-2008 study was approved by the Danish National Committee on Biomedical Research Ethics, and handling of data and registrations were approved by the Danish Data Protection Agency.

[In-house team seminars: working together as a team--from data and statistics to quality development].

PubMed

Berlage, Silvia; Wenzlaff, Paul; Damm, Gabriele; Sens, Brigitte

2010-01-01

The concept of the "ZQ In-house Seminars" provided by external trainers/experts pursues the specific aim to enable all healthcare staff members of hospital departments to analyse statistical data--especially from external quality measurements--and to initiate in-hospital measures of quality improvement based on structured team work. The results of an evaluation in Lower Saxony for the period between 2004 and 2008 demonstrate a sustainable increase in outcome quality of care and a strengthening of team and process orientation in clinical care.

Health insurance premium increases for the 5 largest school districts in the United States, 2004-2008.

PubMed

Cantillo, John R

2010-03-01

Local school districts are often one of the largest, if not the largest, employers in their respective communities. Like many large employers, school districts offer health insurance to their employees. There is a lack of information about the rate of health insurance premiums in US school districts relative to other employers. To assess the change in the costs of healthcare insurance in the 5 largest public school districts in the United States, between 2004 and 2008, as representative of large public employers in the country. Data for this study were drawn exclusively from a survey sent to the 5 largest public school districts in the United States. The survey requested responses on 3 data elements for each benefit plan offered from 2004 through 2008; these included enrollment, employee costs, and employer costs. The premium growth for the 5 largest school districts has slowed down and is consistent with other purchasers-Kaiser/Health Research & Educational Trust and the Federal Employee Health Benefit Program. The average increase in health insurance premium for the schools was 5.9% in 2008, and the average annual growth rate over the study period was 7.5%. For family coverage, these schools provide the most generous employer contribution (80.8%) compared with the employer contribution reported by other employers (73.5%) for 2008. Often the largest employers in their communities, school districts demonstrate a commitment to provide choice of benefits and affordability for employees and their families. Despite constraints typical of public employers, the 5 largest school districts in the United States have decelerated in premium growth consistent with other purchasers, albeit at a slower pace.

Health Insurance Premium Increases for the 5 Largest School Districts in the United States, 2004–2008

PubMed Central

Cantillo, John R.

2010-01-01

Background Local school districts are often one of the largest, if not the largest, employers in their respective communities. Like many large employers, school districts offer health insurance to their employees. There is a lack of information about the rate of health insurance premiums in US school districts relative to other employers. Objective To assess the change in the costs of healthcare insurance in the 5 largest public school districts in the United States, between 2004 and 2008, as representative of large public employers in the country. Methods Data for this study were drawn exclusively from a survey sent to the 5 largest public school districts in the United States. The survey requested responses on 3 data elements for each benefit plan offered from 2004 through 2008; these included enrollment, employee costs, and employer costs. Results The premium growth for the 5 largest school districts has slowed down and is consistent with other purchasers—Kaiser/Health Research & Educational Trust and the Federal Employee Health Benefit Program. The average increase in health insurance premium for the schools was 5.9% in 2008, and the average annual growth rate over the study period was 7.5%. For family coverage, these schools provide the most generous employer contribution (80.8%) compared with the employer contribution reported by other employers (73.5%) for 2008. Conclusions Often the largest employers in their communities, school districts demonstrate a commitment to provide choice of benefits and affordability for employees and their families. Despite constraints typical of public employers, the 5 largest school districts in the United States have decelerated in premium growth consistent with other purchasers, albeit at a slower pace. PMID:25126311

Drinking water in California child care sites before and after 2011-2012 beverage policy.

PubMed

Ritchie, Lorrene D; Yoshida, Sallie; Sharma, Sushma; Patel, Anisha; Vitale, Elyse Homel; Hecht, Ken

2015-06-04

Drinking water is promoted to improve beverage nutrition and reduce the prevalence of obesity. The aims of this study were to identify how water was provided to young children in child care and to determine the extent to which water access changed after a federal and state child care beverage policy was instituted in 2011 and 2012 in California. Two independent cross-sectional samples of licensed child care providers completed a self-administered survey in 2008 (n = 429) and 2012 (n = 435). Logistic regression was used to analyze data for differences between 2008 and 2012 survey responses, after adjustment for correlations among the measurements in each of 6 child care categories sampled. A significantly larger percentage of sites in 2012 than in 2008 always served water at the table with meals or snacks (47.0% vs 28.0%, P = .001). A significantly larger percentage of child care sites in 2012 than in 2008 made water easily and visibly available for children to self-serve both indoors (77.9% vs 69.0%, P = .02) and outside (78.0% vs 69.0%, P = .03). Sites that participated in the federal Child and Adult Care Food Program had greater access to water indoors and outside than sites not in the program. In 2012 most (76.1%) child care providers reported no barriers to serving water to children. Factors most frequently cited to facilitate serving water were information for families (39.0% of sites), beverage policy (37.0%), and lessons for children (37.9%). Water provision in California child care improved significantly between samples of sites studied in 2008 and 2012, but room for improvement remains after policy implementation. Additional training for child care providers and parents should be considered.

Drinking Water in California Child Care Sites Before and After 2011–2012 Beverage Policy

PubMed Central

Yoshida, Sallie; Sharma, Sushma; Patel, Anisha; Vitale, Elyse Homel; Hecht, Ken

2015-01-01

Introduction Drinking water is promoted to improve beverage nutrition and reduce the prevalence of obesity. The aims of this study were to identify how water was provided to young children in child care and to determine the extent to which water access changed after a federal and state child care beverage policy was instituted in 2011 and 2012 in California. Methods Two independent cross-sectional samples of licensed child care providers completed a self-administered survey in 2008 (n = 429) and 2012 (n = 435). Logistic regression was used to analyze data for differences between 2008 and 2012 survey responses, after adjustment for correlations among the measurements in each of 6 child care categories sampled. Results A significantly larger percentage of sites in 2012 than in 2008 always served water at the table with meals or snacks (47.0% vs 28.0%, P = .001). A significantly larger percentage of child care sites in 2012 than in 2008 made water easily and visibly available for children to self-serve both indoors (77.9% vs 69.0%, P = .02) and outside (78.0% vs 69.0%, P = .03). Sites that participated in the federal Child and Adult Care Food Program had greater access to water indoors and outside than sites not in the program. In 2012 most (76.1%) child care providers reported no barriers to serving water to children. Factors most frequently cited to facilitate serving water were information for families (39.0% of sites), beverage policy (37.0%), and lessons for children (37.9%). Conclusion Water provision in California child care improved significantly between samples of sites studied in 2008 and 2012, but room for improvement remains after policy implementation. Additional training for child care providers and parents should be considered. PMID:26043304

Removing the interview for medical school selection is associated with gender bias among enrolled students.

PubMed

Wilkinson, David; Casey, Mavourneen G; Eley, Diann S

2014-02-03

To report, and determine reasons for, a change in the gender ratio observed among enrolled medical students after removal of the interview from the selection process. Cross-sectional study of 4051 students admitted to the medical program at the University of Queensland between 2004 and 2012. Students are enrolled either directly as graduates or via a school-leaver pathway. Change in proportions of male and female students over time, and gender-specific scores in the three sections of the GAMSAT (Graduate Medical School Admissions Test). Between 2004 and 2008 (when an interview was part of the selection process), 891 enrolled students (51.4%) were male, whereas between 2009 and 2012 (no interview), 1134 (57.7%; P < 0.001) were male. This change in gender ratio was limited to domestic direct graduate-entry students, and the male proportion in this group rose from 50.9% (705 students) before the interview was removed to 64.0% (514 students; P < 0.001) after removal of the interview (reaching 73.8% in 2012). Between 2004 and 2012, male students consistently performed better than female students on GAMSAT section III (mean score, 71.5 v 68.5; P < 0.001). The proportion of males enrolled in the medical program at this university increased markedly after removal of the interview from the selection process. This change is limited to domestic direct graduate-entry students, and seems to be due to higher scores by male students in section III of the GAMSAT. The interview may play an important role in ensuring gender equity in selection, and medical schools should carefully monitor the consequences of changes to selection policy.

Effect of special diabetes program for Indians funding on system changes in diabetes care and outcomes among American Indian/Alaska Native people 1994-2004.

PubMed

Ramesh, Meera; Schraer, Cynthia; Mayer, Ann Marie; Asay, Elvin; Koller, Kathryn

2008-06-01

The Alaska Native Medical Center diabetes program analysed Diabetes Care and Outcomes Audit data from 1994-2004 to evaluate the impact of the Special Diabetes Program for Indians (SDPI) funding on process and intermediate outcomes. We conducted a retrospective analysis of data from standardized medical records reviews conducted between 1994 and 2004 from regional sites in Alaska. We analysed 7,735 randomly selected records for trends over three time periods (pre-SDPI, transition and SDPI). Hemoglobin A1c, total and LDL cholesterol, triglycerides and blood pressure significantly improved from the pre-SDPI to the SDPI period. However, as the number of people with diabetes increased, the percentage of patients receiving foot, eye and dental exams decreased, as did the percentage receiving nutrition, exercise and diabetes education. SDPI funding provided resources for interventions necessary to improve the effectiveness of diabetes care. This was associated with improved intermediate outcomes in American Indian/Alaska Native patients with diabetes. Further observations are needed to evaluate whether or not intermediate outcomes result in decreased cardiovascular disease, amputations, dialysis and retinopathy.

The uneven distribution of women in orthopaedic surgery resident training programs in the United States.

PubMed

Van Heest, Ann E; Agel, Julie

2012-01-18

Although women represented 58% of undergraduate students and 48% of medical students in the U.S. in the 2008-2009 academic year, only 13% of orthopaedic residents and only 4% of American Academy of Orthopaedic Surgeons (AAOS) Fellows in 2009 were women. Are all orthopaedic surgery programs in the U.S. equal in their ability to attract female medical students and train female orthopaedic surgeons? This study was undertaken to test the hypothesis that all Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs in the U.S. train a similar number of female residents. Data for all ACGME-accredited orthopaedic surgery residency training programs in the U.S. for five academic years (2004-2005 through 2008-2009) were collected with use of the Graduate Medical Education (GME) Track database. Orthopaedic residency programs in the U.S. do not train women at an equal frequency. In the academic years from 2004-2005 through 2008-2009, forty-five programs had no female residents during at least one of the five academic years reviewed, and nine programs had no female residents during any of the years. More than fifty orthopaedic residency programs in the U.S. had an average of <10% female trainees over the five-year period, and more than ten programs had an average of >20%. There was no significant change in the distribution among these categories over the five years examined (p = 0.234). Significant differences in the representation of women exist among orthopaedic residency training programs in the U.S. Further examination of the characteristics of orthopaedic residency programs that are successful in attracting female residents, particularly the composition of their faculty as role models, will be important in furthering our understanding of how orthopaedic surgery can continue to attract the best and the brightest individuals. Changes in the cultural experiences in programs that have not trained female orthopaedic surgeons, such as an increased number of female faculty, and policies that emphasize diversity may provide a greater opportunity for our orthopaedic profession to attract female medical students.

The effect of prenatal support on birth outcomes in an urban midwestern county.

PubMed

Schlenker, Thomas; Dresang, Lee T; Ndiaye, Mamadou; Buckingham, William R; Leavitt, Judith W

2012-12-01

In Dane County, Wisconsin, the black-white infant mortality gap started decreasing from 2000 and was eliminated from 2004 to 2007. Unfortunately, it has reappeared since 2008. This paper examines risk factors and levels of prenatal care to identify key contributors to the dramatic decline and recent increase in black infant mortality and extremely premature birth rates. This retrospective cohort study analyzed approximately 100,000 Dane County birth, fetal, and infant death records from 1990 to 2007. Levels of prenatal care received were categorized as "less-than-standard," "standard routine" or "intensive." US Census data analysis identified demographic and socioeconomic changes. Infant mortality rates and extremely premature ( < or = 28 weeks gestation) birth rates were main outcome measures. Contributions to improved outcomes were measured by calculating relative risk, risk difference and population attributable fraction (PAF). Mean income and food stamp use by race were analyzed as indicators of general socioeconomic changes suspected to be responsible for worsening outcomes since 2008. Risk of extremely premature delivery for black women receiving standard routine care and intensive care decreased from 1990-2000 to 2001-2007 by 77.8% (95% CI = 49.9-90.1%) and 57.3% (95% CI = 27.6-74.8%) respectively. Women receiving less-than-standard care showed no significant improvement over time. Racial gaps in mean income and food stamp use narrowed 2002-2007 and widened since 2008. Prenatal support played an important role in improving black birth outcomes and eliminating the Dane County black-white infant mortality gap. Increasing socioeconomic disparities with worsening US economy since 2008 likely contributed to the gap's reappearance.

Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database.

PubMed

Cognetti, Daniel; Keeny, Heather M; Samdani, Amer F; Pahys, Joshua M; Hanson, Darrell S; Blanke, Kathy; Hwang, Steven W

2017-10-01

OBJECTIVE Postoperative complications are one of the most significant concerns in surgeries of the spine, especially in higher-risk cases such as neuromuscular scoliosis. Neuromuscular scoliosis is a classification of multiple diseases affecting the neuromotor system or musculature of patients leading to severe degrees of spinal deformation, disability, and comorbidity, all likely contributing to higher rates of postoperative complications. The objective of this study was to evaluate deformity correction of patients with neuromuscular scoliosis over a 12-year period (2004-2015) by looking at changes in postsurgical complications and management. METHODS The authors queried the Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database for neuromuscular scoliosis cases from 2004 to 2015. The SRS M&M database is an international database with thousands of self-reported cases by fellowship-trained surgeons. The database has previously been validated, but reorganization in 2008 created less-robust data sets from 2008 to 2011. Consequently, the majority of analysis in this report was performed using cohorts that bookend the 12-year period (2004-2007 and 2012-2015). Of the 312 individual fields recorded per patient, demographic analysis was completed for age, sex, diagnosis, and preoperative curvature. Analysis of complications included infection, bleeding, mortality, respiratory, neurological deficit, and management practices. RESULTS From 2004 to 2015, a total of 29,019 cases of neuromuscular scoliosis were reported with 1385 complications, equating to a 6.3% complication rate when excluding the less-robust data from 2008 to 2011. This study shows a 3.5-fold decrease in overall complication rates from 2004 to 2015. A closer look at complications shows a significant decrease in wound infections (superficial and deep), respiratory complications, and implant-associated complications. The overall complication rate decreased by approximately 10% from 2004-2007 to 2012-2015. CONCLUSIONS This study demonstrates a substantial decrease in complication rates from 2004 to 2015 for patients with neuromuscular scoliosis undergoing spine surgery. Decreases in specific complications, such as surgical site infection, allow us to gauge our progress while observing how trends in management affect outcomes. Further study is needed to validate this report, but these results are encouraging, helping to reinforce efforts toward continual improvement in patient care.

Improving the Yield of Histological Sampling in Patients With Suspected Colorectal Cancer During Colonoscopy by Introducing a Colonoscopy Quality Assurance Program.

PubMed

Gado, Ahmed; Ebeid, Basel; Abdelmohsen, Aida; Axon, Anthony

2011-08-01

Masses discovered by clinical examination, imaging or endoscopic studies that are suspicious for malignancy typically require biopsy confirmation before treatment is initiated. Biopsy specimens may fail to yield a definitive diagnosis if the lesion is extensively ulcerated or otherwise necrotic and viable tumor tissue is not obtained on sampling. The diagnostic yield is improved when multiple biopsy samples (BSs) are taken. A colonoscopy quality-assurance program (CQAP) was instituted in 2003 in our institution. The aim of this study was to determine the effect of instituting a CQAP on the yield of histological sampling in patients with suspected colorectal cancer (CRC) during colonoscopy. Initial assessment of colonoscopy practice was performed in 2003. A total of five patients with suspected CRC during colonoscopy were documented in 2003. BSs confirmed CRC in three (60%) patients and were nondiagnostic in two (40%). A quality-improvement process was instituted which required a minimum six BSs with adequate size of the samples from any suspected CRC during colonoscopy. A total of 37 patients for the period 2004-2010 were prospectively assessed. The diagnosis of CRC was confirmed with histological examination of BSs obtained during colonoscopy in 63% of patients in 2004, 60% in 2005, 50% in 2006, 67% in 2007, 100% in 2008, 67% in 2009 and 100% in 2010. The yield of histological sampling increased significantly ( p <0.02) from 61% in 2004-2007 to 92% in 2008-2010. The implementation of a quality assurance and improvement program increased the yield of histological sampling in patients with suspected CRC during colonoscopy.

Identification of Directional Couplings

NASA Astrophysics Data System (ADS)

Bezruchko, Boris P.; Smirnov, Dmitry A.

An important piece of information, which can be extracted from parameters of empirical models, is quantitative characteristics of couplings between processes under study. The problem of coupling detection is encountered in multiple fields including physics (Bezruchko et al., 2003), geophysics (Maraun and Kurths, 2005; Mokhov and Smirnov, 2006, 2008; Mosedale et al., 2006; Palus and Novotna, 2006; Verdes, 2005; Wang et al., 2004), cardiology (Rosenblum et al., 2002; Palus and Stefanovska, 2003) and neurophysiology (Arnhold et al., 1999; Brea et al., 2006; Faes et al., 2008; Friston et al., 2003; Kreuz et al., 2007; Kiemel et al., 2003; Le Van Quyen et al., 1999; Mormann et al., 2000; Osterhage et al., 2007; Pereda et al., 2005; Prusseit and Lehnertz, 2008; Smirnov et al., 2005; Romano et al., 2007; Schelter et al., 2006; Schiff et al., 1996; Sitnikova et al., 2008; Smirnov et al., 2008, Staniek and Lehnertz, 2008; Tass, 1999; Tass et al., 2003). Numerous investigations are devoted to synchronisation, which is an effect of interaction between non-linear oscillatory systems (see, e.g., Balanov et al., 2008; Boccaletti et al., 2002; Hramov and Koronovskii, 2004; Kreuz et al., 2007; Maraun and Kurths, 2005; Mormann et al., 2000; Mosekilde et al., 2002; Osipov et al., 2007; Palus and Novotna, 2006; Pikovsky et al., 2001; Prokhorov et al., 2003; Tass et al., 2003). In the last decade, more careful attention is paid to directional coupling analysis. Such characteristics might help, e.g., to localise an epileptic focus (a pathologic area) in the brain from electroencephalogram (EEG) or magnetoencephalogram (MEG) recordings: hypothetically, an increasing influence of an epileptic focus on adjacent areas leads to the seizure onset for some kinds of epilepsy.

Garden-Based Learning: An Experience with "At Risk" Secondary Education Students

ERIC Educational Resources Information Center

Ruiz-Gallardo, José-Reyes; Verde, Alonso; Valdés, Arturo

2013-01-01

The reengagement of disenchanted secondary students is one of the priorities of the educational system. Over a six-year period (2003-2004 to 2008-2009), 63 disruptive and low-performance secondary school students were integrated into a two-year garden-based learning program, which took place in southeastern Spain. This article intends to assess…

Using bald eagles to track spatial (1999-2008) and temporal (1987-1992, 1999-2003, and 2004-2008) trends of contaminants in Michigan's aquatic ecosystems.

PubMed

Wierda, Michael R; Leith, Katherine F; Roe, Amy S; Grubb, Teryl G; Sikarskie, James G; Best, David A; Pittman, H Tyler; Fuentes, Latice; Simon, Kendall L; Bowerman, William

2016-08-01

The bald eagle (Haliaeetus leucocephalus) is an extensively researched tertiary predator. Studies have delineated information about its life history and the influences of various stressors on its reproduction. Due to the bald eagle's position at the top of the food web, it is susceptible to biomagnification of xenobiotics. The Michigan Department of Environmental Quality implemented a program in 1999 to monitor persistent chemicals including polychlorinated biphenols (PCBs) and dichlorodiphenyltrichloroethane (DDE). The objectives of the present study were to evaluate spatial and temporal trends of PCBs and organochlorine pesticides in nestling bald eagles of Michigan. The authors' study found that concentrations of PCBs and DDE were higher in Great Lakes areas with Lakes Michigan and Lake Huron having the highest concentrations of DDE and Lake Erie having the highest concentrations of PCBs. Temporally (1987-1992, 1999-2003, and 2004-2008) the present study found declines in PCB and DDE concentrations with a few exceptions. Continued monitoring of Michigan bald eagle populations is suggested for a couple of reasons. First, nestling blood contaminant levels are an appropriate method to monitor ecosystem contaminant levels. Second, from 1999 to 2008 PCB and DDE concentrations for 30% and 40%, respectively, of the nestling eagles sampled were above the no observable adverse effect level (NOAEL) for bald eagles. Lastly, with the continued development and deployment of new chemistries a continuous long term monitoring program is an invaluable resource. Environ Toxicol Chem 2016;35:1995-2002. © 2016 SETAC. © 2016 SETAC.

VizieR Online Data Catalog: Young star forming region NGC 2264 Spitzer sources (Rapson+, 2014)

NASA Astrophysics Data System (ADS)

Rapson, V. A.; Pipher, J. L.; Gutermuth, R. A.; Megeath, S. T.; Allen, T. S.; Myers, P. C.; Allen, L. E.

2017-05-01

We utilize 3.6-8.0 um images of Mon OB1 East obtained with the Spitzer Space Telescope Infrared Array Camera (IRAC; Fazio et al. 2004ApJS..154...10F), 24 um images obtained with the Multi-Band Imaging Photometer (MIPS; Rieke et al. 2004ApJS..154...25R), along with 1-2.5 um NIR data from the Two Micron All Sky Survey (2MASS; Skrutskie et al. 2006AJ....131.1163S, Cat. VII/233) to classify YSOs. These YSOs in Mon OB1 East are classified as either protostars or stars with circumstellar disks by their infrared excess emission above photospheric emission. Spitzer data were gathered as part of two Guaranteed Time Observation programs and one additional program with the goal of studying clustered and distributed star formation throughout Mon OB1 East and comparing the results with those of other molecular clouds. Mon OB1 East was observed by Spitzer in 2004, 2007, and 2008 as part of the Guaranteed Time Observation programs 37 (IRAC data; PI: G. Fazio) and 58 (MIPS data; PI: G. Rieke), as well as program 40006 (IRAC+MIPS data; PI: G. Fazio). (1 data file).

Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome.

PubMed

Adams, Denise; Wu, Taixiang; Yang, Xunzhe; Tai, Shusheng; Vohra, Sunita

2009-10-07

Chronic fatigue is increasingly common. Conventional medical care is limited in treating chronic fatigue, leading some patients to use traditional Chinese medicine therapies, including herbal medicine. To assess the effectiveness of traditional Chinese medicine herbal products in treating idiopathic chronic fatigue and chronic fatigue syndrome. The following databases were searched for terms related to traditional Chinese medicine, chronic fatigue, and clinical trials: CCDAN Controlled Trials Register (July 2009), MEDLINE (1966-2008), EMBASE (1980-2008), AMED (1985-2008), CINAHL (1982-2008), PSYCHINFO (1985-2008), CENTRAL (Issue 2 2008), the Chalmers Research Group PedCAM Database (2004), VIP Information (1989-2008), CNKI (1976-2008), OCLC Proceedings First (1992-2008), Conference Papers Index (1982-2008), and Dissertation Abstracts (1980-2008). Reference lists of included studies and review articles were examined and experts in the field were contacted for knowledge of additional studies. Selection criteria included published or unpublished randomized controlled trials (RCTs) of participants diagnosed with idiopathic chronic fatigue or chronic fatigue syndrome comparing traditional Chinese medicinal herbs with placebo, conventional standard of care (SOC), or no treatment/wait lists. The outcome of interest was fatigue. 13 databases were searched for RCTs investigating TCM herbal products for the treatment of chronic fatigue. Over 2400 references were located. Studies were screened and assessed for inclusion criteria by two authors. No studies that met all inclusion criteria were identified. Although studies examining the use of TCM herbal products for chronic fatigue were located, methodologic limitations resulted in the exclusion of all studies. Of note, many of the studies labelled as RCTs and conducted in China did not utilize rigorous randomization procedures. Improvements in methodology in future studies is required for meaningful synthesis of data.

The use of VA Disability Compensation and Social Security Disability Insurance among working-aged veterans.

PubMed

Wilmoth, Janet M; London, Andrew S; Heflin, Colleen M

2015-07-01

Although there is substantial disability among veterans, relatively little is known about working-aged veterans' uptake of Department of Veterans Affairs (VA) Disability Compensation and Social Security Disability Insurance (DI). This study identifies levels of veteran participation in VA disability and/or DI benefit programs, examines transitions into and out of VA and DI programs among veterans, and estimates the size and composition of the veteran population receiving VA and/or DI benefits over time. Data from the 1992, 1993, 1996, 2001, 2004, and 2008 Survey of Income and Program Participation (SIPP) are used to describe VA and DI program participation among veterans under the age of 65. The majority of working-aged veterans do not receive VA or DI benefits and joint participation is low, but use of these programs has increased over time. A higher percentage of veterans receive VA compensation, which ranges from 4.9% in 1992 to 13.2% in 2008, than DI compensation, which ranges from 2.9% in 1992 to 6.7% in 2008. The rate of joint participation ranges from less than 1% in 1992 to 3.6% in 2008. Veterans experience few transitions between VA and DI programs during the 36-48 months they are observed. The number of veterans receiving benefits from VA and/or DI nearly doubled between 1992 and 2008. There have been substantial shifts in the composition of veterans using these programs, as cohorts who served prior to 1964 are replaced by those who served after 1964. The findings suggest potential gaps in veterans' access to disability programs that might be addressed through improved coordination of VA and DI benefits. Copyright © 2015 Elsevier Inc. All rights reserved.

The Health Care Cost Implications of Overweight and Obesity during Childhood

PubMed Central

Au, Nicole

2012-01-01

Objective To investigate whether childhood overweight at age 4–5 increases publicly funded health care costs during childhood, and to explore the role of timing and duration of overweight on health costs. Data Sources The Longitudinal Study of Australian Children (2004–2008) and linked records from Medicare, Australia's public health insurance provider (2004–2009). Study Design The influence of overweight status on non-hospital Medicare costs incurred by children over a 5-year period was estimated using two-part models and one-part generalized linear models (GLM). All models controlled for demographic, socioeconomic, and parental characteristics. Principal Findings Being overweight at age 4–5 is associated with significantly higher pharmaceutical and medical care costs. The results imply that for all children aged 4 and 5 in 2004–2005, those who were overweight had a combined 5-year Medicare bill that was AUD$9.8 million higher than that of normal weight children. Results from dynamic analyses show that costs of childhood overweight occur contemporaneously, and the duration of overweight is positively associated with medical costs for children who became overweight after age 5. Conclusions This study reveals that the financial burden to the public health system of childhood overweight and obesity occurs even during the first 5 years of primary school. PMID:22092082

Child Care Health Connections: A Health and Safety Newsletter for California Child Care Professionals. Volume 21, Number 4, July-August 2008

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Calder, Judy, Ed.; Rose, Bobbie, Ed.; Leonard, Victoria, Ed.

2008-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 21, Number 1. January-February 2008

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Calder, Judy, Ed.; Rose, Bobbie, Ed.; Leonard, Victoria, Ed.; Turner, Debra, Ed.

2008-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 21, Number 6. November-December 2008

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Calder, Judy, Ed.; Rose, Bobbie, Ed.; Leonard, Victoria, Ed.

2008-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment for all…

Child Care Health Connections: A Health and Safety Newsletter for California Child Care Professionals. Volume 21, Number 3, May-June 2008

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Calder, Judy, Ed.; Rose, Bobbie, Ed.; Leonard, Victoria, Ed.

2008-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of this newsletter are to promote and support a healthy and safe environment…

Child Care Health Connections. A Health and Safety Newsletter for California Child Care Professionals. Volume 21, Number 2. March-April 2008

ERIC Educational Resources Information Center

Zamani, A. Rahman, Ed.; Calder, Judy, Ed.; Rose, Bobbie, Ed.; Leonard, Victoria, Ed.

2008-01-01

"Child Care Health Connections" is a bimonthly newsletter published by the California Childcare Health Program (CCHP), a community-based program of the University of California, San Francisco School of Nursing, Department of Family Health Care Nursing. The goals of the newsletter are to promote and support a healthy and safe environment…

Changes in school environments with implementation of Arkansas Act 1220 of 2003.

PubMed

Phillips, Martha M; Raczynski, James M; West, Delia S; Pulley, LeaVonne; Bursac, Zoran; Gauss, C Heath; Walker, Jada F

2010-02-01

Changes in school nutrition and physical activity policies and environments are important to combat childhood obesity. Arkansas Act 1220 of 2003 was among the first and most comprehensive statewide legislative initiatives to combat childhood obesity through school-based change. Annual surveys of principals and superintendents have been analyzed to document substantial and important changes in school environments, policies, and practices. For example, results indicate that schools are more likely to require that healthy options be provided for student parties (4.5% in 2004, 36.9% in 2008; P

Case Study of American Healthways' Diabetes Disease Management Program

PubMed Central

Pope, James E.; Hudson, Laurel R.; Orr, Patty M.

2005-01-01

Disease management has been defined as a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant (Disease Management Association of America, 2005). The purpose of this article is to provide an overview of the diabetes disease management program offered by American Healthways (AMHC) and highlight recently reported results of this program (Villagra, 2004a; Espinet et al., 2005). PMID:17288077

Socioeconomic inequalities in dental health services in Sao Paulo, Brazil, 2003-2008.

PubMed

Monteiro, Camila Nascimento; Beenackers, Mariëlle A; Goldbaum, Moisés; de Azevedo Barros, Marilisa Berti; Gianini, Reinaldo José; Cesar, Chester Luiz Galvão; Mackenbach, Johan P

2016-12-07

Access to, and use of, dental health services in Brazil have improved since 2003. The increase of private health care plans and the implementation of the "Smiling Brazil" Program, the largest public oral health care program in the world, could have influenced this increase in access. However, we do not yet know if inequalities in the use of dental health services persist after the improvement in access. The aims of this study are to analyze socioeconomic differences for dental health service use between 2003 and 2008 in São Paulo and to examine changes in these associations since the implementation of the Smiling Brazil program in 2003. Data was obtained via two household health surveys (ISA-Capital 2003 and ISA-Capital 2008) which investigated living conditions, lifestyle, health status and use of health care services. Logistic regression was used to analyze associations between socioeconomic factors and dental services use. Additionally, trends from 2003 to 2008 regarding socioeconomic characteristics and dental health service use were explored. Overall, dental health service use increased between 2003 and 2008 and was at both time points more common among those who had higher income, better education, better housing conditions, private health care plans and were Caucasian. Inequalities in use of dental health care did not decrease over time. Among the reasons for not seeking dental care, not having teeth and financial difficulty were more common in lower socioeconomic groups, while thinking it was unnecessary was more common in higher socioeconomic groups. The Brazilian oral health policy is still in a period of expansion and seems to have contributed slightly to increased dental health service use, but has not influenced socioeconomic inequalities in the use of these services. Acquiring deeper knowledge about inequalities in dental health service use will contribute to better understanding of potential barriers to reducing them.

Cardiovascular services and human resources in Puerto Rico - 2008.

PubMed

García-Palmieri, Mario R

2009-01-01

Available information (2004-2008) concerning population statistics, the occurrence of cardiovascular disease, cardiovascular services and human resources in Puerto Rico is presented. Relevant information concerning life expectancy at birth, death by specific causes in a recent four years period, the commonest causes of death, and the related cardiovascular risk factors prevalence data available is included. The surgical and medical interventional services rendered to cardiovascular patients in different institutions and their locations in Puerto Rico in the year 2008 is presented. Some remarks concerning the productivity of physicians by our Schools of Medicine is included. Information about ACGME accredited postgraduate cardiovascular training programs conducted in Puerto Rico is presented. Data concerning the prevalence of hypertension, diabetes mellitus, overweight and obesity obtained by BRFSS in presented.

The Chinese free antiretroviral treatment program: challenges and responses.

PubMed

Zhang, Fujie; Haberer, Jessica E; Wang, Yu; Zhao, Yan; Ma, Ye; Zhao, Decai; Yu, Lan; Goosby, Eric P

2007-12-01

To respond to the HIV/AIDS epidemic in China, the National Center for AIDS/STD Control and Prevention established the Division of Treatment and Care in late 2001. The pilot for the National Free ART Program began in Henan Province in 2002, and the program fully began in 2003. Treatment efforts initially focused on patients infected through illicit blood and plasma donation in the mid-1990s and subsequently expanded to include HIV-infected injection drug users, commercial sex workers, pregnant women, and children. The National Free ART Database was established in late 2004, and includes data on current patients and those treated before 2004. Over 31 000 adult and pediatric patients have been treated thus far. Challenges for the program include integration of drug treatment services with ART, an under-resourced health care system, co-infections, stigma, discrimination, drug resistance, and procurement of second-line ART. The merging of national treatment and care, epidemiologic, and drug resistance databases will be critical for a better understanding of the epidemic, for earlier identification of patients requiring ART, and for improved patient follow-up. The Free ART Program has made considerable progress in providing the necessary care and treatment for HIV-infected people in China and has strong government support for continued improvement and expansion.

Fifth Annual Report: 2008 Pre-Construction Eelgrass Monitoring and Propagation for King County Outfall Mitigation

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

Woodruff, Dana L.; Judd, Chaeli; Thom, Ronald M.

2010-01-01

This is the fifth and final report in a series documenting progress of the pre-construction eelgrass restoration and mitigation activities for the proposed King County Brightwater marine outfall, discharging to Puget Sound near Point Wells, Washington. King County began implementing a multiyear eelgrass monitoring and restoration program in 2004, with the primary goal of returning intertidal and shallow subtidal habitat and eelgrass to pre-construction conditions, after construction of the outfall. Major eelgrass mitigation program elements include: a) pre-construction monitoring, i.e., documenting initial eelgrass conditions and degree of fluctuation over a 5 year period prior to construction, b) eelgrass transplanting, includingmore » harvesting, offsite propagation and stockpiling of local plants for post-construction planting, and c) post-construction planting and subsequent monitoring, occurring in 2009 and beyond. The overall program is detailed in the Eelgrass Restoration and Biological Resources Implementation Workplan (King County 2008).« less

How physicians have learned to handle sickness-certification cases.

PubMed

Löfgren, Anna; Silén, Charlotte; Alexanderson, Kristina

2011-05-01

Sickness absence is a common ''prescription'' in health care in many Western countries. Despite the significance of sick-listing for the life situation of patients, physicians have limited training in how to handle sickness-certification cases and the research about sickness-certification practices is scarce. Gain knowledge on physicians' learning regarding management of sickness certification of patients in formal, informal, and non-formal learning situations, respectively, and possible changes in this from 2004 to 2008. Data from two comprehensive questionnaires to physicians in Sweden about their sickness-certification practice in 2004 (n = 7665) and 2008 (n = 36,898); response rates: 71% and 61%, respectively. Answers from all the physicians ≤64 years old and who had sickness certification tasks (n = 4019 and n = 14,210) were analysed. ratings of importance of different types of learning situations for their sickness-certification competence. Few physicians stated that formal learning situations had contributed to a large or fairly large extent to their competence in sickness certification, e.g. undergraduate studies had done that for 17%, internship for 37%, and resident training for 46%, respectively. Contacts with colleagues had been helpful for 65%. One-third was helped by training arranged by social insurance offices. There was a significant increase between 2004 and 2008 in all items related to formal and non-formal learning situations, while there were no changes regarding informal learning situations. This study of all physicians in Sweden shows that physicians primarily attain competence in sickness certification in their daily clinical practice; through contacts with colleagues and patients.

Catalog of Mount St. Helens 2004-2007 Dome Samples with Major- and Trace-Element Chemistry

USGS Publications Warehouse

Thornber, Carl R.; Pallister, John S.; Rowe, Michael C.; McConnell, Siobhan; Herriott, Trystan M.; Eckberg, Alison; Stokes, Winston C.; Cornelius, Diane Johnson; Conrey, Richard M.; Hannah, Tammy; Taggart, Joseph E.; Adams, Monique; Lamothe, Paul J.; Budahn, James R.; Knaack, Charles M.

2008-01-01

Sampling and analysis of eruptive products at Mount St. Helens is an integral part of volcano monitoring efforts conducted by the U.S. Geological Survey?s Cascades Volcano Observatory (CVO). The objective of our eruption sampling program is to enable petrological assessments of pre-eruptive magmatic conditions, critical for ascertaining mechanisms for eruption triggering and forecasting potential changes in eruption behavior. This report provides a catalog of near-vent lithic debris and new dome-lava collected during 34 intra-crater sampling forays throughout the October 2004 to October 2007 (2004?7) eruptive interval at Mount St. Helens. In addition, we present comprehensive bulk-rock geochemistry for a time-series of representative (2004?7) eruption products. This data, along with that in a companion report on Mount St. Helens 2004 to 2006 tephra by Rowe and others (2008), are presented in support of the contents of the U.S. Geological Survey Professional Paper 1750 (Sherrod and others, eds., 2008). Readers are referred to appropriate chapters in USGS Professional Paper 1750 for detailed narratives of eruptive activity during this time period and for interpretations of sample characteristics and geochemical data. The suite of rock samples related to the 2004?7 eruption of Mount St. Helens and presented in this catalog are archived at the David A. Johnson Cascades Volcano Observatory, Vancouver, Wash. The Mount St. Helens 2004?7 Dome Sample Catalogue with major- and trace-element geochemistry is tabulated in 3 worksheets of the accompanying Microsoft Excel file, of2008-1130.xls. Table 1 provides location and sampling information. Table 2 presents sample descriptions. In table 3, bulk-rock major and trace-element geochemistry is listed for 44 eruption-related samples with intra-laboratory replicate analyses of 19 dacite lava samples. A brief overview of the collection methods and lithology of dome samples is given below as an aid to deciphering the dome sample catalog. This is followed by an explanation of the categories of sample information (column headers) in Tables 1 and 2. A summary of the analytical methods used to obtain the geochemical data in this report introduces the presentation of major- and trace-element geochemistry of 2004?7 Mount St. Helens dome samples in table 3. Intra-laboratory results for the USGS AGV-2 standard are presented (tables 4 and 5), which demonstrate the compatibility of chemical data from different sources.

A new species of Perlesta (Plecoptera: Perlidae) from North Carolina with additional records for North Carolina and Virginia

USGS Publications Warehouse

Kondratieff, B.C.; Zuellig, R.E.; Lenat, D.R.

2011-01-01

Twenty-eight species of Nearctic Perlesta are currently recognized (Stark 1989, 2004; Kondratieff et al. 2006, 2008; Grubbs and DeWalt 2008, Grubbs and DeWalt 2011, Kondratieff and Myers 2011). Interestingly, but needing confirmation, Perlesta has been recently recorded from Central America (Gutiérrez-Fonseca and Springer 2011). Continued collecting and study of Perlesta from North Carolina by the authors revealed one additional undescribed species. Ten species of Perlesta currently have been recorded from North Carolina (Stark 1989, 2004, Kondratieff et al. 2006, 2008, Grubbs and DeWalt 2008). Additionally, new Perlesta species records are given for Virginia. The terminology used in the description of the male adult follows Stark (1989, 2004).

Risk factors and acute in-hospital costs for infected pressure ulcers among gunshot-spinal cord injury victims in southeastern Michigan.

PubMed

Chopra, Teena; Marchaim, Dror; Awali, Reda A; Levine, Miriam; Sathyaprakash, Smitha; Chalana, Indu K; Ahmed, Farah; Martin, Emily T; Sieggreen, Mary; Sobel, Jack D; Kaye, Keith S

2016-03-01

Management of pressure ulcers (PrUs) in patients with gunshot-spinal cord injuries (SCIs) presents unique medical and economic challenges for practitioners. A retrospective chart review was conducted at 3 acute care hospitals in metropolitan Detroit for patients admitted with PrUs due to gunshot-SCIs between January 2004 and December 2008. Multivariate analysis using logistic regression was conducted to choose for the independent predictors of infected PrUs. Mean adjusted in-hospital costs per patient and per hospitalization were calculated and compared between infected and noninfected PrUs. The study cohort included 201 gunshot-SCI patients with PrUs contributing to 395 admissions, including readmissions, between 2004 and 2008. Seventy-six patients (38%) had infected PrUs at time of the index admission. Independent predictors of infected PrUs on index admission included Charlson Comorbidity Index ≥2 (odds ratio, 2.18, P = .026) and stage III/IV PrU (odds ratio, 4.82; P <.0001). During the study period, the cumulative median duration of hospitalization per patient was 12 days (interquartile range, 6-24 days), resulting in a mean adjusted cost of $19,969 ± $6639 per patient. The mean adjusted cost per hospitalization for patients with infected PrUs was significantly higher than that for patients with noninfected PrUs ($16,735 ± $8310 vs $12,356 ± $7007; P <.001). A multidisciplinary approach including home-based rehabilitation programs and SCI wound clinics might help prevent PrUs and their complications and reduce associated costs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Framework Guidance Manual for In Situ Wetland Restoration Demonstration

DTIC Science & Technology

2013-08-26

within the laboratory include activated carbon, apatite, coke, organoclay, zeolites , and zero valent iron (Barth, 2008; Reible, 2004). Three of...apatite, coke, organoclay, zeolites , and zero-valent iron (Barth, 2008; Reible, 2004, Patmont et al., 2013). Activated carbon, apatite and organoclay

Analysis of traffic crash data in Kentucky : 2004-2008.

DOT National Transportation Integrated Search

2009-09-01

The report documents an analysis of traffic crash data in Kentucky for the years of 2004 through 2008. A primary objective of this study was to determine average crash statistics for Kentucky highways. Average and critical numbers and rates of crashe...

Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.

PubMed

Kang, Yu; Meng, Hongdao; Miller, Nancy A

2011-12-01

To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

Trouble Sleeping Associated With Lower Work Performance and Greater Health Care Costs: Longitudinal Data From Kansas State Employee Wellness Program.

PubMed

Hui, Siu-kuen Azor; Grandner, Michael A

2015-10-01

To examine the relationships between employees' trouble sleeping and absenteeism, work performance, and health care expenditures over a 2-year period. Utilizing the Kansas State employee wellness program (EWP) data set from 2008 to 2009, multinomial logistic regression analyses were conducted with trouble sleeping as the predictor and absenteeism, work performance, and health care costs as the outcomes. EWP participants (N = 11,698 in 2008; 5636 followed up in 2009) who had higher levels of sleep disturbance were more likely to be absent from work (all P < 0.0005), have lower work performance ratings (all P < 0.0005), and have higher health care costs (P < 0.0005). Longitudinally, more trouble sleeping was significantly related to negative changes in all outcomes. Employees' trouble sleeping, even at a subclinical level, negatively impacts on work attendance, work performance, and health care costs.

Decreasing Prevalence of Obesity Among Young Children in Massachusetts From 2004 to 2008

PubMed Central

Gillman, Matthew W.; Rifas-Shiman, Sheryl L.; Sherry, Bettylou; Kleinman, Ken; Taveras, Elsie M.

2012-01-01

OBJECTIVE: To examine whether the obesity prevalence is increasing, level, or decreasing among young US children (aged <6 years) in the past decade; and to compare regional data to those of 2 national databases. METHODS: We analyzed data from 108 762 well-child visits (36 827 children) at a multisite pediatric practice in eastern Massachusetts during 1999–2008. By using the Centers for Disease Control and Prevention 2000 gender-specific growth charts, we defined obesity as weight-for-length ≥95th percentile for children aged <24 months and BMI ≥95th percentile for children aged 24 to <72 months. By using multivariable logistic regression, we estimated gender-specific obesity trends in 2 separate periods, 1999–2003 and 2004–2008, adjusting for age group, race/ethnicity, health insurance, and practice site. RESULTS: From 1999 to 2003, the obesity prevalence was fairly stable among both boys and girls. From 2004 to 2008, the obesity prevalence substantially decreased among both boys and girls. The decline in obesity prevalence during 2004–2008 was more pronounced among children insured by non-Medicaid health plans than among those insured by Medicaid. CONCLUSIONS: Among children aged <6 years at this multisite pediatric practice, obesity prevalence decreased during 2004–2008, which is in line with national data showing no increase in prevalence during this time period. The smaller decrease among Medicaid-insured children may portend widening of socioeconomic disparities in childhood obesity. PMID:22529276

Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database.

PubMed

Lin, Heui-Fen; Wu, Ying-Tai; Tsauo, Jau-Yih

2012-08-16

Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients' functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet.

A faculty development program integrating cross-cultural care into a gastrointestinal pathophysiology tutorial benefits students, tutors, and the course.

PubMed

Shields, Helen M; Leffler, Daniel A; Peters, Antoinette S; Llerena-Quinn, Roxana; Nambudiri, Vinod E; White, Augustus A; Hayward, Jane N; Pelletier, Stephen R

2015-06-01

A specific faculty development program for tutors to teach cross-cultural care in a preclinical gastrointestinal pathophysiology course with weekly longitudinal followup sessions was designed in 2007 and conducted in the same manner over a 6-yr period. Anonymous student evaluations of how "frequently" the course and the tutor were actively teaching cross-cultural care were performed. The statements "This tutor actively teaches culturally competent care" and "Issues of culture and ethnicity were addressed" were significantly improved over baseline 2004 data. These increases were sustained over the 6-yr period. A tutor's overall rating as a teacher was moderately correlated with his/her "frequently" actively teaching cross-cultural care (r = 0.385, P < 0. 001). Course evaluation scores were excellent and put the course into the group of preclinical courses with the top ratings. Students in the Race in Curriculum Group asked that the program be expanded to other preclinical courses. In conclusion, from 2007 to 2012, a faculty development program for teaching cross-cultural care consistently increased the discussion of cross-cultural care in the tutorial and course over each year beginning with 2007 compared with the baseline year of 2004. Our data suggest that cross-cultural care can be effectively integrated into pathophysiology tutorials and helps improve students' satisfaction and tutors' ratings. Teaching cross-cultural care in a pathophysiology tutorial did not detract from the course's overall evaluations, which remained in the top group over the 6-yr period. Copyright © 2015 The American Physiological Society.

Outcomes in patients with community-acquired pneumonia admitted to the intensive care unit.

PubMed

Cavallazzi, Rodrigo; Wiemken, Timothy; Arnold, Forest W; Luna, Carlos M; Bordon, Jose; Kelley, Robert; Feldman, Charles; Chalmers, James D; Torres, Antoni; Ramirez, Julio

2015-06-01

Severe community-acquired pneumonia (CAP) portends a serious prognosis. The temporal trend in outcome of severe CAP is not well established. We evaluated the temporal trends in the outcomes of severe CAP. This is a secondary analysis of 800 patients with severe CAP enrolled in the Community-Acquired Pneumonia Organization International Cohort. Severe CAP was defined as CAP requiring admission to the intensive care unit. Only patients admitted to the ICU upon hospital admission were included in this study. We assessed the trend in outcomes of these patients during three time periods: Period I (June 2001 to April 2004), Period II (May 2004 to January 31 2008), and Period III (February 2008 to February 2013). After adjustment for other variables, mortality was higher for patients admitted during Period II compared with Period I (RR: 1.46; 95% CI: 1.002 to 2.14; P value = 0.049), and for Period III compared with Period I (RR: 1.70; 95% CI: 1.15 to 2.50; P value = 0.008). No significant difference in length of stay or time to clinical stability was found among the three periods. The mortality of patients with severe CAP increased over time in our study population. This finding has important health policy implications if confirmed by other studies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Hospitalizations for Substance Abuse Disorders Before and After Hurricane Katrina: Spatial Clustering and Area-Level Predictors, New Orleans, 2004 and 2008.

PubMed

Moise, Imelda K; Ruiz, Marilyn O

2016-10-13

Identifying at-risk groups is a challenge in post-disaster psychosocial response. Geospatial techniques can support the design and deployment of targeted and tailored interventions. This study compared spatial patterns in the distribution of hospitalizations for substance abuse disorders and associated area-level predictors before and after Hurricane Katrina in New Orleans, Louisiana. We used hospital data from the Louisiana Department of Health and Hospitals for 2004 (pre-Katrina) and 2008 (post-Katrina). Data were assessed by using descriptive statistics, multivariable Poisson regression, and geospatial analysis. We assessed hospitalizations by US Census block group in relation to the presence of blighted properties (ie, buildings declared an imminent health threat, in danger of collapse, or a public nuisance), race of residents (white or nonwhite), presence of nondisplaced residents (measured by the number of households receiving mail in 2008), and depth of water levels. The hospitalization rate for substance abuse disorders was 7.13 per 1,000 population for 2004 and 9.65 per 1,000 for 2008. The concentration of hospitalizations shifted geographically from block groups exposed to floods (levee breaches) in 2004 to the center of the city in 2008. Post Katrina, predictors for hospitalizations were presence of blighted properties, nonwhite populations, and presence of nondisplaced residents. Distance from flooded areas (high water depth) and levee breaches was negatively associated with hospitalizations. Men were more likely than women to be hospitalized during both periods (78%, 2004; 63%, 2008), and the percentage of the hospitalized white population increased from 2004 (28.8%) to 2008 (44.9%). Geographic patterns of hospitalizations for substance abuse disorders shifted in post-Katrina New Orleans from flood-exposed areas to less exposed areas in the center of the city; however, poverty was a main predictor for hospitalizations during both periods. Approaches used in this study are generalizable to other disaster areas and to other psychological vulnerabilities (eg, anxiety).

Hospitalizations for Substance Abuse Disorders Before and After Hurricane Katrina: Spatial Clustering and Area-Level Predictors, New Orleans, 2004 and 2008

PubMed Central

Ruiz, Marilyn O.

2016-01-01

Introduction Identifying at-risk groups is a challenge in post-disaster psychosocial response. Geospatial techniques can support the design and deployment of targeted and tailored interventions. This study compared spatial patterns in the distribution of hospitalizations for substance abuse disorders and associated area-level predictors before and after Hurricane Katrina in New Orleans, Louisiana. Methods We used hospital data from the Louisiana Department of Health and Hospitals for 2004 (pre-Katrina) and 2008 (post-Katrina). Data were assessed by using descriptive statistics, multivariable Poisson regression, and geospatial analysis. We assessed hospitalizations by US Census block group in relation to the presence of blighted properties (ie, buildings declared an imminent health threat, in danger of collapse, or a public nuisance), race of residents (white or nonwhite), presence of nondisplaced residents (measured by the number of households receiving mail in 2008), and depth of water levels. Results The hospitalization rate for substance abuse disorders was 7.13 per 1,000 population for 2004 and 9.65 per 1,000 for 2008. The concentration of hospitalizations shifted geographically from block groups exposed to floods (levee breaches) in 2004 to the center of the city in 2008. Post Katrina, predictors for hospitalizations were presence of blighted properties, nonwhite populations, and presence of nondisplaced residents. Distance from flooded areas (high water depth) and levee breaches was negatively associated with hospitalizations. Men were more likely than women to be hospitalized during both periods (78%, 2004; 63%, 2008), and the percentage of the hospitalized white population increased from 2004 (28.8%) to 2008 (44.9%). Conclusion Geographic patterns of hospitalizations for substance abuse disorders shifted in post-Katrina New Orleans from flood-exposed areas to less exposed areas in the center of the city; however, poverty was a main predictor for hospitalizations during both periods. Approaches used in this study are generalizable to other disaster areas and to other psychological vulnerabilities (eg, anxiety). PMID:27736053

Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000–2010

PubMed Central

Buchacz, Kate; Lau, Bryan; Jing, Yuezhou; Bosch, Ronald; Abraham, Alison G.; Gill, M. John; Silverberg, Michael J.; Goedert, James J.; Sterling, Timothy R.; Althoff, Keri N.; Martin, Jeffrey N.; Burkholder, Greer; Gandhi, Neel; Samji, Hasina; Patel, Pragna; Rachlis, Anita; Thorne, Jennifer E.; Napravnik, Sonia; Henry, Keith; Mayor, Angel; Gebo, Kelly; Gange, Stephen J.; Moore, Richard D.; Brooks, John T.

2016-01-01

Background. There are few recent data on the rates of AIDS-defining opportunistic infections (OIs) among human immunodeficiency virus (HIV)–infected patients in care in the United States and Canada. Methods. We studied HIV-infected participants in 16 cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) during 2000–2010. After excluding 16 737 (21%) with any AIDS-defining clinical events documented before NA-ACCORD enrollment, we analyzed incident OIs among the remaining 63 541 persons, most of whom received antiretroviral therapy during the observation. We calculated incidence rates per 100 person-years of observation (hereafter, “person-years”) with 95% confidence intervals (CIs) for the first occurrence of any OI and select individual OIs during 2000–2003, 2004–2007, and 2008–2010. Results. A total of 63 541 persons contributed 261 573 person-years, of whom 5836 (9%) developed at least 1 OI. The incidence rate of any first OI decreased over the 3 observation periods, with 3.0 cases, 2.4 cases, and 1.5 cases per 100 person-years of observation during 2000–2003, 2004–2007, and 2008–2010, respectively (Ptrend<.001); the rates of most individual OIs decreased as well. During 2008–2010, the leading OIs included Pneumocystis jiroveci pneumonia, esophageal candidiasis, and disseminated Mycobacterium avium complex or Mycobacterium kansasii infection. Conclusions. For HIV-infected persons in care during 2000–2010, rates of first OI were relatively low and generally declined over this time. PMID:27559122

Families as Decision-Makers: When Researchers and Advocates Work Together

ERIC Educational Resources Information Center

Fields-Smith, Cheryl; Neuharth-Pritchett, Stacey

2009-01-01

Families across the United States must routinely make difficult choices about child care arrangements because of the need to resume a job, continue an education or training program, or care for other family members. Leaving children in the care of others for the first time can be difficult (Sayer, Bianchi, & Robinson, 2004; Van Horn, Ramey,…

Mobile health care operations and return on investment in predominantly underserved children with asthma: the breathmobile program.

PubMed

Morphew, Tricia; Scott, Lyne; Li, Marilyn; Galant, Stanley P; Wong, Webster; Garcia Lloret, Maria I; Jones, Felita; Bollinger, Mary Elizabeth; Jones, Craig A

2013-08-01

Underserved populations have limited access to care. Improved access to effective asthma care potentially improves quality of life and reduces costs associated with emergency department (ED) visits. The purpose of this study is to examine return on investment (ROI) for the Breathmobile Program in terms of improved patient quality-adjusted life years saved and reduced costs attributed to preventable ED visits for 2010, with extrapolation to previous years of operation. It also examines cost-benefit related to reduced morbidity (ED visits, hospitalizations, and school absenteeism) for new patients to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits). This is a retrospective analysis of data for 15,986 pediatric patients, covering 88,865 visits, participating in 4 Southern California Breathmobile Programs (November 16, 1995-December 31, 2010). The ROI calculation expressed the cost-benefit ratio as the net benefits (ED costs avoided+relative value of quality-adjusted life years saved) over the per annum program costs (∼$500,000 per mobile). The ROI across the 4 California programs in 2010 was $6.73 per dollar invested. Annual estimated emergency costs avoided in the 4 regions were $2,541,639. The relative value of quality-adjusted life years saved was $24,381,000. For patients new to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits), total annual morbidity costs avoided per patient were $1395. This study suggests that mobile health care is a cost-effective strategy to deliver medical care to underserved populations, consistent with the Triple Aims of Therapy.

Income dynamics and the Affordable Care Act.

PubMed

Shore-Sheppard, Lara D

2014-12-01

To examine the sources of family income dynamics leading to movement into and out of Medicaid expansion and subsidy eligibility under the Affordable Care Act. Survey of Income and Program Participation (SIPP): 1996, 2001, 2004, 2008 panels. Considering four broad subsidy eligibility categories for monthly Modified Adjusted Gross Income (MAGI) (<138 percent of the Federal Poverty Level [FPL], 138-250 percent FPL, 250-400 percent FPL, and >400 percent FPL), I use duration analysis to examine determinants of movements between categories over the course of a year. Using detailed monthly data, I determine the members of tax-filing units and calculate an approximation of MAGI at the monthly level. The analysis sample is adults ages 22-64 years. Incomes are highly variable within a year, particularly at the lower end of the income distribution. Employment transitions, including transitions not involving a period of nonemployment, and family structure changes strongly predict sufficient income volatility to trigger a change in subsidy category. Income volatility arising from employment and family structure changes is likely to trigger changes in subsidy eligibility within the year, but the sources and effects of the volatility differ substantially depending on the individual's position in the income distribution. © Health Research and Educational Trust.

Temporal changes in stress preceding the 2004-2008 eruption of Mount St. Helens, Washington

USGS Publications Warehouse

Lehto, H.L.; Roman, D.C.; Moran, S.C.

2010-01-01

The 2004-2008 eruption of Mount St. Helens (MSH), Washington, was preceded by a swarm of shallow volcano-tectonic earthquakes (VTs) that began on September 23, 2004. We calculated locations and fault-plane solutions (FPS) for shallow VTs recorded during a background period (January 1999 to July 2004) and during the early vent-clearing phase (September 23 to 29, 2004) of the 2004-2008 eruption. FPS show normal and strike-slip faulting during the background period and on September 23; strike-slip and reverse faulting on September 24; and a mixture of strike-slip, reverse, and normal faulting on September 25-29. The orientation of ??1 beneath MSH, as estimated from stress tensor inversions, was found to be sub-horizontal for all periods and oriented NE-SW during the background period, NW-SE on September 24, and NE-SW on September 25-29. We suggest that the ephemeral ~90?? change in ??1 orientation was due to intrusion and inflation of a NE-SW-oriented dike in the shallow crust prior to the eruption onset. ?? 2010 Elsevier B.V.

Development of early comprehensive stroke inpatient rehabilitation in Poland - current status and future requirements.

PubMed

Sarzyńska-Długosz, Iwona; Krawczyk, Maciej; Członkowska, Anna

2011-01-01

Every stroke patient should undergo early rehabilitation. We aimed to evaluate accessibility, development and needs in early stroke inpatient rehabilitation in Poland. A questionnaire evaluating rehabilitation departments was prepared and sent (in 2004 and 2008) to rehabilitation wards in Poland, where stroke patients are treated and undergo early rehabilitation. We divided departments into classes: class A - having comprehensive rehabilitation (physiotherapy minimum 60 minutes/day, speech therapy minimum 30 minutes/5 days/week, rehabilitation of other cognitive impairments minimum 30 minutes/5 days/week, group physiotherapy); B - having the possibility of all types of therapy, but done less frequently; C - physiotherapy and speech therapy; D - physiotherapy and cognitive rehabilitation; E - only physiotherapy. In 2004, we obtained responses from 115 of 172 (66.9%) rehabilitation departments. According to prespecified criteria there were 11 class A, 31 class B, 28 class C, 4 class D, and 41 class E wards. In 2008, we received response from 89 of 149 (59.7%) rehabilitation departments. According to prespecified criteria there were 17 class A, 40 class B, 22 class C, 0 class D, and 10 class E wards. In 2004, 159 beds and in 2008, 294 beds in class A departments were available for stroke patients. The minimal number of needed but lacking beds was 604 in 2004 and 469 in 2008. Development of departments providing early comprehensive stroke rehabilitation from 2004 to 2008 is marked, but still insufficient. In 2008, 19% of rehabilitation departments could provide comprehensive stroke rehabilitation and this was 38.5% of beds actually needed.

Retention among North American HIV-infected persons in clinical care, 2000-2008.

PubMed

Rebeiro, Peter; Althoff, Keri N; Buchacz, Kate; Gill, John; Horberg, Michael; Krentz, Hartmut; Moore, Richard; Sterling, Timothy R; Brooks, John T; Gebo, Kelly A; Hogg, Robert; Klein, Marina; Martin, Jeffrey; Mugavero, Michael; Rourke, Sean; Silverberg, Michael J; Thorne, Jennifer; Gange, Stephen J

2013-03-01

Retention in care is key to improving HIV outcomes. The goal of this study was to describe 'churn' in patterns of entry, exit, and retention in HIV care in the United States and Canada. Adults contributing ≥1 CD4 count or HIV-1 RNA (HIV-lab) from 2000 to 2008 in North American AIDS Cohort Collaboration on Research and Design clinical cohorts were included. Incomplete retention was defined as lack of 2 HIV-laboratories (≥90 days apart) within 12 months, summarized by calendar year. Beta-binomial regression models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) of factors associated with incomplete retention. Among 61,438 participants, 15,360 (25%) with incomplete retention significantly differed in univariate analyses (P < 0.001) from 46,078 (75%) consistently retained by age, race/ethnicity, HIV risk, CD4, antiretroviral therapy use, and country of care (United States vs. Canada). From 2000 to 2004, females (OR = 0.82, CI: 0.70 to 0.95), older individuals (OR = 0.78, CI: 0.74 to 0.83 per 10 years), and antiretroviral therapy users (OR = 0.61, CI: 0.54 to 0.68 vs. all others) were less likely to have incomplete retention, whereas black individuals (OR = 1.31, CI: 1.16 to 1.49, vs. white), those with injection drug use HIV risk (OR = 1.68, CI: 1.49 to 1.89, vs. noninjection drug use), and those in care longer (OR = 1.09, CI: 1.07 to 1.11 per year) were more likely to have incomplete retention. Results from 2005 to 2008 were similar. From 2000 to 2008, 75% of the North American AIDS Cohort Collaboration on Research and Design population was consistently retained in care with 25% experiencing some changes in status or churn. In addition to the programmatic and policy implications, the findings of this study identify patient groups who may benefit from focused retention efforts.

Retention Among North American HIV–infected Persons in Clinical Care, 2000–2008

PubMed Central

Rebeiro, Peter; Althoff, Keri N.; Buchacz, Kate; Gill, M. John; Horberg, Michael; Krentz, Hartmut; Moore, Richard; Sterling, Timothy R.; Brooks, John T.; Gebo, Kelly A.; Hogg, Robert; Klein, Marina; Martin, Jeffrey; Mugavero, Michael; Rourke, Sean; Silverberg, Michael J.; Thorne, Jennifer; Gange, Stephen J.

2013-01-01

Background Retention in care is key to improving HIV outcomes. Our goal was to describe “churn” in patterns of entry, exit, and retention in HIV care in the US and Canada. Methods Adults contributing ≥1 CD4 count or HIV-1 RNA (HIV-lab) from 2000–2008 in North American Cohort Collaboration on Research and Design (NA-ACCORD) clinical cohorts were included. Incomplete retention was defined as lack of 2 HIV-labs (≥90 days apart) within 12 months, summarized by calendar year. We used beta-binomial regression models to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) of factors associated with incomplete retention. Results Among 61,438 participants, 15,360 (25%) with incomplete retention significantly differed in univariate analyses (p<0.001) from 46,078 (75%) consistently retained by age, race/ethnicity, HIV risk, CD4, ART use, and country of care (US vs. Canada). From 2000–2004, females (OR=0.82, CI:0.70–0.95), older individuals (OR=0.78, CI:0.74–0.83 per 10 years), and ART users (OR= 0.61, CI:0.54–0.68 vs all others) were less likely to have incomplete retention, while black individuals (OR=1.31, CI:1.16–1.49, vs. white), those with injection drug use (IDU) HIV risk (OR=1.68, CI:1.49–1.89, vs. non-IDU) and those in care longer (OR=1.09, CI:1.07–1.11 per year) were more likely to have incomplete retention. Results from 2005–2008 were similar. Discussion From 2000 to 2008, 75% of the NA-ACCORD population was consistently retained in care with 25% experiencing some change in status, or churn. In addition to the programmatic and policy implications, our findings identify patient groups who may benefit from focused retention efforts. PMID:23242158

Incremental conditions of isolation as a predictor of suicide in prisoners.

PubMed

Roma, Paolo; Pompili, Maurizio; Lester, David; Girardi, Paolo; Ferracuti, Stefano

2013-12-10

In a study of the incidence of suicide in jails and prisons under increasing conditions of deprivation in Italy from 2004 to 2008, imprisonment involving greater levels of isolation was found to be associated with a higher rate of suicide. Greater care should be taken to ensure that prisoners in isolation do not commit suicide by limiting this option when possible or providing mental health services when isolation is necessary. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Epidemiology of chronic hepatitis B virus in Ireland using routinely collected surveillance and administrative data, 2004-2014.

PubMed

van Gemert, Caroline E; Murphy, Niamh; Mitchell, Tara A; Hellard, Margaret E; Thornton, Thornton

2017-12-09

Ireland has a low prevalence of chronic hepatitis B virus (HBV) infection; however, there are limited recently published epidemiological data. This study aimed to describe the epidemiology of chronic HBV in Ireland between 2004 and 2014 using routine surveillance data and identify and interrogate additional data sources in Ireland to complement the interpretation of HBV surveillance data. Routinely collected passive surveillance data of notified cases of HBV infection were collated for 2004-2014. Additional data sources relating to primary liver cancer and cirrhosis were collated, including hospital discharge data (2005-2013), diagnoses of primary liver cancer (2004-2013), and deaths (2007-2014). Publicly available immigration (2004-2014) data were also collated. Between 2004 and 2014, a total of 7463 notifications of HBV were made in Ireland; the majority (91%) were classified as chronic cases. Notifications peaked in 2008 and decreased until 2013. Hospital discharges, new cancer registrations, and deaths from primary liver cancer and hospital discharges from cirrhosis have increased each year. The epidemiology of HBV in Ireland mirrors immigration patterns. Without a coordinated screening and care programme for priority populations, particularly for immigrants from high prevalence countries, it is likely that hospitalisations and deaths from HBV-attributable cirrhosis and primary liver cancer will continue to rise, with considerable associated public health expense.

Health care management of sickness certification tasks: results from two surveys to physicians

PubMed Central

2013-01-01

Background Health care in general and physicians in particular, play an important role in patients’ sickness certification processes. However, a lack of management within health care regarding how sickness certification is carried out has been identified in Sweden. A variety of interventions to increase the quality of sickness certification were introduced by the government and County Councils. Some of these measures were specifically aimed at strengthening health care management of sickness certification; e.g. policy making and management support. The aim was to describe to what extent physicians in different medical specialties had access to a joint policy regarding sickness certification in their clinical settings and experienced management support in carrying out sickness certification. Method A descriptive study, based on data from two cross-sectional questionnaires sent to all physicians in the Stockholm County regarding their sickness certification practice. Criteria for inclusion in this study were working in a clinical setting, being a board-certified specialist, <65 years of age, and having sickness certification consultations at least a few times a year. These criteria were met by 2497 physicians in 2004 and 2204 physicians in 2008. Proportions were calculated regarding access to policy and management support, stratified according to medical specialty. Results The proportions of physicians working in clinical settings with a well-established policy regarding sickness certification were generally low both in 2004 and 2008, but varied greatly between different types of medical specialties (from 6.1% to 46.9%). Also, reports of access to substantial management support regarding sickness certification varied greatly between medical specialties (from 10.5% to 48.8%). More than one third of the physicians reported having no such management support. Conclusions Most physicians did not work in a clinical setting with a well-established policy on sickness certification tasks, nor did they experience substantial support from their manager. The results indicate a need of strengthening health care management of sickness certification tasks in order to better support physicians in these tasks. PMID:23701711

Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care.

PubMed

Wang, C Jason; Cheng, Skye H; Wu, Jen-You; Lin, Yi-Ping; Kao, Wen-Hsin; Lin, Chia-Li; Chen, Yin-Jou; Tsai, Shu-Ling; Kao, Feng-Yu; Huang, Andrew T

2017-03-01

Value-driven payment system reform is a potential tool for aligning economic incentives with the improvement of quality and efficiency of health care and containment of cost. Such a payment system has not been researched satisfactorily in full-cycle cancer care. To examine the association of outcomes and medical expenditures with a bundled-payment pay-for-performance program for breast cancer in Taiwan compared with a fee-for-service (FFS) program. Data were obtained from the Taiwan Cancer Database, National Health Insurance Claims Data, the National Death Registry, and the bundled-payment enrollment file. Women with newly diagnosed breast cancer and a documented first cancer treatment from January 1, 2004, to December 31, 2008, were selected from the Taiwan Cancer Database and followed up for 5 years, with the last follow-up data available on December 31, 2013. Patients in the bundled-payment program were matched at a ratio of 1:3 with control individuals in an FFS program using a propensity score method. The final sample of 17 940 patients included 4485 (25%) in the bundled-payment group and 13 455 (75%) in the FFS group. Rates of adherence to quality indicators, survival rates, and medical payments (excluding bonuses paid in the bundled-payment group). The Kaplan-Meier method was used to calculate 5-year overall and event-free survival rates by cancer stage, and the Cox proportional hazards regression model was used to examine the effect of the bundled-payment program on overall and event-free survival. Sensitivity analysis for bonus payments in the bundled-payment group was also performed. The study population included 17 940 women (mean [SD] age, 52.2 [10.3] years). In the bundled-payment group, 1473 of 4215 patients (34.9%) with applicable quality indicators had full (100%) adherence to quality indicators compared with 3438 of 12 506 patients (27.5%) with applicable quality indicators in the FFS group (P < .001). The 5-year event-free survival rates for patients with stages 0 to III breast cancer were 84.48% for the bundled-payment group and 80.88% for the FFS group (P < .01). Although the 5-year medical payments of the bundled-payment group remained stable, the cumulative medical payments for the FFS group steadily increased from $16 000 to $19 230 and exceeded pay-for-performance bundled payments starting in 2008. In Taiwan, compared with the regular FFS program, bundled payment may lead to better adherence to quality indicators, better outcomes, and more effective cost-control over time.

Cost and utilisation of hospital based delivery care in Empowered Action Group (EAG) states of India.

PubMed

Mohanty, Sanjay K; Srivastava, Akanksha

2013-10-01

Large scale investment in the National Rural Health Mission is expected to increase the utilization and reduce the cost of maternal care in public health centres in India. The objective of this paper is to examine recent trends in the utilization and cost of hospital based delivery care in the Empowered Action Group (EAG) states of India. The unit data from the District Level Household Survey 3, 2007-2008 is used in the analyses. The coverage and the cost of hospital based delivery at constant price is analyzed for five consecutive years preceding the survey. Descriptive and multivariate analyses are used to understand the socio-economic differentials in cost and utilization of delivery care. During 2004-2008, the utilization of delivery care from public health centres has increased in all the eight EAG states. Adjusting for inflation, the household cost of delivery care has declined for the poor, less educated and in public health centres in the EAG states. The cost of delivery care in private health centres has not shown any significant changes across the states. Results of the multivariate analyses suggest that time, state, place of residence, economic status; educational attainment and delivery characteristics of mother are significant predictors of hospital based delivery care in India. The study demonstrates the utility of public spending on health care and provides a thrust to the ongoing debate on universal health coverage in India.

Association of Human Q Fever with Animal Husbandry, Taiwan, 2004-2012.

PubMed

Lai, Chung-Hsu; Chang, Lin-Li; Lin, Jiun-Nong; Liao, Ming-Huei; Liu, Shyh-Shyan; Lee, Hsu-Hsun; Lin, Hsi-Hsun; Chen, Yen-Hsu

2015-12-01

In Taiwan, Q fever cases in humans began increasing in 2004 and peaked in 2007 but dramatically declined in 2008 and 2011. Cases were significantly correlated with the number of goats. The decline might be associated with the collateral effects of measures to control goat pox in 2008 and 2010.

[Drugs in pregnancy: study in the EFEMERIS database (2004 to 2008)].

PubMed

Hurault-Delarue, C; Lacroix, I; Vidal, S; Montastruc, J-L; Damase-Michel, C

2011-10-01

To analyze the evolution of drug prescriptions during pregnancy from 2004 to 2008 in Haute-Garonne (France) and the impact of recommendations concerning drugs in pregnancy sent by French health authorities (AFSSAPS) and French college of gynaecologists and obstetricians to health professionals during the period. This descriptive study of reimbursed drug prescriptions during pregnancy concerns women included in the EFEMERIS database who have given birth from July 1st, 2004 to June 30th, 2008. The health insurance service records of Haute-Garonne were used. Taking into account 2 subsequent delistings of drugs for reimbursement during the period, we observed a significant increase of reimbursed drug prescriptions dispensed to pregnant women (8.7 different substances for women who have given birth in 2004 and 9.4 in 2008). Vitamins, immunserums, immunoglobulins and homeopathy prescriptions have especially increased. Paracetamol, iron, folic acid and phloroglucinol were the most prescribed drugs during all the periods. Since 2004, EFEMERIS represents a monitoring centre for the prescription of reimbursed drugs to pregnant women. This analysis allowed to exhibit trends in prescription patterns. Most of the alerts or recommendations had a positive but limited impact. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database

PubMed Central

2012-01-01

Background Cancer is a major cause of global morbidity and mortality. Since a high prevalence of functional impairments has been observed among cancer patients, rehabilitation has been proposed as a strategy to restore patients’ functional independence. The increasing number of cancer patients combined with a growing need for rehabilitation may result in increased utilization of rehabilitation services. This study aimed to investigate the utilization of rehabilitation services among hospitalized cancer patients in Taiwan between 2004 and 2008. Methods Annual admissions and total inpatient expenditures for admissions with a cancer diagnosis were calculated from the National Health Insurance Research Database (NHIRD). Rehabilitation services used by cancer and non-cancer patients, as well as the distributions of rehabilitation service type among the different hospital departments were also analyzed. Results The percentages of inpatient admissions with a cancer diagnosis increased from 14.01% to 17.1% between 2004 and 2008. During 2004, 5.25% of all inpatient admissions received rehabilitation services; this percentage increased to 5.62% by 2008. Among cancer admissions, 2.26% to 2.62% received rehabilitation services from 2004 to 2008. By comparison, 5.68% to 6.24% of non-cancer admissions received rehabilitation services during this period. Of the admissions who received rehabilitation services, only 6.44% and 7.96% had a cancer diagnosis in 2004 and 2008, respectively. Sixty-one percent of rehabilitation services were delivered in the departments of orthopedics (25.6%), neurology (14.4%), rehabilitation (11.9%), and neurosurgery (9.2%). Conclusions In Taiwan, the utilization of rehabilitation services during hospitalization increased from 2004 to 2008. Although this trend was noted for cancer and non-cancer admissions, the utilization of rehabilitation services was generally greater by non-cancer admissions. Despite the benefits of rehabilitation, the actual rehabilitation needs of cancer patients remain unmet. PMID:22898402

The impact of generic substitution on the activities of pharmaceutical companies - a survey from the companies' perspective one year and five years after the introduction of generic substitution in finland

PubMed Central

2010-01-01

Background Mandatory generic substitution (GS) was introduced in Finland on 1 April 2003. The aim of this study was to explore and compare the impacts of GS on the activities of pharmaceutical companies representing mainly original or generic pharmaceutical products in Finland. The self-reported impact of GS from pharmaceutical companies' perspective was explored with a focus on the number of employees, the range of sales packages on the market, the marketing activities, the research and development of new pharmaceutical products and storage of pharmaceuticals. Methods A cross-sectional postal survey was conducted among pharmaceutical companies with an office in Finland and substitutable medicines in the Finnish pharmaceutical market one year (2004) and five years (2008) after the introduction of GS. Completed questionnaires were returned by 16 original and 7 generic product companies in 2004 (response rate 56%, n = 41) and by 16 original and 6 generic product companies in 2008 (response rate 56%, n = 39). Descriptive statistical analyses were performed. Results The number of employees (2004: n = 6/16, 2008: n = 7/16) and the amount of prescription medicine marketing (2004: n = 7/16, 2008: n = 8/16) decreased in many of the original product companies after the introduction of GS. GS resulted in problems related to the storage of pharmaceuticals in the original product companies shortly after GS was introduced (p = 0.032 between 2004 and 2008). In the generic product companies, the prescription medicine representatives' visits to pharmacies increased at the beginning of GS (p = 0.021 between 2004 and 2008). In addition, GS caused problems with the storage of pharmaceuticals one year and five years after the reform (2004: n = 4/7, 2008: n = 3/6). The differences between original and generic product companies regarding the impacts of GS were not, however, statistically significant. GS did not affect on the range of sales packages on the market or the research activities of the majority of companies. Conclusions The study suggests that GS has had impacts on the activities of pharmaceutical companies in Finland. There were also some differences, although not statistically significant, between the surveyed original and generic product companies regarding the self-reported impacts of GS. More investigations are needed in this field. PMID:20964869

The impact of generic substitution on the activities of pharmaceutical companies - a survey from the companies' perspective one year and five years after the introduction of generic substitution in finland.

PubMed

Timonen, Johanna; Bengtström, Marina; Karttunen, Pekka; Ahonen, Riitta

2010-10-22

Mandatory generic substitution (GS) was introduced in Finland on 1 April 2003. The aim of this study was to explore and compare the impacts of GS on the activities of pharmaceutical companies representing mainly original or generic pharmaceutical products in Finland. The self-reported impact of GS from pharmaceutical companies' perspective was explored with a focus on the number of employees, the range of sales packages on the market, the marketing activities, the research and development of new pharmaceutical products and storage of pharmaceuticals. A cross-sectional postal survey was conducted among pharmaceutical companies with an office in Finland and substitutable medicines in the Finnish pharmaceutical market one year (2004) and five years (2008) after the introduction of GS. Completed questionnaires were returned by 16 original and 7 generic product companies in 2004 (response rate 56%, n = 41) and by 16 original and 6 generic product companies in 2008 (response rate 56%, n = 39). Descriptive statistical analyses were performed. The number of employees (2004: n = 6/16, 2008: n = 7/16) and the amount of prescription medicine marketing (2004: n = 7/16, 2008: n = 8/16) decreased in many of the original product companies after the introduction of GS. GS resulted in problems related to the storage of pharmaceuticals in the original product companies shortly after GS was introduced (p = 0.032 between 2004 and 2008). In the generic product companies, the prescription medicine representatives' visits to pharmacies increased at the beginning of GS (p = 0.021 between 2004 and 2008). In addition, GS caused problems with the storage of pharmaceuticals one year and five years after the reform (2004: n = 4/7, 2008: n = 3/6). The differences between original and generic product companies regarding the impacts of GS were not, however, statistically significant. GS did not affect on the range of sales packages on the market or the research activities of the majority of companies. The study suggests that GS has had impacts on the activities of pharmaceutical companies in Finland. There were also some differences, although not statistically significant, between the surveyed original and generic product companies regarding the self-reported impacts of GS. More investigations are needed in this field.

Congenital syphilis - United States, 2003-2008.

PubMed

2010-04-16

Untreated syphilis during pregnancy, especially early syphilis, can lead to stillbirth, neonatal death, or infant disorders such as deafness, neurologic impairment, and bone deformities. Congenital syphilis (CS) can be prevented by early detection of maternal infection and treatment at least 30 days before delivery. Changes in the population incidence of primary and secondary (P&S) syphilis among women usually are followed by similar changes in the incidence of CS. To assess recent trends in CS rates, CDC analyzed national surveillance data from the period 2003--2008. This report summarizes the results of that analysis, which indicated that, after declining for 14 years, the CS rate among infants aged <1 year increased 23%, from 8.2 cases per 100,000 live births in 2005 to 10.1 during 2008. That increase followed a 38% increase in the P&S syphilis rate among females aged >or=10 years from 2004 to 2007. During 2005-2008, CS rates increased primarily in the South (from 9.6 per 100,000 live births to 15.7) and among infants born to black mothers (from 26.6 per 100,000 live births to 34.6). Reversing the upward trend in CS rates will require collaboration among health-care providers, health departments, health insurers, policymakers, and the public to reduce syphilis among women and to increase early prenatal care access and syphilis screening during pregnancy.

Getting out what we put in: productivity of the English National Health Service.

PubMed

Castelli, Adriana; Laudicella, Mauro; Street, Andrew; Ward, Padraic

2011-07-01

Many countries are incorporating direct measures of non-market outputs in the national accounts. For any particular output to be included there has to be data about it for two adjacent periods. This is problematic because the classification of non-market outputs is often subject to wholesale revision. We outline the challenges associated with classification changes and propose a solution. To illustrate we construct output and input indices and estimate productivity growth of the English National Health Service (NHS) for the period 2003-2004 to 2007-2008. Our index of output growth incorporates all care provided to NHS patients and captures improvements in survival rates, waiting times and disease management. We find that more patients are being treated and the quality of the care they receive has been improving. We implement our approach to dealing with changes as to how health services are defined and show what effect this has on estimates of output growth. Our index of input growth captures all labour, intermediate and capital inputs into health service production and we improve on how capital has been measured in the past. Inputs have increased over time but there has also been a slowdown since 2005-2006, primarily the result of a levelling off in staff recruitment and less reliance on the use of agency staff. Productivity is assessed by comparing output growth with growth in inputs, the net effect being constant productivity growth between 2003-2004 and 2007-2008.

Use of Nutritional Information in Canada: National Trends between 2004 and 2008

ERIC Educational Resources Information Center

Goodman, Samantha; Hammond, David; Pillo-Blocka, Francy; Glanville, Theresa; Jenkins, Richard

2011-01-01

Objective: To examine longitudinal trends in use of nutrition information among Canadians. Design: Population-based telephone and Internet surveys. Setting and Participants: Representative samples of Canadian adults recruited with random-digit dialing sampling in 2004 (n = 2,405) and 2006 (n = 2,014) and an online commercial panel in 2008 (n =…

Federal Student Aid (FSA) Five-Year Strategic Plan. FY 2004-2008

ERIC Educational Resources Information Center

US Department of Education, 2004

2004-01-01

The FSA Five-Year Strategic Plan is a roadmap for FY 2004-2008 that identifies five long-range strategic objectives, tactical short-term goals, and performance management initiatives. In working toward the goals outlined in the plan, FSA will address a number of key challenges, including legacy system migration, business process re-engineering,…

Seroprevalence of West Nile Virus in feral horses on Sheldon National Wildlife Refuge, Nevada, United States

USGS Publications Warehouse

Franson, J. Christian; Hofmeister, Erik K.; Collins, Gail H.; Dusek, Robert J.

2011-01-01

We screened 1,397 feral horses (Equus caballus) on Sheldon National Wildlife Refuge, Nevada, United States, for IgM and IgG against flavivirus during 2004–2006, 2008, and 2009. Positive serum samples were tested for neutralizing antibodies to West Nile virus (WNV) and St. Louis encephalitis virus (SLEV). One animal was positive for antibody against WNV in 2004, but all others tested in 2004–2006 were negative. In 2008 and 2009, we found evidence of increasing seropositive horses with age, whereas seroprevalence of WNV decreased from 19% in 2008 to 7.2% in 2009. No horses were positive for antibody against SLEV. Being unvaccinated, feral horses can be useful for WNV surveillance.

How Maryland increased infection prevention and control activity in long-term care facilities, 2003-2008.

PubMed

Roup, Brenda J; Scaletta, Joseph M

2011-05-01

In January 2003, the Maryland Department of Health and Mental Hygiene (DHMH) assessed the state of infection prevention and control (IPC) resources and practices in all long-term care facilities (LTC) in the state. Only 8.1% of facilities that responded employed a trained IPC professional (IP) who managed the facility IPC program. Between 2003 and 2008, the DHMH partnered with long-term care industry trade associations and spearheaded regulatory, educational, and financial initiatives to improve this situation. In January 2008, all LTC facilities in the state were resurveyed to determine the impact of these initiatives on IPC activities. The 2008 survey indicated that 44% of LTC facilities used a trained IP who managed the IPC program, a 5-fold increase from 2003. Unpublished DHMH outbreak data indicated that LTC facilities with a trained IP recognized and reported outbreaks to the local health department 2 days sooner than facilities without a trained IP, resulting in fewer cases of disease. Multiple initiatives with concerned stakeholders and LTC partners over the course of 5 years resulted in increased numbers of LTC facilities with trained IPs who recognized and responded to outbreaks sooner than facilities without trained IPs. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Epidemiology of syphilis among Hispanic women and associations with congenital syphilis, Maricopa county, Arizona.

PubMed

Kirkcaldy, Robert D; Su, John R; Taylor, Melanie M; Koumans, Emilia; Mickey, Tom; Winscott, Michelle; Kenney, Kerry; Weinstock, Hillard S

2011-07-01

We investigated factors associated with high rates of congenital syphilis among Hispanic infants in Maricopa County, AZ. Using 2004-2008 syphilis case report data from the state and county health departments, we examined characteristics of pregnant and nonpregnant women with syphilis and their male partners. During 2004-2008, 970 women were reported to have syphilis: 49% were Hispanic (of whom 49% were non-US citizens), 27% were white, 13% were black, and 8% were American Indian/Alaskan Native. Although 16% of Hispanic noncitizens reported drug use or high-risk sexual behaviors, 64% of these women had a male sex partner who reported drug use or anonymous sex. Hispanic women with syphilis were more likely to be pregnant (37%) than white (15%) or black women (13%) (P < 0.05), and were overrepresented among pregnant women with syphilis. Pregnant Hispanic noncitizens were treated later than pregnant Hispanic citizens (median 28 weeks gestation vs. 21 weeks, P = 0.01). Innovative congenital syphilis prevention strategies that are relevant to Hispanic women are warranted. Strategies should address the reproductive health and prenatal care needs of Hispanic women, and may include interventions for their male partners.

The Future of Family Engagement in Residential Care Settings

ERIC Educational Resources Information Center

Affronti, Melissa L.; Levison-Johnson, Jody

2009-01-01

Residential programs for children and youth are increasingly implementing engagement strategies to promote family-centered and family-driven models of care (Leichtman, 2008). The practice of engagement is a fairly new area of research, especially in residential care. Driven by their goal to increase the use of state-of-the-art family engagement…

Multidisciplinary acute care research organization (MACRO): if you build it, they will come.

PubMed

Early, Barbara J; Huang, David T; Callaway, Clifton W; Zenati, Mazen; Angus, Derek C; Gunn, Scott R; Yealy, Donald M; Unikel, Daniel; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

2013-07-01

Clinical research will increasingly play a core role in the evolution and growth of acute care surgery program development across the country. What constitutes an efficient and effective clinical research infrastructure in the current fiscal and academic environment remains obscure. We sought to characterize the effects of implementation of a multidisciplinary acute care research organization (MACRO) at a busy tertiary referral university setting. In 2008, to minimize redundancy and cost as well as to maximize existing resources promoting acute care research, MACRO was created, unifying clinical research infrastructure among the Departments of Critical Care Medicine, Emergency Medicine, and Surgery. During the periods 2008 to 2012, we performed a retrospective analysis and determined volume of clinical studies, patient enrollment for both observational and interventional trials, and staff growth since MACRO's origination and characterized changes over time. From 2008 to 2011, the volume of patients enrolled in clinical studies, which MACRO facilitates has significantly increased more than 300%. The percentage of interventional/observational trials has remained stable during the same period (50-60%). Staff has increased from 6 coordinators to 10, with an additional 15 research associates allowing 24/7 service. With this significant growth, MACRO has become financially self-sufficient, and additional outside departments now seek MACRO's services. Appropriate organization of acute care clinical research infrastructure minimizes redundancy and can promote sustainable, efficient growth in the current academic environment. Further studies are required to determine if similar models can be successful at other acute care surgery programs.

Review of the President’s Fiscal Year 2009 Budget Request for the Defense Health Program’s Private Sector Care Budget Activity Group

DTIC Science & Technology

2008-05-28

2009 budget request for the Defense Health Program’s Private Sector Care BAG. To do this, we reviewed (1) DOD’s justification for the request for the... Private Sector Care BAG, including the underlying estimates and the extent to which DOD considered historical information; and (2) changes between this...develop the budget requests for the Private Sector Care BAG in fiscal years 2008 and 2009. We also interviewed officials and analyzed documents from

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

Gerald Hill; Kenneth Nemeth; Gary Garrett

The Southern States Energy Board's (SSEB) 'Regional Effort to Deploy Clean Coal Technologies' program began on June 1, 2003, and was completed on January 31, 2009. The project proved beneficial in providing state decision-makers with information that assisted them in removing barriers or implementing incentives to deploy clean coal technologies. This was accomplished through two specific tasks: (1) domestic energy security and diversity; and (2) the energy-water interface. Milestones accomplished during the project period are: (1) Presentations to Annual Meetings of SSEB Members, Associate Member Meetings, and the Gasification Technologies Council. (2) Energy: Water reports - (A) Regional Efforts tomore » Deploy Clean Coal Technologies: Impacts and Implications for Water Supply and Quality. June 2004. (B) Energy-Water Interface Challenges: Coal Bed Methane and Mine Pool Water Characterization in the Southern States Region. 2004. (C) Freshwater Availability and Constraints on Thermoelectric Power Generation in the Southeast U.S. June 2008. (3) Blackwater Interactive Tabletop Exercise - Decatur, Georgia April 2007. (4) Blackwater Report: Blackwater: Energy and Water Interdependency Issues: Best Practices and Lessons Learned. August 2007. (5) Blackwater Report: BLACKWATER: Energy Water Interdependency Issues REPORT SUMMARY. April 2008.« less

Integration of HIV/AIDS services into African primary health care: lessons learned for health system strengthening in Mozambique - a case study

PubMed Central

2010-01-01

Introduction In 2004, Mozambique, supported by large increases in international disease-specific funding, initiated a national rapid scale-up of antiretroviral treatment (ART) and HIV care through a vertical "Day Hospital" approach. Though this model showed substantial increases in people receiving treatment, it diverted scarce resources away from the primary health care (PHC) system. In 2005, the Ministry of Health (MOH) began an effort to use HIV/AIDS treatment and care resources as a means to strengthen their PHC system. The MOH worked closely with a number of NGOs to integrate HIV programs more effectively into existing public-sector PHC services. Case Description In 2005, the Ministry of Health and Health Alliance International initiated an effort in two provinces to integrate ART into the existing primary health care system through health units distributed across 23 districts. Integration included: a) placing ART services in existing units; b) retraining existing workers; c) strengthening laboratories, testing, and referral linkages; e) expanding testing in TB wards; f) integrating HIV and antenatal services; and g) improving district-level management. Discussion: By 2008, treatment was available in nearly 67 health facilities in 23 districts. Nearly 30,000 adults were on ART. Over 80,000 enrolled in the HIV/AIDS program. Loss to follow-up from antenatal and TB testing to ART services has declined from 70% to less than 10% in many integrated sites. Average time from HIV testing to ART initiation is significantly faster and adherence to ART is better in smaller peripheral clinics than in vertical day hospitals. Integration has also improved other non-HIV aspects of primary health care. Conclusion The integration approach enables the public sector PHC system to test more patients for HIV, place more patients on ART more quickly and efficiently, reduce loss-to-follow-up, and achieve greater geographic HIV care coverage compared to the vertical model. Through the integration process, HIV resources have been used to rehabilitate PHC infrastructure (including laboratories and pharmacies), strengthen supervision, fill workforce gaps, and improve patient flow between services and facilities in ways that can benefit all programs. Using aid resources to integrate and better link HIV care with existing services can strengthen wider PHC systems. PMID:20180975

Effects of a Hypertension Management Program by Seongcheon Primary Health Care Post in South Korea: An Analysis of Changes in the Level of Knowledge of Hypertension in the Period from 2004 to 2009

ERIC Educational Resources Information Center

Song, In Han; Kim, Sang-A; Park, Woong-Sub

2012-01-01

The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in…

Child Care: Recent State Policy Changes Affecting the Availability of Assistance for Low-Income Families. Report to the Ranking Minority Member, Subcommittee on Human Resources, Committee on Ways and Means, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

At Congressional request, the General Accounting Office examined states choices for providing child care assistance to families and states' proposed changes to child care assistance programs for fiscal year 2004. Information was obtained through a survey of child care administrators of the 50 states and the District of Columbia. Findings revealed…

Regulating Medicines in Croatia: Five-year Experience of Agency for Medicinal Products and Medical Devices

PubMed Central

Tomić, Siniša; Filipović Sučić, Anita; Plazonić, Ana; Truban Žulj, Rajka; Macolić Šarinić, Viola; Čudina, Branka; Ilić Martinac, Adrijana

2010-01-01

Aim To present the activities of the Agency for Medicinal Products and Medical Devices in the first 5 years of its existence and to define its future challenges. Methods Main activities within the scope of the Agency as a regulatory authority were retrospectively analyzed for the period from 2004-2008. Data were collected from the Agency’s database and analyzed by descriptive statistics. Results The number of issued medicine authorizations rose from 240 in 2004 to 580 in 2008. The greatest number of new chemical and biological entities was approved in 2005. The greatest number of regular quality controls (n = 5833) and special quality controls was performed in 2008 (n = 589), while the greatest number of off-shelf quality controls (n = 132) was performed in 2007. The greatest number of medicine labeling irregularities was found in 2007 (n = 19) and of quality irregularities in 2004 (n = 9). The greatest number of adverse reactions was reported in 2008 (n = 1393). The number of registered medical devices rose from 213 in 2004 to 565 in 2008. Conclusion Over its 5 years of existence, the Agency has successfully coped with the constant increase in workload. In the future, as Croatia enters the European Union, the Agency will have to face the challenge of joining the integrated European regulatory framework. PMID:20401952

ASSOCIATION BETWEEN PAYMENT REFORM AND PROVIDER CONSOLIDATION

PubMed Central

Neprash, Hannah T.; Chernew, Michael E.; McWilliams, J. Michael

2017-01-01

Provider consolidation has been associated with higher health care prices and spending. Prevailing wisdom assumes that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing from a number of data sources from 2008 onward, we examined the relationship between Medicare’s Accountable Care Organization (ACO) programs and provider consolidation. According to multiple measures, consolidation was underway in 2008–2010, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and specialty-oriented physician group size increased after the ACA, we found minimal evidence associating consolidation with ACO penetration at a market level or with ACO participation by physicians within markets. We conclude that payment reform has been associated with little acceleration in consolidation apart from trends already underway, but with some evidence of potential defensive consolidation in response to new payment models. PMID:28167725

What Are We Missing A Call for Red Teaming Within the Domestic Maritime Domain for Anti-Terrorism Programs

DTIC Science & Technology

2015-12-01

Sherman Kent Center, Central Intelligence Agency 3, no. 2 (October 2004), https://www.cia.gov/ library /kent-center-occasional-papers/vol3no2.htm...Naval Intelligence (Norfolk, VA: Naval Warfare Development Command, 2008), http://www.nwdc.navy.mil/content/ Library /Documents/NDPs/ ndp2/ndp20007.htm...Fathali M. Moghaddam, “ Multiculturalism and Intergroup Relations,” American Psychological Association, November 2011, 95. 114 Matherly, The Red Teaming

Oral health status of New Hampshire Head Start children, 2007-2008.

PubMed

Anderson, Ludmila; Martin, Nancy R; Burdick, Arnie; Flynn, Regina T; Blaney, David D

2010-01-01

We report on the baseline prevalence and severity of dental caries of children enrolled in the New Hampshire Head Start program during the 2007-2008 school year. We selected a random cluster sample of 607 children aged 3-5 years attending 27 Head Start centers across the state. Four volunteer dentists provided oral examinations and determined the presence of untreated dental caries, caries experience, and treatment urgency. Overall, 40 percent of the participating children had experienced dental caries, and 31 percent had at least one untreated decayed tooth. Approximately 22 percent of the children had evidence of maxillary anterior caries, 23 percent were in need of dental care, and < 1 percent needed urgent care. The prevalence of dental caries is comparable with that reported by Head Start programs elsewhere. The prevalence of caries affecting maxillary anterior teeth is higher. Further studies should examine state-specific barriers to dental care among this population.

Catalog of Mount St. Helens 2004 - 2005 Tephra Samples with Major- and Trace-Element Geochemistry

USGS Publications Warehouse

Rowe, Michael C.; Thornber, Carl R.; Gooding, Daniel J.; Pallister, John S.

2008-01-01

This open-file report presents a catalog of information about 135 ash samples along with geochemical analyses of bulk ash, glass and individual mineral grains from tephra deposited as a result of volcanic activity at Mount St. Helens, Washington, from October 1, 2004 until August 15, 2005. This data, in conjunction with that in a companion report on 2004?2007 Mount St. Helens dome samples by Thornber and others (2008a) are presented in support of the contents of the U.S. Geological Survey Professional Paper 1750 (Sherrod and others, ed., 2008). Readers are referred to appropriate chapters in USGS Professional Paper 1750 for detailed narratives of eruptive activity during this time period and for interpretations of sample characteristics and geochemical data presented here. All ash samples reported herein are currently archived at the David A. Johnston Cascades Volcano Observatory in Vancouver, Washington. The Mount St. Helens 2004?2005 Tephra Sample Catalogue along with bulk, glass and mineral geochemistry are tabulated in 6 worksheets of the accompanying Microsoft Excel file, of2008-1131.xls. Samples in all tables are organized by collection date. Table 1 is a detailed catalog of sample information for tephra deposited downwind of Mount St. Helens between October 1, 2004 and August 18, 2005. Table 2 provides major- and trace-element analyses of 8 bulk tephra samples collected throughout that interval. Major-element compositions of 82 groundmass glass fragments, 420 feldspar grains, and 213 mafic (clinopyroxene, amphibole, hypersthene, and olivine) mineral grains from 12 ash samples collected between October 1, 2004 and March 8, 2005 are presented in tables 3 through 5. In addition, trace-element abundances of 198 feldspars from 11 ash samples (same samples as major-element analyses) are provided in table 6. Additional mineral and bulk ash analyses from 2004 and 2005 ash samples are published in chapters 30 (oxide thermometry; Pallister and others, 2008), 32 (amphibole major elements; Thornber and others, 2008b) and 37 (210Pb; 210Pb/226Pa; Reagan and others, 2008) of U.S. Geological Survey Professional Paper 1750 (Sherrod and others, 2008). A brief overview of sample collection methods is given below as an aid to deciphering the tephra sample catalog. This is followed by an explanation of the categories of sample information (column headers) in table 1. A summary of the analytical methods used to obtain the geochemical data in this report introduces the presentation of major- and trace-element geochemistry of Mount St. Helens 2004?2005 tephra samples in tables 2?6. Rhyolite glass standard analyses are reported (Appendix 1) to demonstrate the accuracy and precision of similar glass analyses presented herein.

Permanent pacemaker insertion following isolated aortic valve replacement before and after the introduction of TAVI.

PubMed

Kogan, Alexander; Sternik, Leonid; Beinart, Roy; Shalabi, Amjad; Glikson, Michael; Spiegelstein, Danny; Levin, Shany; Raanani, Ehud

2015-04-01

Permanent pacemaker (PPM) implantation is required in 3-12% of all patients undergoing surgical aortic valve replacement (AVR). Our aim was to evaluate the contemporary incidence and impact of the introduction of transcatheter aortic valve implantation (TAVI) for PPM insertion after isolated AVR. Since 2004, during a 10-year period, a total of 858 patients underwent isolated AVR at our institution. Forty-one patients with PPM before operation were excluded from the study and 817 patients were included in the statistical analysis. Of these, 20 patients (2.45%) developed significant conduction disorders, leading to PPM implantation within 120 days postoperatively. Patients were further divided into two groups. Before (Group I: June 2004 to September 2008) and after (Group II: October 2008 to May 2014) the introduction of the TAVI program. There were 343 patients in Group I and 475 patients in Group II. The incidence of PPM implantation decreased from 3.79% (13 patients) in Group I to 1.47% (seven patients) in Group II (P < 0.001). Risk factors for permanent pacing identified by univariate analysis were: Group I (before introducing TAVI program), pulmonary hypertension, preoperative anemia, age older than 75 years, and previous myocardial infarction. Multivariate analysis identified Group I (before introducing TAVI program; P < 0.005; odds ratio [OR] 15.2, 95% confidence interval [CI] 6.3-19.9) and pulmonary hypertension (P < 0.005; OR 12.5, 95% CI 3.2-18.3) to be significant. Irreversible atrio-ventricular block or symptomatic bradycardia requiring PPM implantation is a relatively rare complication. The incidence of PPM implantation after isolated surgical AVR decreased in a contemporary setting after the introduction of the TAVI program. ©2015 Wiley Periodicals, Inc.

Making a Difference in Science Education: The Impact of Undergraduate Research Programs

PubMed Central

Eagan, M. Kevin; Hurtado, Sylvia; Chang, Mitchell J.; Garcia, Gina A.; Herrera, Felisha A.; Garibay, Juan C.

2014-01-01

To increase the numbers of underrepresented racial minority students in science, technology, engineering, and mathematics (STEM), federal and private agencies have allocated significant funding to undergraduate research programs, which have been shown to students’ intentions of enrolling in graduate or professional school. Analyzing a longitudinal sample of 4,152 aspiring STEM majors who completed the 2004 Freshman Survey and 2008 College Senior Survey, this study utilizes multinomial hierarchical generalized linear modeling (HGLM) and propensity score matching techniques to examine how participation in undergraduate research affects STEM students’ intentions to enroll in STEM and non-STEM graduate and professional programs. Findings indicate that participation in an undergraduate research program significantly improved students’ probability of indicating plans to enroll in a STEM graduate program. PMID:25190821

Differences between HIV-Infected men and women in antiretroviral therapy outcomes - six African countries, 2004-2012.

PubMed

2013-11-29

Evaluation of differences between human immunodeficiency virus (HIV)-infected men and women in antiretroviral therapy (ART) enrollment characteristics and outcomes might identify opportunities to improve ART program patient outcomes and prevention impact. During September 2008-February 2012, retrospective cohort studies to estimate attrition of enrollees (i.e., from death, stopping ART, or loss to follow-up) at 6-month intervals after ART initiation were completed among samples of adult men and women (defined as aged ≥15 years or aged ≥18 years) who initiated ART during 2004-2010 in six African countries: Côte d'Ivoire in western Africa; Swaziland, Mozambique, and Zambia in southern Africa; and Uganda and Tanzania in eastern Africa. Records for 13,175 ART enrollees were analyzed; sample sizes among the six countries ranged from 1,457 to 3,682. In each country, women comprised 61%-67% of ART enrollees. Median CD4 count range was 119-141 cells/µL for men and 137-161 cells/µL for women. Compared with women, a greater percentage of men initiated ART who had World Health Organization (WHO) HIV stage IV disease. In cohorts from western Africa and southern Africa, the risk for attrition was 15%-26% lower among women compared with men in multivariable analysis. However, in eastern Africa, differences between men and women in risk for attrition were not statistically significant. Research to identify country-specific causes for increased attrition and delayed initiation of care among men could identify strategies to improve ART program outcomes among men, which might contribute to prevention of new HIV infections in female partners.

Health Insurance Instability Among Older Immigrants: Region of Origin Disparities in Coverage

PubMed Central

Hardy, Melissa

2015-01-01

Objectives. We provide a detailed analysis of how the dynamics of health insurance coverage (HIC) at older ages differs among Latino, Asian, and European immigrants in the United States. Method. Using Survey of Income and Program Participation data from the 2004 and 2008 panels, we estimate discrete-time event history models to examine first and second transitions into and out of HIC, highlighting substantial differences in hazard rates among immigrants aged 50–64 from Asia, Latin America, and Europe. Results. We find that the likelihood of having HIC at first observation and the rates of gaining and losing coverage within a relatively short time frame are least favorable for older Latino immigrants, although immigrants from all three regions are at a disadvantage relative to native-born non-Hispanic Whites. This disparity among immigrant groups persists even when lower rates of citizenship, greater difficulty with English, and low-skill job placements are taken into account. Discussion. Factors that have contributed to the lower rates and shorter durations of HIC among older immigrants, particularly those from Latin America, may not be easily resolved by the Affordable Care Act. The importance of region of origin and assimilation characteristics for the risk of being uninsured in later life argues that immigration and health care policy should be jointly addressed. PMID:25637934

Income Dynamics and the Affordable Care Act

PubMed Central

Shore-Sheppard, Lara D

2014-01-01

Objective To examine the sources of family income dynamics leading to movement into and out of Medicaid expansion and subsidy eligibility under the Affordable Care Act. Data Source Survey of Income and Program Participation (SIPP): 1996, 2001, 2004, 2008 panels. Study Design Considering four broad subsidy eligibility categories for monthly Modified Adjusted Gross Income (MAGI) (<138 percent of the Federal Poverty Level [FPL], 138–250 percent FPL, 250–400 percent FPL, and >400 percent FPL), I use duration analysis to examine determinants of movements between categories over the course of a year. Data Collection/Extraction Using detailed monthly data, I determine the members of tax-filing units and calculate an approximation of MAGI at the monthly level. The analysis sample is adults ages 22–64 years. Principal Findings Incomes are highly variable within a year, particularly at the lower end of the income distribution. Employment transitions, including transitions not involving a period of nonemployment, and family structure changes strongly predict sufficient income volatility to trigger a change in subsidy category. Conclusions Income volatility arising from employment and family structure changes is likely to trigger changes in subsidy eligibility within the year, but the sources and effects of the volatility differ substantially depending on the individual's position in the income distribution. PMID:25327987

National School Lunch Program

ERIC Educational Resources Information Center

US Department of Agriculture, 2009

2009-01-01

The National School Lunch Program is a federally assisted meal program operating in over 101,000 public and non-profit private schools and residential child care institutions. It provides nutritionally balanced, low-cost or free lunches to more than 30.5 million children each school day in 2008. In 1998, Congress expanded the National School Lunch…

ExCEL in Social Work: Excellence in Cancer Education & Leadership: An Oncology Social Work Response to the 2008 Institute of Medicine Report.

PubMed

Otis-Green, Shirley; Jones, Barbara; Zebrack, Brad; Kilburn, Lisa; Altilio, Terry A; Ferrell, Betty

2015-09-01

ExCEL in Social Work: Excellence in Cancer Education & Leadership was a multi-year National Cancer Institute (NCI)-funded grant for the development and implementation of an innovative educational program for oncology social workers. The program's curriculum focused upon six core competencies of psychosocial-spiritual support necessary to meet the standard of care recommended by the 2008 Institute of Medicine (IOM) Report: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The curriculum was delivered through a collaborative partnership between the City of Hope National Medical Center and the two leading professional organizations devoted exclusively to representing oncology social workers--the Association of Oncology Social Work and the Association of Pediatric Oncology Social Workers. Initial findings support the feasibility and acceptability of this tailored leadership skills-building program for participating oncology social workers.

Selected time-lapse movies of the east rift zone eruption of KĪlauea Volcano, 2004–2008

USGS Publications Warehouse

Orr, Tim R.

2011-01-01

Since 2004, the U.S. Geological Survey's Hawaiian Volcano Observatory has used mass-market digital time-lapse cameras and network-enabled Webcams for visual monitoring and research. The 26 time-lapse movies in this report were selected from the vast collection of images acquired by these camera systems during 2004–2008. Chosen for their content and broad aesthetic appeal, these image sequences document a variety of flow-field and vent processes from Kīlauea's east rift zone eruption, which began in 1983 and is still (as of 2011) ongoing.

Persistently high prevalence and unrecognized HIV infection among men who have sex with men in Baltimore: the BESURE Study

PubMed Central

German, Danielle; Sifakis, Frangiscos; Maulsby, Cathy; Towe, Vivian L.; Flynn, Colin P.; Latkin, Carl A.; Celentano, David D.; Hauck, Heather; Holtgrave, David R.

2017-01-01

Background Given high rates of HIV among Baltimore MSM, we examined characteristics associated with HIV prevalence and unrecognized HIV infection among Baltimore MSM at two time points. Methods Cross-sectional behavioral surveys and HIV testing in 2004–2005 and 2008 using venue-based sampling among adult Baltimore men at MSM-identified locations. MSM was defined as sex with a male partner in the past year. Bivariate and backwards stepwise regression identified characteristics associated with HIV and unrecognized infection. Findings HIV prevalence was 37.7% overall in 2004–2005 (n=645) and 37.5% in 2008 (n=448), 51.4% and 44.7% among Black MSM, and 12.9% and 18.3% among non-Hispanic White MSM. Compared to non-Hispanic White MSM, Black MSM were 4.0 times (95% C.I.: 2.3, 7.0) more likely to be HIV-positive in 2004–2005 and 2.5 times (95% C.I.: 1.5, 4.0) more likely in 2008. Prevalence of unrecognized HIV infection was 58.4% overall in 2004–2005 and 74.4% in 2008, 63.8% and 76.9% among Black MSM, and 15.4% and 47.4% among non-Hispanic White MSM. In adjusted models, unrecognized infection was significantly associated with minority race/ethnicity, younger age, and no prior year doctor visits in 2004–5 and with younger age and no prior year doctor visits in 2008. Conclusion High rates of HIV infection and substantial rates of unrecognized HIV infection among Baltimore MSM, particularly men of color and young men, require urgent public and private sector attention and increased prevention response. PMID:21297479

Rural and remote dementia care challenges and needs: perspectives of formal and informal care providers residing in Saskatchewan, Canada.

PubMed

Dal Bello-Haas, Vanina P M; Cammer, Allison; Morgan, Debra; Stewart, Norma; Kosteniuk, Julie

2014-01-01

Rural and remote settings pose particular healthcare and service delivery challenges. Providing appropriate care and support for individuals with dementia and their families living in these communities is especially difficult, and can only be accomplished when the needs of care providers and the context and complexity of care provision are understood. This paper describes formal and informal caregivers' perceptions of the challenges and needs in providing care and support for individuals with dementia living in rural and remote areas of Saskatchewan, Canada. A mixed-methods exploratory approach was used to examine caregivers' needs. This research was a component of a broader process evaluation designed to inform the initial and ongoing development of a community-based participatory research program in rural dementia care, which included the development of the Rural and Remote Memory Clinic (RRMC). Four approaches were used for data collection and analyses: (1) thematic analysis of consultation meetings with rural healthcare providers: documented discussions from consultation meetings that occurred in 2003-2004 with rural physicians and healthcare providers regarding plans for a new RRMC were analysed thematically; (2) telephone and mail questionnaires: consultation meeting participants completed a subsequent telephone or mail questionnaire (2003-2004) that was analysed descriptively; (3) thematic analysis of referral letters to the Rural and Remote Memory Clinic: physician referral letters over a five-year period (2003-2008) were analysed descriptively and thematically; and (4) examination of family caregiver satisfaction: four specific baseline questionnaire questions completed by family caregivers (2007-2010) were analysed descriptively and thematically. Both physician and non-physician healthcare providers identified increased facilities and care programs as needs. Physicians were much more likely than other providers to report available support services for patients and families as adequate. Non-physician providers identified improved services, better coordination of services, travel and travel burden related needs, and staff training and education needs as priorities. Physician needs, as determined via referral letters, included confirmation of diagnosis or treatment, request for further management suggestions, patient or family request, and consultation regarding difficult cases. One-third of informal caregivers expressed not being satisfied with the care received prior to the Rural and Remote Memory Clinic assessment visit, and identified lack of diagnosis and long wait times for services as key issues. Delivering services and providing care and support for individuals with dementia living in rural and remote communities are especially challenging. The need for increased extent of services was a commonality among formal and informal caregivers. Primary care physicians may seek confirmation of their diagnosis or may need assistance when dealing with difficult aspects of care, as identified by referral letters. Differences between the needs identified via referral letters and questionnaire responses of physicians may be a reflection of the rural or remote context of care provision. Informal caregiver needs were more aligned with non-physician healthcare providers with respect to the need for improved access to additional healthcare professionals and services. The findings have implications for regional policy development that addresses human and other resource shortages.

Expanding the Role of Nurse Practitioners: Effects on Rural Access to Care for Injured Workers

ERIC Educational Resources Information Center

Sears, Jeanne M.; Wickizer, Thomas M.; Franklin, Gary M.; Cheadle, Allen D.; Berkowitz, Bobbie

2008-01-01

Context: A 3-year pilot program to expand the role of nurse practitioners (NPs) in the Washington State workers' compensation system was implemented in 2004 (SHB 1691), amid concern about disparities in access to health care for injured workers in rural areas. SHB 1691 authorized NPs to independently perform most functions of an attending…

Mandating Education of Dental Graduates to Provide Care to Individuals with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Waldman, H. Barry; Perlman, Steven P.

2006-01-01

In 2004, The Commission on Dental Accreditation adopted new standards for dental and dental hygiene education programs to ensure the preparation of practitioners to provide oral health services for persons with special health care needs. The course of action leading to the adoption of the new standards, together with the continuing obstacles of…

Avoidable deaths until 48 [corrected] months of age among children from the 2004 Pelotas birth cohort.

PubMed

Gorgot, Luis Ramon Marques da Rocha; Santos, Iná; Valle, Neiva; Matijasevich, Alicia; Matisajevich, Alicia; Barros, Aluisio J D; Albernaz, Elaine

2011-04-01

To describe avoidable deaths of children from the 2004 Pelotas Birth Cohort. The death of 92 children between 2004/2008 from Pelotas Birth Cohort were identified and classified according to the Brazilian List of Avoidable Causes of Mortality of Brazilian Unified Healthcare System. The Mortality Information System (SIM) for the State of Rio Grande do Sul (Southern Brazil) and the city of Pelotas were screened to search for deaths that occurred outside the city, as well as causes of deaths after the 1st year. Causes of infant deaths (<1 year of age) were compared between information from a sub-study and SIM. Mortality coefficients per 1,000 LB and proportional mortality for avoidable causes, including by type of health facility (traditional or Family Health Strategy) were calculated. The mortality coefficient was 22.2/ 1,000 LB, 82 the deaths occurred in the first year of life (19.4/1,000LB), and these included 37 (45%) in the first week. More than ¾ of the deaths (70/92) were avoidable. In infancy, according to the sub-study, the majority (42/82) could be prevented through adequate care of the woman during pregnancy; according to SIM, the majority could have been prevented through adequate newborn care (32/82). There was no difference in the proportion of avoidable deaths by type of health facility. The proportion of avoidable deaths is high. The quality of death certificate registries needs improvement so that avoidable deaths can be employed as an indicator to monitor maternal and child health care.

United States Nuclear Data Program (USNDP)

Science.gov Websites

Report FY 2016 Annual Report FY 2015 Annual Report FY 2014 Annual Report FY 2013 Annual Report FY 2012 Annual Report FY 2011 Annual Report FY 2010 Annual Report FY 2009 Annual Report FY 2008 Annual Report FY 2007 Annual Report FY 2006 Annual Report FY 2005 Annual Report FY 2004 Final Report FY 2003 Final

Deepwater Program: Exploration and Research of Northern Gulf of Mexico Deepwater Natural and Artificial Hard Bottom Habitats with Emphasis on Coral Communities: Reefs, Rigs and Wrecks

DTIC Science & Technology

2011-01-01

this analysis. They coordinate with Dr. Christina A. Kellogg with USGS for other microbiology aspects during the project. Dr. Bernie Bernard, TDI...of Mexico OCS Region, New Orleans, LA. OCS Study MMS 2008-018. Church, Robert and Lynn Samuel. 2004. Archaeological, Engineering and Hazard Study...methods using multilocus genotypes from 20 chicken breeds. Genetics 159, 699-713. Ross, S. W. and A. M. Quattrini. 2007. The fish fauna

Deepwater Program: Exploration and Research of Northern Gulf of Mexico Deepwater Natural and Artificial Hard Bottom Habitats with Emphasis on Coral Communities: Reefs, Rigs and Wrecks

DTIC Science & Technology

2009-01-01

Dr. Sheli Smith (PAST Foundation) - eighteenth and nineteenth century marine architecture, Dr. Christina A. Kellogg, USGS, microbiology In...of Mexico. Investigations at the wooden wrecks detailed them with video and still imagery and placed long and short-term microbiological experiments...Study MMS 2008-018. Church, Robert and Lynn Samuel. 2004. Archaeological, Engineering and Hazard Study for a Proposed 16-inch Oil Export Pipeline

Acute myocardial infarction mortality in Cuba, 1999-2008.

PubMed

Armas, Nurys B; Ortega, Yanela Y; de la Noval, Reinaldo; Suárez, Ramón; Llerena, Lorenzo; Dueñas, Alfredo F

2012-10-01

Acute myocardial infarction is one of the leading causes of death in the world. This is also true in Cuba, where no national-level epidemiologic studies of related mortality have been published in recent years. Describe acute myocardial infarction mortality in Cuba from 1999 through 2008. A descriptive study was conducted of persons aged ≥25 years with a diagnosis of acute myocardial infarction from 1999 through 2008. Data were obtained from the Ministry of Public Health's National Statistics Division database for variables: age; sex; site (out of hospital, in hospital or in hospital emergency room) and location (jurisdiction) of death. Proportions, age- and sex-specific rates and age-standardized overall rates per 100,000 population were calculated and compared over time, using the two five-year time frames within the study period. A total of 145,808 persons who had suffered acute myocardial infarction were recorded, 75,512 of whom died, for a case-fatality rate of 51.8% (55.1% in 1999-2003 and 49.7% in 2004-2008). In the first five-year period, mortality was 98.9 per 100,000 population, falling to 81.8 per 100,000 in the second; most affected were people aged ≥75 years and men. Of Cuba's 14 provinces and special municipality, Havana, Havana City and Camagüey provinces, and the Isle of Youth Special Municipality showed the highest mortality; Holguín, Ciego de Ávila and Granma provinces the lowest. Out-of-hospital deaths accounted for the greatest proportion of deaths in both five-year periods (54.8% and 59.2% in 1999-2003 and 2004-2008, respectively). Although risk of death from acute myocardial infarction decreased through the study period, it remains a major health problem in Cuba. A national acute myocardial infarction case registry is needed. Also required is further research to help elucidate possible causes of Cuba's high acute myocardial infarction mortality: cardiovascular risk studies, studies of out-of-hospital mortality and quality of care assessments for these patients.

Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice.

PubMed

Wiler, Jennifer L; Granovsky, Michael; Cantrill, Stephen V; Newell, Richard; Venkatesh, Arjun K; Schuur, Jeremiah D

2016-03-01

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician's to focus on quality of care measures and report quality performance for the first time. Initially termed "The Physician Voluntary Reporting Program," various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the "traditional PQRS" reporting program and the newer "Value Modifier" program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians.

Case histories of six consumers and their families in Cash and Counseling.

PubMed

San Antonio, Patricia M; Simon-Rusinowitz, Lori; Loughlin, Dawn; Eckert, J Kevin; Mahoney, Kevin J

2007-02-01

To examine how the lives of consumers and their caregivers were affected by making choices and controlling their own resources with the cash option, this paper focuses on six case studies from the Cash and Counseling Demonstration Program. Twenty-one consumers, caregivers, and state consultants were interviewed about their experiences in the program. The data come from a larger study of over 200 interviews conducted from June 2000 to August 2004. Interview data were analyzed for themes about caregiving and program satisfaction. Cash and Counseling benefited consumers and caregivers by allowing consumers increased continuity and reliability of care, increased ability to set hours of care, more satisfaction with how caregiving is offered and more satisfaction with the quality of care. The cash option allowed consumers to create, schedule, and manage their own model of care. Some consumers faced challenges in the program with paperwork, accounting, worries about receiving care, and some ineffective state consultants who could have been more helpful.

Case Histories of Six Consumers and Their Families in Cash and Counseling

PubMed Central

San Antonio, Patricia M; Simon-Rusinowitz, Lori; Loughlin, Dawn; Eckert, J Kevin; Mahoney, Kevin J

2007-01-01

Objective To examine how the lives of consumers and their caregivers were affected by making choices and controlling their own resources with the cash option, this paper focuses on six case studies from the Cash and Counseling Demonstration Program. Data Sources Twenty-one consumers, caregivers, and state consultants were interviewed about their experiences in the program. Study Design The data come from a larger study of over 200 interviews conducted from June 2000 to August 2004. Interview data were analyzed for themes about caregiving and program satisfaction. Principal Findings Cash and Counseling benefited consumers and caregivers by allowing consumers increased continuity and reliability of care, increased ability to set hours of care, more satisfaction with how caregiving is offered and more satisfaction with the quality of care. Conclusions The cash option allowed consumers to create, schedule, and manage their own model of care. Some consumers faced challenges in the program with paperwork, accounting, worries about receiving care, and some ineffective state consultants who could have been more helpful. PMID:17244296

["Healthy Region Lower Rhine ... against Stroke": the concept and implementation of an intersectoral public health programme 2003-2008].

PubMed

Rau, Rüdiger; Rumpeltin, Carsten; Hoop, Renate; Pfeiffer, Holger; Drees, Jeannette; Paas, Birgit; Schmitz-Buhl, Gabriele; Geraedts, Max

2009-01-01

When the Public Health Service Act of North Rhine-Westphalia (OGDG-NRW) came into effect local health conferences (KGK) were established in both rural and urban districts. These conferences are designed to optimize medical and social healthcare at the local level. In 2001 KGK managers from six neighbouring districts founded the Network Healthy Lower Rhine. From 2003 to 2008 this network was able to implement the "Healthy Lower Rhine ... against Stroke" programme. The initiative primarily aims at improving community knowledge of stroke with regard to 1) proper action ("Stroke is a medical emergency, so call the emergency number 112!") and 2) stroke warning signs. Eventually these steps are intended 3) to reduce prehospital delays. Before the program started a project plan was developed including evaluation approaches. The central elements of the concept include local health targets, intersectoral collaboration and networking, 5-year programme duration, social marketing and a communication strategy. Initially, a needs assessment was conducted using local expert panels, surveys on community knowledge, and clinical data sampling to assess healthcare quality. Subsequently, a package of measures with a "two-level implementation model" was prepared. Normative evaluation consisted of self-reflection within the network-team. The summative evaluation was based on two approaches: surveys on community knowledge of stroke (city of Düsseldorf and district of Wesel) as well as data sample collection in hospitals on health care quality. The central elements of the concepts were implemented. Community surveys revealed similar deficits in community knowledge of stroke in the city of Dusseldorf (2000 and 2004) and in the district of Wesel (2002 and 2008). Knowledge of proper action (call 112 in case of stroke) significantly improved in the Dusseldorf community from 32.5% of correct statements in 2000 to 50.6% correct answers in 2004 and, finally, in 2008 to 69% correct answers in the Wesel district. Hospitals in the district of Wesel collected three-month samples of data on prehospital times in 2003 (before the initiative was started) and in 2005. There was no significant change: the portion of 28% of patients being hospitalized within a three-hour window after the onset of stroke symptoms remained unchanged. Due to medical progress and demographic changes stroke remains a paramount issue of public health in Germany. With its programme "Healthy Lower Rhine ... against Stroke" the Network Healthy Lower Rhine provides a strategy for launching and implementing a complex and intersectoral public health intervention.

Rate, Relative Risk, and Method of Suicide by Students at 4-Year Colleges and Universities in the United States, 2004-2005 through 2008-2009

ERIC Educational Resources Information Center

Schwartz, Allan J.

2011-01-01

A total of 622 suicides were reported among students attending 645 distinct campuses from 2004-2005 through 2008-2009. Adjusting for gender in the population at risk of 14.9 million student-years and for the source of these data, the student suicide rate of 7.0 was significantly and substantially lower than for a matched national sample. Suicide…

Evaluation Summary of the Expanding Opportunities Interagency Inclusion Initiative: Increasing and Enhancing Access, Participation and Supports for All Children in High Quality Inclusive Programs and Services

ERIC Educational Resources Information Center

National Early Childhood Technical Assistance Center (NECTAC), 2011

2011-01-01

This paper describes the impetus for creating the Expanding Opportunities Interagency Inclusion Initiative and achievements to date in identifying and implementing effective and efficient inclusion strategies in the participating states. In March 2004, the Child Care Bureau (CCB) (renamed the Office of Child Care) and the Administration on…

Search for Cosmic-Ray Antiproton Origins and for Cosmological Antimatter with BESS

NASA Technical Reports Server (NTRS)

Yamamoto, A.; Mitchell, J. W.; Yoshimura, K.; Abe, K.; Fuke, H.; Haino, S.; Hams, T.; Hasegawa, M.; Horikoshi, A.; Itazaki, A.;

National Academies-Review of the Research Program of the FreedomCAR and Fuel Partnership. Third Report

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

none,

2011-06-09

This report by the National Research Council's (NRC's) Committee on Review of the FreedomCAR and Fuel Research Program, Phase 3, is the third NRC review. The Phase 1 and Phase 2 reviews were issued in 2005 and 2008, respectively (NRC, 2005, 2008). The long-range goals of the Partnership focus on a transition to a highway transportation system that uses sustainable energy resources and reduces emissions, including net carbon emissions, on a life-cycle or well (source)-to-wheels basis (DOE, 2004). The Partnership focuses on precompetitive research and development (R&D) that can help to accelerate the emergence of technologies that can meet themore » long-range goals. • This review document is published by National Academies Press. You may (a) read the text for free on the National Academies Press web site, (b) download a free PDF after providing some identifying information, or (c) purchase a paperback copy of the book.« less

Reducing hospital-acquired heel ulcer rates in an acute care facility: an evaluation of a nurse-driven performance improvement project.

PubMed

McElhinny, Mary Louise; Hooper, Christine

2008-01-01

A nurse-driven performance improvement project designed to reduce the incidence of hospital-acquired ulcers of the heel in an acute care setting was evaluated. This was a descriptive evaluative study using secondary data analysis. Data were collected in 2004, prior to implementation of the prevention project and compared to results obtained in 2006, after the project was implemented. Data were collected in a 172-bed, not-for-profit inpatient acute care facility in North Central California. All medical-surgical inpatients aged 18 years and older were included in the samples. Data were collected on 113 inpatients prior to implementation of the project in 2004. Data were also collected on a sample of 124 inpatients in 2006. The prevalence and incidence of heel pressure ulcers were obtained through skin surveys prior to implementation of the prevention program and following its implementation. Results from 2004 were compared to data collected in 2006 after introduction of the Braden Scale for Predicting Pressure Sore Risk. Heel pressure ulcers were staged using the National Pressure Ulcer Advisory Panel (NPUAP) staging system and recommendations provided by the Agency for Health Care Quality Research (AHRQ) clinical practice guidelines. The incidence of hospital-acquired heel pressure ulcers in 2004 was 13.5% (4 of 37 patients). After implementation of the program in 2006, the incidence of hospital-acquired heel pressure ulcers was 13.8% (5 of 36 patients). The intervention did not appear to receive adequate staff nurse support needed to make the project successful. Factors that influenced the lack of support may have included: (1) educational method used, (2) lack of organization approved, evidenced-based standardized protocols for prevention and treatment of heel ulcers, and (3) failure of facility management to convey the importance as well as their support for the project.

Psychiatric inpatient care at a county hospital before and after the inception of a university-affiliated psychiatry residency program.

PubMed

Woo, Benjamin K P; Ma, Albert Y

2007-09-01

The University of California, Los Angeles (UCLA), along with Kern Medical Center (KMC) and Kern County Mental Health (KCMH), established a new psychiatry residency program in 2004. In this study, we compared psychiatric care at a county psychiatric facility serving a population of 760,000 inhabitants before and after the initiation of this psychiatry residency program. Medical charts for all patients admitted to the psychiatric inpatient service during the year before the inception of the psychiatry residency program (2003-2004) and during the first year in which there was full implementation of residents after inception of the psychiatry residency program (2005-2006) were reviewed. Baseline characteristics, demographics, and various outcomes of the two groups were compared. After the residency program was established, the mean length of stay increased from 8.8 to 9.8 days (p < 0.05), the 30-day readmission rate increased from 3.5% (32/915) to 5.6% (48/853) (p < 0.05), more intramuscular emergency medications were given (p < 0.01), and more radiological assessments were obtained (p < 0.01). However, there was less delay in discharge (p < 0.01) and fewer days without medical necessity (p < 0.01). The patient satisfaction rate dropped from 77% (547/711) to 70% (476/680) (p < 0.01) after initiation of the residency program. The results of this study suggest a statistically significant difference in multiple characteristics of treatment after initiation of a psychiatry residency program in the psychiatric inpatient setting. More research is needed to identify strategies, such as guidelines to eliminate over-utilization of resources and methods to improve residents' competency, that may successfully enhance the quality of care provided by residents to psychiatric inpatients.

Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations.

PubMed

Weissman, David E; Morrison, R Sean; Meier, Diane E

2010-02-01

Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders and policymakers. Since 2000, the Center to Advance Palliative Care (CAPC) has provided technical assistance to hospitals, health systems and hospices working to start, sustain, and grow nonhospice palliative care programs. CAPC convened a consensus panel in 2008 to develop recommendations for specific clinical and customer metrics that programs should track. The panel agreed on four key domains of clinical metrics and two domains of customer metrics. Clinical metrics include: daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites. For customer metrics, consensus was reached on two domains that should be tracked to assess satisfaction: patient/family satisfaction, and referring clinician satisfaction. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care programs are encouraged to collect and report outcomes for each of the metric domains described here.

Little Evidence Exists To Support The Expectation That Providers Would Consolidate To Enter New Payment Models.

PubMed

Neprash, Hannah T; Chernew, Michael E; McWilliams, J Michael

2017-02-01

Provider consolidation has been associated with higher health care prices and spending. The prevailing wisdom is that payment reform will accelerate consolidation, especially between physicians and hospitals and among physician groups, as providers position themselves to bear financial risk for the full continuum of patient care. Drawing on data from a number of sources from 2008 onward, we examined the relationship between Medicare's accountable care organization (ACO) programs and provider consolidation. We found that consolidation was under way in the period 2008-10, before the Affordable Care Act (ACA) established the ACO programs. While the number of hospital mergers and the size of specialty-oriented physician groups increased after the ACA was passed, we found minimal evidence that consolidation was associated with ACO penetration at the market level or with physicians' participation in ACOs within markets. We conclude that payment reform has been associated with little acceleration in consolidation in addition to trends already under way, but there is evidence of potential defensive consolidation in response to new payment models. Project HOPE—The People-to-People Health Foundation, Inc.

Development of an Inter-Service Complex Wound and Limb Salvage Center within the DoD (Briefing charts)

DTIC Science & Technology

2010-10-15

CWLSC Patient Growth: 2008-2010  Complex soft-tissue wound management in austere settings  NPWT/VAC application and management  Ostomy , fistula, and...acute and chronic wounds Complex Wound Limb Salvage Program WRAMC/NNMC Inpatient Care Wound and Ostomy NNMC and WRAMC Outpatient Care 2 Clinics...Standardization Ostomy Wound care Skin Care Cleansers Research / EBP Pressure ulcer protocol CPG development Wound education research grant WRNMMC

Cecal intubation rates in different eras of endoscopic technological development.

PubMed

Matyja, Maciej; Pasternak, Artur; Szura, Mirosław; Pędziwiatr, Michał; Major, Piotr; Rembiasz, Kazimierz

2018-03-01

Colonoscopy plays a critical role in colorectal cancer (CRC) screening and has been widely regarded as the gold standard. Cecal intubation rate (CIR) is one of the well-defined quality indicators used to assess colonoscopy. To assess the impact of new technologies on the quality of colonoscopy by assessing completion rates. This was a dual-center study at the 2 nd Department of Surgery at Jagiellonian University Medical College and at the Specialist Center "Medicina" in Krakow, Poland. The CIR and cecal intubation time (CIT) in three different eras of technological advancement were determined. The study enrolled 27 463 patients who underwent colonoscopy as part of a national CRC screening program. The patients were divided into three groups: group I - 3408 patients examined between 2000 and 2003 (optical endoscopes); group II - 10 405 patients examined between 2004 and 2008 (standard electronic endoscopes); and group III - 13 650 patients examined between 2009 and 2014 (modern endoscopes). There were statistically significant differences in the CIR between successive eras. The CIR in group I (2000-2003) was 69.75%, in group II (2004-2008) was 92.32%, and in group III (2009-2014) was 95.17%. The mean CIT was significantly reduced in group III. Our study shows that the technological innovation of novel endoscopy devices has a great influence on the effectiveness of the CRC screening program. The new era of endoscopic technological development has the potential to reduce examination-related patient discomfort, obviate the need for sedation and increase diagnostic yields.

Gender policy developments and policy regimes in 22 OECD countries, 1979-2008.

PubMed

Backhans, Mona C; Burström, Bo; Marklund, Staffan

2011-01-01

This study investigates trends and clustering of gender policy in 22 OECD (Organization for Economic Cooperation and Development) countries during 1979-2008. The starting point was Sainsbury's gender policy regime framework, and the study included indicators reflecting the male bread-winner, individual earner-carer, and separate gender roles regimes. The indicators were followed over seven time points for mean, range, and distribution. Cluster analyses were performed for the years 1979, 1989, 1999, and 2004. In accordance with previous studies, the authors found a Nordic cluster of earner-carer countries, while several Southern European countries and the United States were marked by their low generosity and high pension requirements. Though aspects of the separate gender roles regime have become more widespread, no country could be classified as fully belonging to this regime type. The two aspects of the model--compensatory measures in the pension system, and benefits for caring activities--were never present simultaneously.

Changes in second-line regimen durability and continuity of care in relation to national ART guideline changes in South Africa

PubMed Central

Onoya, Dorina; Brennan, Alana T; Berhanu, Rebecca; van der Berg, Liudmyla; Buthelezi, Thulasizwe; Fox, Matthew P

2016-01-01

Abstract Introduction: Little is known about the impact of antiretroviral therapy (ART) guideline changes on the durability of second-line ART and continuity of care. This study examines predictors of early drug substitutions and treatment interruptions using a cohort analysis of HIV positive adults switched to second-line ART between January 2004 and September 2013 in Johannesburg, South Africa. Methods: The main outcomes were having a drug substitution or treatment interruption in the first 24 months on second-line ART. Kaplan Meiers analyses and Cox proportional hazards regression were used to identify predictors of drug substitutions and treatment interruptions. Results: Of 3028 patients on second-line ART, 353 (11.7%) had a drug substitution (8.6 per 100PY, 95% CI: 7.8–9.6) and 260 (8.6%) had a treatment interruption (6.3 per 100PY, 95% CI: 5.6–7.1). While treatment interruptions decreased from 32.5 per 100PY for the 2004 cohort to 2.3 per 100PY for the 2013 cohort, the rates of drug substitutions steadily increased, peaking at an incidence of 26.7 per 100PY for the 2009 cohort and then decreased to 4.2 per 100PY in the 2011 cohort. Compared to the 2004 to 2008 cohorts, the hazard of early drug substitutions was highest among patients switched to AZT + ddI + LPVr in 2009 to 2010 (aHR 5.1, 95% CI: 3.4–7.1) but remained low over time among patients switched to TDF + 3TC/FTC + LPVr or AZT/ABC + 3TC + LPVr. The main common predictor of both treatment interruption and drug substitution was drug toxicity. Conclusions: Our results show a rapid transition between 2004 and 2010 ART guidelines and concurrent improvements in continuity of care among second-line ART patients. Drug toxicity reporting and monitoring systems need improvements to inform timely regimen changes and ensure that patients remain in care. However, reasons for drug substitutions should be closely monitored to ensure that patients do not run out of treatment options in the future. PMID:28364563

Three Independent Evaluations of Healthy Kids Programs Find Substantial Gains in Children's Dental Health Care. In Brief, September 2008, Number 2

ERIC Educational Resources Information Center

Hughes, Dana; Howell, Embry; Trenholm, Christopher; Hill, Ian; Dubay, Lisa

2008-01-01

This brief presents highlights from rigorous, independent evaluations of the Healthy Kids programs in three California counties: Los Angeles, San Mateo, and Santa Clara. Launched by Children's Health Initiatives (CHIs) in these counties between 2001 and 2003, the three Healthy Kids programs provide children with comprehensive health insurance…

Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care.

PubMed

Cant, Robyn P; Foster, Michele M

2011-11-01

To critically examine utilisation of the 13 allied health services provided through Medicare Chronic Disease Management program and related general practitioner (GP) care planning initiatives. Statistics generated from national billing data from July 2005 to June 2009 were extracted from Medicare data and compared by profession, State or Territory and population. Most services grew over 4 years although nationally consistent service levels were not found for any allied health provider profession. On referral from GPs, podiatry, physiotherapy and dietetics provided most services (82%) in 2008-09. Professions had unique patterns of referral instanced by age range and sex of clientele. Wide variation was apparent in per capita utilisation of allied health services by State or Territory; some with far less than average national use and others with high use. Annual number of GP Management Plans or Team Care Arrangements was low (mean: ≤22 per GP in 2008-09), indicating low use of care planning. Inequality of accessibility for patients was apparent. Five years into the program, a review of Medicare Allied Health CDM policy is warranted. Implications. Research and evaluation is needed to identify whether the program is meeting the needs of GPs, allied health providers and chronic disease patients.

Costs of newly diagnosed neovascular age-related macular degeneration among medicare beneficiaries, 2004-2008.

PubMed

Qualls, Laura G; Hammill, Bradley G; Wang, Fang; Lad, Eleonora M; Schulman, Kevin A; Cousins, Scott W; Curtis, Lesley H

2013-04-01

To examine associations between newly diagnosed neovascular age-related macular degeneration and direct medical costs. This retrospective observational study matched 23,133 Medicare beneficiaries diagnosed with neovascular age-related macular degeneration between 2004 and 2008 with a control group of 92,532 beneficiaries on the basis of age, sex, and race. The index date for each case-control set corresponded to the first diagnosis for the case. Main outcome measures were total costs per patient and age-related macular degeneration-related costs per case 1 year before and after the index date. Mean cost per case in the year after diagnosis was $12,422, $4,884 higher than the year before diagnosis. Postindex costs were 41% higher for cases than controls after adjustment for preindex costs and comorbid conditions. Age-related macular degeneration-related costs represented 27% of total costs among cases in the postindex period and were 50% higher for patients diagnosed in 2008 than in 2004. This increase was attributable primarily to the introduction of intravitreous injections of vascular endothelial growth factor antagonists. Intravitreous injections averaged $203 for patients diagnosed in 2004 and $2,749 for patients diagnosed in 2008. Newly diagnosed neovascular age-related macular degeneration was associated with a substantial increase in total medical costs. Costs increased over time, reflecting growing use of anti-vascular endothelial growth factor therapies.

Evaluating the Impact of Dental Care on Housing Intervention Program Outcomes Among Homeless Veterans

PubMed Central

Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A.; Schinka, John A.

2013-01-01

Objectives. In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Methods. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Results. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Conclusions. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation. PMID:23678921

A comparison of trends in research into home care services in Japan and Korea

PubMed Central

2013-01-01

Background The purpose of this study is to compare of the research trends for home care services in Japan and the Republic of Korea (Korea). In particular, it was compared as the research design, the method of data collection, and key words by literature review. Methods Original articles on home care services were selected from Japanese and Korean journals published from the year of 2004 to 2008. The articles were classified, and compared in terms of the number of articles per year. Results The research design was quite different. Quantitative research design was dominantly conducted in Korea, qualitative research design was used same level of design in Japan. In particular, outcome study was shown in Korean. Conclusions It is suggested that future collaboration be undertaken to improve the variety of research design and method especially in both countries under the aged society. In addition, it provides information concerning research concepts, which can be applied to optimize future home care services. PMID:23870373

Physician Quality Reporting System Program Updates and the Impact on Emergency Medicine Practice

PubMed Central

Wiler, Jennifer L.; Granovsky, Michael; Cantrill, Stephen V.; Newell, Richard; Venkatesh, Arjun K.; Schuur, Jeremiah D.

2016-01-01

In 2007, the Centers for Medicaid and Medicare Services (CMS) created a novel payment program to create incentives for physician’s to focus on quality of care measures and report quality performance for the first time. Initially termed “The Physician Voluntary Reporting Program,” various Congressional actions, including the Tax Relief and Health Care Act of 2006 (TRHCA) and Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) further strengthened and ensconced this program, eventually leading to the quality program termed today as the Physician Quality Reporting System (PQRS). As a result of passage of the Affordable Care Act of 2010, the PQRS program has expanded to include both the “traditional PQRS” reporting program and the newer “Value Modifier” program (VM). For the first time, these programs were designed to include pay-for-performance incentives for all physicians providing care to Medicare beneficiaries and to measure the cost of care. The recent passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act in March of 2015 includes changes to these payment programs that will have an even more profound impact on emergency care providers. We describe the implications of these important federal policy changes for emergency physicians. PMID:26973757

Working with Family, Friend, and Neighbor Caregivers: Lessons from Four Diverse Communities

ERIC Educational Resources Information Center

Powell, Douglas R.

2011-01-01

This article is excerpted from "Who's Watching the Babies? Improving the Quality of Family, Friend, and Neighbor Care" by Douglas R. Powell ("ZERO TO THREE," 2008). The article explores questions about program development and implementation strategies for supporting Family, Friend, and Neighbor (FFN) caregivers: How do programs and their host…

Recent cancer survival in Germany: an analysis of common and less common cancers.

PubMed

Jansen, Lina; Castro, Felipe A; Gondos, Adam; Krilaviciute, Agne; Barnes, Benjamin; Eberle, Andrea; Emrich, Katharina; Hentschel, Stefan; Holleczek, Bernd; Katalinic, Alexander; Brenner, Hermann

2015-06-01

The monitoring of cancer survival by population-based cancer registries is a prerequisite to evaluate the current quality of cancer care. Our study provides 1-, 5- and 10-year relative survival as well as 5-year relative survival conditional on 1-year survival estimates and recent survival trends for Germany using data from 11 population-based cancer registries, covering around one-third of the German population. Period analysis was used to estimate relative survival for 24 common and 11 less common cancer sites for the period 2007-2010. The German and the United States survival estimates were compared using the Surveillance, Epidemiology and End Results 13 database. Trends in cancer survival in Germany between 2002-2004 and 2008-2010 were described. Five-year relative survival increased in Germany from 2002-2004 to 2008-2010 for most cancer sites. Among the 24 most common cancers, largest improvements were seen for multiple myeloma (8.0% units), non-Hodgkin lymphoma (6.2% units), prostate cancer (5.2% units) and colorectal cancer (4.6% units). In 2007-2010, the survival disadvantage in Germany compared to the United States was largest for cancers of the mouth/pharynx (-11.0% units), thyroid (-6.8% units) and prostate (-7.5% units). Although survival estimates were much lower for elderly patients in both countries, differences in age patterns were observed for some cancer sites. The reported improvements in cancer survival might reflect advances in the quality of cancer care on the population level as well as increased use of screening in Germany. The survival differences across countries and the survival disadvantage in the elderly require further investigation. © 2014 UICC.

LMS and New Media

DTIC Science & Technology

2009-08-19

Management of Social Media The Caring Personal Agent SUSAN BULL1, JIM GREER2, GORD MCCALLA2 1 Educational Technology Research Group, Electronic...Discussion Forums, Leader Education , On Demand Learning . 24 Cianciolo, A. (2008) Study Report 2008-05. Program Evaluation for U.S. Army Lifelong...AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Advanced Decision Learning (ADL

Seasonal Variation of the Indonesian Throughflow in Makassar Strait

DTIC Science & Technology

2012-07-01

HYCOM). Twenty-eight years (1981–2008) of 1/38 Indo-Pacific basin HYCOM simulations and three years (2004–06) from a 1/128 global HYCOM simulation are...eight years (1981?2008) of 1/ 38 Indo-Pacific basin HYCOM simulations and three years (2004?06) from a 1/ 128 global HYCOM simulation are analyzed...Wyrtki 1973) and the propa- gation of Kelvin waves along the coasts of Sumatra and Java, such as observed and modeled during May 1997 (Sprintall et

State Test Score Trends through 2008-09, Part 4: Is Achievement Improving and Are Gaps Narrowing for Title I Students? Utah

ERIC Educational Resources Information Center

Center on Education Policy, 2011

2011-01-01

This paper profiles Utah's test score trends through 2008-09. In 2004, the mean scale score on the state 4th grade reading test was 167 for non-Title I students and 164 for Title I students. In 2009 the mean scale score in 4th grade reading was 168 for non-Title I students and 164 for Title I students. Between 2004 and 2009, the mean scale score…

State Test Score Trends through 2008-09, Part 4: Is Achievement Improving and Are Gaps Narrowing for Title I Students? Maryland

ERIC Educational Resources Information Center

Center on Education Policy, 2011

2011-01-01

This paper profiles Maryland's test score trends through 2008-09. In 2004, 82% of non-Title I 4th graders and 61% of Title I 4th graders scored at the proficient level on the state reading test. In 2009, 90% of non-Title I 4th graders and 78% of Title I 4th graders scored at the proficient level in reading. Between 2004 and 2009, the percentage…

Electronic laboratory system reduces errors in National Tuberculosis Program: a cluster randomized controlled trial.

PubMed

Blaya, J A; Shin, S S; Yale, G; Suarez, C; Asencios, L; Contreras, C; Rodriguez, P; Kim, J; Cegielski, P; Fraser, H S F

2010-08-01

To evaluate the impact of the e-Chasqui laboratory information system in reducing reporting errors compared to the current paper system. Cluster randomized controlled trial in 76 health centers (HCs) between 2004 and 2008. Baseline data were collected every 4 months for 12 months. HCs were then randomly assigned to intervention (e-Chasqui) or control (paper). Further data were collected for the same months the following year. Comparisons were made between intervention and control HCs, and before and after the intervention. Intervention HCs had respectively 82% and 87% fewer errors in reporting results for drug susceptibility tests (2.1% vs. 11.9%, P = 0.001, OR 0.17, 95%CI 0.09-0.31) and cultures (2.0% vs. 15.1%, P < 0.001, OR 0.13, 95%CI 0.07-0.24), than control HCs. Preventing missing results through online viewing accounted for at least 72% of all errors. e-Chasqui users sent on average three electronic error reports per week to the laboratories. e-Chasqui reduced the number of missing laboratory results at point-of-care health centers. Clinical users confirmed viewing electronic results not available on paper. Reporting errors to the laboratory using e-Chasqui promoted continuous quality improvement. The e-Chasqui laboratory information system is an important part of laboratory infrastructure improvements to support multidrug-resistant tuberculosis care in Peru.

Health care resource use and costs among patients with cushing disease.

PubMed

Swearingen, Brooke; Wu, Ning; Chen, Shih-Yin; Pulgar, Sonia; Biller, Beverly M K

2011-01-01

To assess health care costs associated with Cushing disease and to determine changes in overall and comorbidity-related costs after surgical treatment. In this retrospective cohort study, patients with Cushing disease were identified from insurance claims databases by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for Cushing syndrome (255.0) and either benign pituitary adenomas (227.3) or hypophysectomy (07.6×) between 2004 and 2008. Each patient with Cushing disease was age- and sex-matched with 4 patients with nonfunctioning pituitary adenomas and 10 population control subjects. Comorbid conditions and annual direct health care costs were assessed within each calendar year. Postoperative changes in health care costs and comorbidity-related costs were compared between patients presumed to be in remission and those with presumed persistent disease. Of 877 identified patients with Cushing disease, 79% were female and the average age was 43.4 years. Hypertension, diabetes mellitus, and hyperlipidemia were more common among patients with Cushing disease than in patients with nonfunctioning pituitary adenomas or in control patients (P<.01). For every calendar year studied, patients with Cushing disease had significantly higher total health care costs (2008: $26 440 [Cushing disease] vs $13 708 [nonfunctioning pituitary adenomas] vs $5954 [population control], P<.01). Annual outpatient costs decreased significantly for patients in remission after surgery, and there was a trend towards improvement in overall disease-related costs with remission. A significant increase in postoperative health care costs was observed in those patients not in remission. Patients with Cushing disease had more comorbidities than patients with nonfunctioning pituitary adenomas or control patients and incurred significantly higher annual health care costs; these costs decreased after successful surgery and increased after unsuccessful surgery.

Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy.

PubMed

McGregor, Alecia J; Siqueira, Carlos Eduardo; Zaslavsky, Alan M; Blendon, Robert J

2017-07-12

This study analyzed several political determinants of increased private-sector management in Brazilian health care. In Brazil, the poor depend almost exclusively on the public Unified Health System (the SUS), which remains severely underfunded. Given the overhead costs associated with privately contracted health services, increased private management is one driver of higher expenditures in the system. Although left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested. Drawing on multiple publicly available data sources, we used linear regression to analyze how political party-in-power and existing private sector health care contracting affect the share of privately managed health care services and outsourcing in municipalities. Data from two election periods-2004 to 2008 and 2008 to 2012-were analyzed. Our findings showed that although private sector contracting varies greatly across municipalities, this variation is not systematically associated with political party in power. This suggests that electoral politics plays a relatively minor role in municipal-level health care administration. Existing levels of private sector management appear to have a greater effect on the public-private makeup of the Brazilian healthcare system, suggesting a strong role of path dependence in the evolution of Brazilian health care delivery. Despite campaign rhetoric asserting distinct positions on privatization in the SUS, factors other than political party in power have a greater effect on private-sector health system management at the municipal-level in Brazil. Given the limited effect of elections on this issue, strengthening participatory bodies such as municipal health councils may better enfranchise citizens in the fundamental debate over public and private roles in the health care sector.

Rabies: Diagnosis in Animals and Humans

MedlinePlus

... Dogs Reported in the United States, 2008 Rabid Cattle Reported in the United States, 2008 Terrestrial Rabies ... Texas December 23, 2005: Rabies in a Dairy Cow; Oklahoma November 15, 2004: Clinician Information Line July ...

How Can You Prevent Rabies in Animals?

MedlinePlus

... Dogs Reported in the United States, 2008 Rabid Cattle Reported in the United States, 2008 Terrestrial Rabies ... Texas December 23, 2005: Rabies in a Dairy Cow; Oklahoma November 15, 2004: Clinician Information Line July ...

Association between food assistance program participation and overweight

PubMed Central

Chaparro, M Pia; Bernabe-Ortiz, Antonio; Harrison, Gail G

2014-01-01

OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition. PMID:26039391

Association between food assistance program participation and overweight.

PubMed

Chaparro, M Pia; Bernabe-Ortiz, Antonio; Harrison, Gail G

2014-12-01

OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.

VizieR Online Data Catalog: Spitzer and VRIJHK photometry of V582 Mon (Arulanantham+, 2016)

NASA Astrophysics Data System (ADS)

Arulanantham, N. A.; Herbst, W.; Cody, A. M.; Stauffer, J. R.; Rebull, L. M.; Agol, E.; Windemuth, D.; Marengo, M.; Winn, J. N.; Hamilton, C. M.; Mundt, R.; Johns-Krull, C. M.; Gutermuth, R. A.

2016-07-01

We have continued to obtain ground-based optical and near-infrared photometry over the last two years using A Novel Dual Imaging CAMera (ANDICAM) on the 1.3m telescope at Cerro-Tololo Inter-American Observatory (CTIO) in Chile. The instrument is operated by the SMARTS consortium. Data were collected almost nightly from 2013 October through 2014 April. Observations were resumed in 2014 September and continued until 2015 April. Each night, four 150s exposures were obtained in each of the three optical bands (VRI) along with 10-15 dithered exposures (30s each) in the near-infrared bands (JHK). All images have a 10.2'*10.2' field of view. The data acquisition and reduction processes are discussed briefly in Appendix A, and a more complete description is given by Windemuth & Herbst 2014 (cat. J/AJ/147/9). The VRIJHK magnitudes from the last two observing seasons have been added to the entire set of CCD data obtained since 1995, which is presented here as Table1. Images of KH 15D were collected with the InfraRed Array Camera (IRAC) on the Spitzer Space Telescope during six observational runs with five separate PI's spanning three distinct epochs since 2004 (2004 Mar 6 and 2004 Oct 08, PI Giovanni Fazio, Program ID=37; 2004 Oct 5-12 and 2005 Oct 21-29, PI Massimo Marengo, Program ID=3441; 2006 Mar 23-27, PI Eric Agol, Program ID=3469; 2008 Nov 1-2, PI Lucas A. Cieza, Program ID=50773). The fifth set of observations was obtained by the CSI 2264 team (PI=John R. Stauffer, Program ID=61027, 80040) as part of a large campaign to monitor young variable objects in NGC2264 (Cody et al. 2014, cat. J/AJ/147/82). These data were obtained over 28 consecutive days of observation in 2011 December (2011 Dec 3-2012 Jan 1). A final set of observations was obtained on eight nights between 2013 December and 2014 January (2013 Dec 22-2014 Jan 20, PI William Herbst, Program ID=90154, 90098). The full set of Spitzer photometry at all epochs is given in Table3. (2 data files).

Characteristics of nurse leaders in hospitals in the U.S.A. from 1992 to 2008.

PubMed

Westphal, Judith A

2012-10-01

Describe the nurse leader workforce in hospitals in the USA over time by exploring three research questions: (1) What are the characteristics of the nurse leader workforce in U.S. hospitals? (2) How does the nurse leader workforce change over time? (3) How do nurses in executive positions (administrators) differ from nurses in first-line supervisory positions (supervisors)? Effective nurse leaders use management skills to ensure safe patient care in hospitals in the USA. Changes in the nurse leader workforce have an impact on patient care. non-experimental design was used to explore the characteristics of 10,150 nurse leaders using the 1992, 1996, 2000, 2004 and 2008 National Sample Surveys of Registered Nurses. Number of masters and doctorally prepared nurse leaders increased from 14.5% to 23.2% along with an increase in mean age. A 30% decrease in the number of nurses in leadership positions was found. Male nurses reported significantly higher salaries P < 0.000. Nurse leaders are older and have achieved higher educational degrees. Salary disparities based on gender still prevail. Implications for nursing management  Identifying and developing future leaders with necessary skills and competencies is critical for organizational success. © 2012 Blackwell Publishing Ltd.

Care and outcomes of Asian-American acute myocardial infarction patients: findings from the American Heart Association Get With The Guidelines-Coronary Artery Disease program.

PubMed

Qian, Feng; Ling, Frederick S; Deedwania, Prakash; Hernandez, Adrian F; Fonarow, Gregg C; Cannon, Christopher P; Peterson, Eric D; Peacock, W Frank; Kaltenbach, Lisa A; Laskey, Warren K; Schwamm, Lee H; Bhatt, Deepak L

2012-01-01

Asian-Americans represent an important United States minority population, yet there are limited data regarding the clinical care and outcomes of Asian-Americans following acute myocardial infarction (AMI). Using data from the American Heart Association Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program, we compared use of and trends in evidence-based care AMI processes and outcome in Asian-American versus white patients. We analyzed 107,403 AMI patients (4412 Asian-Americans, 4.1%) from 382 United States centers participating in the Get With The Guidelines-Coronary Artery Disease program between 2003 and 2008. Use of 6 AMI performance measures, composite "defect-free" care (proportion receiving all eligible performance measures), door-to-balloon time, and in-hospital mortality were examined. Trends in care over this time period were explored. Compared with whites, Asian-American AMI patients were significantly older, more likely to be covered by Medicaid and recruited in the west region, and had a higher prevalence of diabetes, hypertension, heart failure, and smoking. In-hospital unadjusted mortality was higher among Asian-American patients. Overall, Asian-Americans were comparable with whites regarding the baseline quality of care, except that Asian-Americans were less likely to get smoking cessation counseling (65.6% versus 81.5%). Asian-American AMI patients experienced improvement in the 6 individual measures (P≤0.048), defect-free care (P<0.001), and door-to-balloon time (P<0.001). The improvement rates were similar for both Asian-Americans and whites. Compared with whites, the adjusted in-hospital mortality rate was higher for Asian-Americans (adjusted relative risk: 1.16; 95% confidence interval: 1.00-1.35; P=0.04). Evidence-based care for AMI processes improved significantly over the period of 2003 to 2008 for Asian-American and white patients in the Get With The Guidelines-Coronary Artery Disease program. Differences in care between Asian-Americans and whites, when present, were reduced over time.

Covering the uninsured in 2008: current costs, sources of payment, and incremental costs.

PubMed

Hadley, Jack; Holahan, John; Coughlin, Teresa; Miller, Dawn

2008-01-01

People uninsured for any part of 2008 spend about $30 billion out of pocket and receive approximately $56 billion in uncompensated care while uninsured. Government programs finance about 75 percent of uncompensated care. If all uninsured people were fully covered, their medical spending would increase by $122.6 billion. The increase represents 5 percent of current national health spending and 0.8 percent of gross domestic product. However, it is neither the cost of a specific plan nor necessarily the same as the government's costs, which could be higher, depending on plans' financing structures and the extent of crowd-out.

Geochemistry of basement rocks of incoming plate (Cocos Ridge) from Sites U1381 and 1414, IODP Expeditions 334 and 344

NASA Astrophysics Data System (ADS)

Yan, Q.; Shi, X.

2015-12-01

The drilling sites of IODP 334 and 344 lie in the being subducted part of Cocos Ridge, offshore Costa Rica. Some seamount clusters distributed in the northwest side of the sites. Most scientists accepted that the Cocos ridge is intimately related to the activity of Galapagos plume (e.g., Hoernle et al., 2000, 2004, 2008). In this study we have selected some basaltic samples from U1381A, U1381C and U1414A (IODP 334 and 344) (Harris et al., 2015a, b) to carry out petrogenetic study. Major element compositions show that these basaltic rocks belong to sub-alkaline rocks, which is consistent with previous study on basalts from northern side of Cocos ridge. The characteristics of trace element composition are similar to that of EMORB, and the compositional differences in trace elements among samples reflect the influence of fractional crystallization. Sr-Nd-Pb isotopic compositions of these basaltic rocks show that there exist mantle heterogeneity beneath the Cocos ridge, and they may be the product of mixing between DMM/GSC and EMII. The new data show more enriched source feature than those from Galapagos hotspot (and its tracks) in previous study (Hoernle et al., 2000,2004), and slightly more enriched than those Miocene to Pliocene arc volcanics from Central America (Gazel et al., 2009). Partial melting model show that the parental basalts for these basaltic rocks may be produced by 13 to 28% partial melting of garnet pyroxenite. ReferencesGazel et al., 2009. G-cubed.10, Q02S11, doi:10.1029/2008GC002246.//Harris, R.N., Sakaguchi, A., Petronotis, K., and the Expedition 344 Scientists. 2015a. Input Site U1381. Proceedings of the Integrated Ocean Drilling Program, Volume 344//Harris, R.N., Sakaguchi, A., Petronotis, K., and the Expedition 344 Scientists. 2015b. Input Site U1414.Proceedings of the Integrated Ocean Drilling Program, Volume 344//Hoernle et al., 2000. Geology, 28(5),435-438//Hoernle et al., 2004. Geology, 32,697-700//Hoernle et al., 2008. Nature, 451,1094-1098 (This study was supported by National Natural Science Foundation of China (NSFC nos. 41296030 and 41322036, and IODP-China.)

Seasonal influenza vaccine dose distribution in 157 countries (2004-2011).

PubMed

Palache, Abraham; Oriol-Mathieu, Valerie; Abelin, Atika; Music, Tamara

2014-11-12

Globally there are an estimated 3-5 million cases of severe influenza illness every year, resulting in 250,000-500,000 deaths. At the World Health Assembly in 2003, World Health Organization (WHO) resolved to increase influenza vaccine coverage rates (VCR) for high-risk groups, particularly focusing on at least 75% of the elderly by 2010. But systematic worldwide data have not been available to assist public health authorities to monitor vaccine uptake and review progress toward vaccination coverage targets. In 2008, the International Federation of Pharmaceutical Manufacturers and Associations Influenza Vaccine Supply task force (IFPMA IVS) developed a survey methodology to assess global influenza vaccine dose distribution. The current survey results represent 2011 data and demonstrate the evolution of the absolute number distributed between 2004 and 2011 inclusive, and the evolution in the per capita doses distributed in 2008-2011. Global distribution of IFPMA IVS member doses increased approximately 86.9% between 2004 and 2011, but only approximately 12.1% between 2008 and 2011. The WHO's regions in Eastern Mediterranean (EMRO), Southeast Asian (SEARO) and Africa (AFRO) together account for about 47% of the global population, but only 3.7% of all IFPMA IVS doses distributed. While distributed doses have globally increased, they have decreased in EURO and EMRO since 2009. Dose distribution can provide a reasonable proxy of vaccine utilization. Based on the dose distribution, we conclude that seasonal influenza VCR in many countries remains well below the WHA's VCR targets and below the recommendations of the Council of the European Union in EURO. Inter- and intra-regional disparities in dose distribution trends call into question the impact of current vaccine recommendations at achieving coverage targets. Additional policy measures, particularly those that influence patients adherence to vaccination programs, such as reimbursement, healthcare provider knowledge, attitudes, practices, and communications, are required for VCR targets to be met and benefit public health. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Influenza-Associated Hospitalizations, Singapore, 2004–2008 and 2010–2012

PubMed Central

Lim, Cindy; Lee, Vernon Jian Ming; Ma, Stefan; Tiong, Wei Wei; Ooi, Peng Lim; Lin, Raymond Tzer Pin; James, Lyn; Cutter, Jeffery

2014-01-01

Studies of influenza-associated hospitalizations in tropical settings are lacking. To increase understanding of the effect of influenza in Singapore, we estimated the age-specific influenza-associated hospitalizations for pneumonia and influenza during 2004–2008 and 2010–2012. The rate of hospitalization was 28.3/100,000 person-years during 2004–2008 and 29.6/100,000 person-years during 2010–2012. The age-specific influenza-associated hospitalization rates followed a J-shaped pattern: rates in persons >75 years of age and in children <6 months of age were >47 times and >26 times higher, respectively, than those for persons 25–44 years of age. Across all ages during these 2 study periods, ≈12% of the hospitalizations for pneumonia and influenza were attributable to influenza. The rates and proportions of hospitalizations for influenza, particularly among the very young and the elderly, are considerable in Singapore and highlight the importance of vaccination in protecting populations at risk. PMID:25275710

ExCEL in Social Work: Excellence in Cancer Education & Leadership An Oncology Social Work Response to the 2008 Institute of Medicine Report

PubMed Central

Otis-Green, Shirley; Jones, Barbara; Zebrack, Brad; Kilburn, Lisa; Altilio, Terry A.; Ferrell, Betty

2014-01-01

ExCEL in Social Work : Excellence in Cancer Education & Leadership was a multi-year National Cancer Institute (NCI)-funded grant for the development and implementation of an innovative educational program for oncology social workers. The program’s curriculum focused upon six core competencies of psychosocial-spiritual support necessary to meet the standard of care recommended by the 2008 Institute of Medicine (IOM) Report: Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The curriculum was delivered through a collaborative partnership between the City of Hope National Medical Center and the two leading professional organizations devoted exclusively to representing oncology social workers - the Association of Oncology Social Work and the Association of Pediatric Oncology Social Workers. Initial findings support the feasibility and acceptability of this tailored leadership skills-building program for participating oncology social workers. PMID:25146345

Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs.

PubMed

Goldhaber-Fiebert, Jeremy D; Babiarz, Kimberly S; Garfield, Rachel L; Wulczyn, Fred; Landsverk, John; Horwitz, Sarah M

2014-04-01

U.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26 billion annually. Out-of-home foster care is a critical and expensive Child Welfare service, a major component of which is the maintenance rate paid to support housing and caring for a foster child. Maintenance rates vary widely across states and over time, but reasons for this variation are not well understood. As evidence-based programs are disseminated to state Child Welfare systems, it is important to understand what may be the important drivers in the uptake of these practices including state spending on core system areas. We assembled a unique, longitudinal, state-level panel dataset (1990-2008) for all 50 states with annual data on foster care maintenance rates and measures of child population in need, poverty, employment, urbanicity, proportion minority, political party control of the state legislature and governorship, federal funding, and lawsuits involving state foster care systems. All monetary values were expressed in per-capita terms and inflation adjusted to 2008 dollars. We used longitudinal panel regressions with robust standard errors and state and year fixed effects to estimate the relationship between state foster care maintenance rates and the other factors in our dataset, lagging all factors by one year to mitigate the possibility that maintenance rates influenced their predictors. Exploratory analyses related maintenance rates to Child Welfare outcomes. State foster care maintenance rates have increased in nominal terms, but in many states, have not kept pace with inflation, leading to lower real rates in 2008 compared to those in 1991 for 54% of states for 2 year-olds, 58% for 9 year-olds, and 65% for 16 year-olds. In multivariate analyses including socioeconomic, demographic, and political factors, monthly foster care maintenance rates declined $15 for each 1% increase in state unemployment and declined $40 if a state's governorship and legislature became Republican, though significance was marginal. In analyses also examining state revenue, federal funding, and legal challenges, maintenance rates increased as the federal share of maximum TANF payments increased. However, >50% of variation in foster care maintenance rates was explained by unobserved state-level factors as measured by state fixed effects. These factors did not appear to be strongly related to 2008 Child Welfare outcomes like foster care placement stability and maltreatment which were also not correlated with foster care maintenance rates. Despite being part of a social safety net, foster care maintenance rates have declined in real terms since 1991 in many states, and there is no strong evidence that they increase in response to harsher economic climates or to federal programs or legal reviews. State variation in maintenance rates was not related to Child Welfare outcomes, though further analysis of this important relationship is needed. Variability in state foster care maintenance rates appears highly idiosyncratic, an important contextual factor to consider when designing and disseminating evidence-based services.

What Is the Rabies Risk for My Pet?

MedlinePlus

... Dogs Reported in the United States, 2008 Rabid Cattle Reported in the United States, 2008 Terrestrial Rabies ... Texas December 23, 2005: Rabies in a Dairy Cow; Oklahoma November 15, 2004: Clinician Information Line July ...

What Are the Signs and Symptoms of Rabies?

MedlinePlus

... Dogs Reported in the United States, 2008 Rabid Cattle Reported in the United States, 2008 Terrestrial Rabies ... Texas December 23, 2005: Rabies in a Dairy Cow; Oklahoma November 15, 2004: Clinician Information Line July ...

Driving Forces of Dynamic Changes in Soil Erosion in the Dahei Mountain Ecological Restoration Area of Northern China Based on GIS and RS

PubMed Central

Li, Xiao; Niu, Xiang; Wang, Bing; Gao, Peng; Liu, Yu

2016-01-01

Dynamic change in soil erosion is an important focus of regional ecological restoration research. Here, the dynamic changes of soil erosion and its driving forces in the Dahei Mountain ecological restoration area of northern China were analyzed by LANDSAT TM remote sensing captured via geographic information system (GIS) technologies during three typical periods in 2004, 2008 and 2013. The results showed the following: (1) a decrease in intensive erosion and moderate erosion areas, as well as an increase in light erosion areas, was observed during two periods: one from 2004 to 2008 and the other from 2008 to 2013. (2) Between 2004 and 2008, the variation in the range of slight erosion was the largest (24.28%), followed by light erosion and intensive erosion; between 2008 and 2013, the variation in the range of intensive erosion area was the largest (9.89%), followed by slight erosion and moderate erosion. (3) Socioeconomic impact, accompanied by natural environmental factors, was the main driving force underlying the change in soil erosion within the ecological restoration area. In particular, the socioeconomic factors of per capita forest area and land reclamation rate, as well as the natural environmental factor of terrain slope, significantly influenced soil erosion changes within the ecological restoration area. PMID:26981637

The Take-Up of Employer-Sponsored Insurance Among Americans with Mental Disorders: Implications for Health Care Reform.

PubMed

Zuvekas, Samuel H

2015-07-01

Little is known about how take-up of private health insurance coverage differs between those with and without mental disorders. This study seeks to fill this gap by using data from the 2004-2008 Medical Expenditure Panel Survey to examine differences in offers and take-up of employer-sponsored insurance (ESI) among adults aged 27-54. Little evidence that mental disorders are associated with take-up of offers of ESI coverage was found. This suggests that take-up rates in the Affordable Care Act (ACA) marketplaces by those with and without mental disorders may be similar. The ACA is especially important to Americans with mental disorders, many of whom lack access to ESI coverage to pay for mental health treatment either through their own job or through a spouse's job.

Awareness of the Food and Drug Administration's Bad Ad Program and Education Regarding Pharmaceutical Advertising: A National Survey of Prescribers in Ambulatory Care Settings.

PubMed

O'Donoghue, Amie C; Boudewyns, Vanessa; Aikin, Kathryn J; Geisen, Emily; Betts, Kevin R; Southwell, Brian G

2015-01-01

The U.S. Food and Drug Administration's Bad Ad program educates health care professionals about false or misleading advertising and marketing and provides a pathway to report suspect materials. To assess familiarity with this program and the extent of training about pharmaceutical marketing, a sample of 2,008 health care professionals, weighted to be nationally representative, responded to an online survey. Approximately equal numbers of primary care physicians, specialists, physician assistants, and nurse practitioners answered questions concerning Bad Ad program awareness and its usefulness, as well as their likelihood of reporting false or misleading advertising, confidence in identifying such advertising, and training about pharmaceutical marketing. Results showed that fewer than a quarter reported any awareness of the Bad Ad program. Nonetheless, a substantial percentage (43%) thought it seemed useful and 50% reported being at least somewhat likely to report false or misleading advertising in the future. Nurse practitioners and physician assistants expressed more openness to the program and reported receiving more training about pharmaceutical marketing. Bad Ad program awareness is low, but opportunity exists to solicit assistance from health care professionals and to help health care professionals recognize false and misleading advertising. Nurse practitioners and physician assistants are perhaps the most likely contributors to the program.

Psychosocial Care for Adult and Child Survivors of the 2004 Tsunami Disaster in India

PubMed Central

Becker, Susan M.

2006-01-01

The tsunami disaster in South Asia affected the mental health of thousands of survivors, but psychological aspects of rehabilitation are frequently overlooked in public health initiatives. From January to March 2005, teams from the National Institute of Mental Health and Neurosciences in Bangalore, India, traveled to south India and implemented a “train the trainer” community-based mental health program of psychosocial care to facilitate the recovery of child and adult survivors. Psychosocial care has applications to natural and man-made disasters in developing countries. PMID:16809599

Group interventions for patients with cancer and HIV disease: part IV. Clinical and policy recommendations.

PubMed

Leszcz, Molyn; Sherman, Allen; Mosier, Julie; Burlingame, Gary M; Cleary, Trish; Ulman, Kathleen Hubbs; Simonton, Stephanie; Latif, Umaira; Strauss, Bernhard; Hazelton, Lara

2004-10-01

Group interventions have assumed a growing role in primary prevention and supportive care for cancer and HIV disease. Earlier sections of this Special Report examined empirical findings for these interventions and provided recommendations for future research. The current section offers brief recommendations for service providers, policymakers, and stakeholders. Group services now occupy an increasingly prominent place in primary prevention programs and medical settings. In previous sections of this Special Report (Sherman, Leszcz et al., 2004; Sherman, Mosier et al., 2004a, 2004b) we examined the efficacy of different group interventions at different phases of cancer or HIV disease, considered characteristics of the intervention and the participants that might influence outcomes, and discussed mechanisms of action. Methodological challenges and priorities for future research were highlighted. In this, the final section, we offer brief recommendations for service providers, policymakers, and other stakeholders. We consider some of the barriers that constrain use of empirically-based group interventions and note how these programs might be implemented more widely and effectively.

Remotely sensed imagery revealing the effects of hurricanes Gustav and Ike on coastal Louisiana

USGS Publications Warehouse

Barras, John A.; Brock, John C.; Morton, Robert A.; Travers, Laurinda J.

2010-01-01

Hurricane Gustav, a category 2 storm with 170 kilometers per hour (km/h) winds, approached the Louisiana coast from the south-southeast, making landfall near Cocodrie, La., on September 1, 2008 (Beven and Kimberlain, 2009); Hurricane Ike, a category 2 storm with 175 km/h winds, approached the Texas coast from the southeast, paralleling offshore of the Louisiana coast, before making landfall along the north end of Galveston Island, Tex., on September 13, 2008 (Berg, 2009). Hurricane Ike's large wind field elevated water levels, increasing coastal flooding well before making landfall (Berg, 2009). An initial land area change assessment, based on comparison of Landsat Thematic Mapper (TM) satellite imagery, acquired before 2006 and after the 2008 landfalls of Hurricanes Gustav and Ike and classified to identify land and water, reported that the water area increased by 323 square kilometers (km2) in coastal Louisiana as a result of the storms (Barras, 2009). The land area decrease of 195 km2 was less than the 513 km2 decrease reported between 2004 and 2006 (Barras and others, 2008) after the landfalls of Hurricane Katrina, a strong category 3 storm that made landfall near Buras, La., on August 29, 2005, and Hurricane Rita, a category 3 storm that made landfall just west of Johnsons Bayou, La., on September 29, 2005. The 2004 to 2006 land area decrease is 49 km2 less than the 562 km2 initial change estimate based on satellite imagery obtained two months after the 2005 storms (Barras, 2007a). The comparison area used to identify the 2004 to 2006 land area change matches the extent of historical land and water data used to quantify coastal land loss from 1956 to 2006 (Barras and others, 2008) and is 3,841 km2 less than the 33,457.7 km2 used for Barras (2006) and Barras (2009). The greater comparison area used for the 2006 to 2008 period (Barras, 2009) resulted in a 2004 to 2006 loss estimate of 525.8 km2, 13.0 km2 greater than the 512.8 km2 estimate reported in Barras (2008).

The effect of performance-volume limit on the DRG based acute care hospital financing in Hungary.

PubMed

Endrei, Dóra; Zemplényi, Antal; Molics, Bálint; Agoston, István; Boncz, Imre

2014-04-01

The aim of our paper is to analyse the effect of the so-called performance volume limit (PVL) financing method on acute hospital care. The data were derived from the nationwide administrative dataset of the National Health Insurance Fund Administration (OEP) covering the period 2003-2008. We analysed the trends in the DRG cost-weights, number of cases, case-mix, and average length of stay. We calculated the average annual reimbursement rate per DRG cost-weight with and without the application of PVL degression according to the hospital type and medical professions. Our results showed that although the national case mix (i.e., the sum of all of the DRG cost-weights produced in one year) did not change between 2003-2006, the trend of the annual number of cases increased, and the average length of stay decreased. During 2007-2008, a significant decline was found in each indicator. The introduction of the PVL resulted in a health insurance budget saving of 1.9% in 2004, 2.6% in 2005, 3.4% in 2006, 5.6% in 2007, and 3.2% in 2008. We found the lowest reimbursement rate per DRG cost-weight at the university medical schools (HUF 138,200 or € 550) and children's hospitals (HUF 132,547 or € 528), whereas the highest was at the county hospitals (HUF 143,451 or € 571) and city hospitals (HUF 142, 082 or € 565). The implementation of the PVL reduced the acute care hospital activity and reimbursement. The effect of the PVL was different on the different types of hospitals, and it had a serious disadvantageous effect on the university medical schools and children's hospitals. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Practice patterns of graduates of 2- and 3-year family medicine programs: in Ontario, 1996 to 2004.

PubMed

Green, Michael; Birtwhistle, Richard; Macdonald, Ken; Kane, John; Schmelzle, Jason

2009-09-01

To compare patterns of practice between graduates of core 2-year family medicine (FM) training programs and those completing an additional postgraduate year (PGY3) of training. Retrospective cohort study using administrative data from the Ontario Health Insurance Plan. Ontario. Graduates of Ontario FM residency programs from 1996 to 2002 who provided insured services in Ontario for 1 or more fiscal years between 1996 and 2004. Proportion of physician years of service in which a minimum number of services were provided in each of the following categories: anesthesia, emergency medicine (EM), home visits, hospital visits, nursing home visits, intrapartum obstetrics, palliative care, office-only practice, and rural locations, as well as deciles for proportion of billings for emergency department work and "quasi-specialty" designations based on billing patterns. Results are stratified by type of training and years in practice. Graduates of PGY3 programs are significantly more likely to practise in a range of nonoffice settings than their counterparts who completed core 2-year FM training programs. Differences were the most marked in areas in which additional training had been undertaken, but also extended to other categories. There was no effect on the proportion practising in rural locations, unless the training was undertaken in a rural setting or in anesthesia. Physicians including EM in their practices were more likely to practise mostly or almost all EM if they had undertaken either EM programs or self-directed programs at non-northern training sites. Very few graduates of any type were classified as belonging to a quasi-specialty group, other than those who completed care of the elderly or palliative care (hospitalist) and anesthesia programs. Completion of a PGY3 program is strongly associated with increased participation in practice outside the office, particularly in the area of the training provided.

Sex Differences in Reported Concussion Injury Rates and Time Loss From Participation: An Update of the National Collegiate Athletic Association Injury Surveillance Program From 2004-2005 Through 2008-2009.

PubMed

Covassin, Tracey; Moran, Ryan; Elbin, R J

2016-03-01

Epidemiologic studies have identified differences in concussion incidence between the sexes. However, few authors to date have updated injury rates (IRs) and time loss between male and female concussed athletes. To examine sex differences in IRs and time loss in concussed National Collegiate Athletic Association (NCAA) athletes. Descriptive epidemiologic study. National Collegiate Athletic Association athletics. A total of 1702 concusssed NCAA athletes, consisting of 903 females and 779 males participating in soccer, basketball, ice hockey, lacrosse, softball, or baseball over a 5-year period from 2004-2005 through 2008-2009. Using the NCAA Injury Surveillance Program, athletic trainers reported concussions, athlete-exposures (AEs), and time loss across 10 NCAA sports. An IR is the number of injuries in a particular category divided by the number of AEs in that category. During the study period, 1702 concussions were reported during 4 170 427 AEs for an overall total of 5.47 per 10 000 AEs. In sex-comparable sports, females had a 1.4 times higher overall concussion IR than males (IRs = 4.84 and 3.46, respectively), with greater rates in women's baseball/softball, basketball, ice hockey, and soccer than men. Female soccer and basketball players also displayed more time loss after concussion compared with male basketball and soccer players. Female athletes sustained a higher rate of concussion and, in all sports except lacrosse, had greater time loss from concussion than male athletes. Additional research is needed on sex differences in time loss after concussions.

Cecal intubation rates in different eras of endoscopic technological development

PubMed Central

Pasternak, Artur; Szura, Mirosław; Pędziwiatr, Michał; Major, Piotr; Rembiasz, Kazimierz

2018-01-01

Introduction Colonoscopy plays a critical role in colorectal cancer (CRC) screening and has been widely regarded as the gold standard. Cecal intubation rate (CIR) is one of the well-defined quality indicators used to assess colonoscopy. Aim To assess the impact of new technologies on the quality of colonoscopy by assessing completion rates. Material and methods This was a dual-center study at the 2nd Department of Surgery at Jagiellonian University Medical College and at the Specialist Center “Medicina” in Krakow, Poland. The CIR and cecal intubation time (CIT) in three different eras of technological advancement were determined. The study enrolled 27 463 patients who underwent colonoscopy as part of a national CRC screening program. The patients were divided into three groups: group I – 3408 patients examined between 2000 and 2003 (optical endoscopes); group II – 10 405 patients examined between 2004 and 2008 (standard electronic endoscopes); and group III – 13 650 patients examined between 2009 and 2014 (modern endoscopes). Results There were statistically significant differences in the CIR between successive eras. The CIR in group I (2000–2003) was 69.75%, in group II (2004–2008) was 92.32%, and in group III (2009–2014) was 95.17%. The mean CIT was significantly reduced in group III. Conclusions Our study shows that the technological innovation of novel endoscopy devices has a great influence on the effectiveness of the CRC screening program. The new era of endoscopic technological development has the potential to reduce examination-related patient discomfort, obviate the need for sedation and increase diagnostic yields. PMID:29643961

Rabies: What If I Receive Treatment Outside the United States?

MedlinePlus

... Dogs Reported in the United States, 2008 Rabid Cattle Reported in the United States, 2008 Terrestrial Rabies ... Texas December 23, 2005: Rabies in a Dairy Cow; Oklahoma November 15, 2004: Clinician Information Line July ...

Comparison of clinical features and outcomes of medically attended influenza A and influenza B in a defined population over four seasons: 2004-2005 through 2007-2008.

PubMed

Irving, Stephanie A; Patel, Darshan C; Kieke, Burney A; Donahue, James G; Vandermause, Mary F; Shay, David K; Belongia, Edward A

2012-01-01

There are few prospectively collected data comparing illnesses caused by different subtypes of influenza. We compared the clinical presentation and outcomes of subjects with primarily outpatient-attended influenza A and B infections during four consecutive influenza seasons (2004-2005 through 2007-2008). Patients were prospectively enrolled and tested for influenza following an encounter for acute respiratory illness. Influenza infections were confirmed by culture or reverse transcription polymerase chain reaction; subtype was determined for a sample of influenza A isolates each season. Clinical characteristics of influenza A and B infections were compared across and within individual seasons. We identified 901 cases of influenza A and 284 cases of influenza B; 98% of cases were identified through an outpatient medical encounter. Thirty-six percent of patients with each strain had received seasonal influenza vaccine prior to illness onset. There were no consistent differences in symptoms associated with influenza A and B. Influenza A infection was associated with earlier care seeking compared with influenza B during the 2005-2006 and 2007-2008 seasons, when H3N2 was the dominant type A virus, and in a combined analysis that included all seasons. Twenty-six (2·2%) of 1185 cases were diagnosed with radiographically confirmed pneumonia, and 59 (5%) of 1185 patients were hospitalized within 30 days of illness onset. Over four influenza seasons, aside from shorter intervals from illness onset to clinical encounter for infections with the A(H3N2) subtype, clinical symptoms and outcomes were similar for patients with predominantly outpatient-attended influenza A and B infections. © 2011 Blackwell Publishing Ltd.

HIV drug resistance early warning indicators in cohorts of individuals starting antiretroviral therapy between 2004 and 2009: World Health Organization global report from 50 countries.

PubMed

Bennett, Diane E; Jordan, Michael R; Bertagnolio, Silvia; Hong, Steven Y; Ravasi, Giovanni; McMahon, James H; Saadani, Ahmed; Kelley, Karen F

2012-05-01

The World Health Organization developed a set of human immunodeficiency virus drug resistance (HIVDR) early warning indicators (EWIs) to assess antiretroviral therapy clinic and program factors associated with HIVDR. EWIs are monitored by abstracting data routinely recorded in clinical records, and the results enable clinics and program managers to identify problems that should be addressed to minimize preventable emergence of HIVDR in clinic populations. As of June 2011, 50 countries monitored EWIs, covering 131 686 patients initiating antiretroviral treatment between 2004 and 2009 at 2107 clinics. HIVDR prevention is associated with patient care (appropriate prescribing and patient monitoring), patient behavior (adherence), and clinic/program management efforts to reduce treatment interruptions (follow up, retention on first-line ART, procurement and supply management of antiretroviral drugs). EWIs measure these factors and the results have been used to optimize patient and population treatment outcomes.

The cardiocerebral resuscitation protocol for treatment of out-of-hospital primary cardiac arrest.

PubMed

Ewy, Gordon A

2012-09-15

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol.

The Cardiocerebral Resuscitation protocol for treatment of out-of-hospital primary cardiac arrest

PubMed Central

2012-01-01

Out-of-hospital cardiac arrest (OHCA) is a significant public health problem in most westernized industrialized nations. In spite of national and international guidelines for cardiopulmonary resuscitation and emergency cardiac care, the overall survival of patients with OHCA was essentially unchanged for 30 years--from 1978 to 2008 at 7.6%. Perhaps a better indicator of Emergency Medical System (EMS) effectiveness in treating patients with OHCA is to focus on the subgroup that has a reasonable chance of survival, e.g., patients found to be in ventricular fibrillation (VF). But even in this subgroup, the average survival rate was 17.7% in the United States, unchanged between 1980 and 2003, and 21% in Europe, unchanged between 1980 and 2004. Prior to 2003, the survival of patients with OHCA, in VF in Tucson, Arizona was less than 9% in spite of incorporating previous guideline recommendations. An alternative (non-guidelines) approach to the therapy of patients with OHCA and a shockable rhythm, called Cardiocerebral Resuscitation, based on our extensive physiologic laboratory studies, was introduced in Tucson in 2003, in rural Wisconsin in 2004, and in selected EMS areas in the metropolitan Phoenix area in 2005. Survival of patients with OHCA due to VF treated with Cardiocerebral Resuscitation in rural Wisconsin increased to 38% and in 60 EMS systems in Arizona to 39%. In 2004, we began a statewide program to advocate chest compression-only CPR for bystanders of witnessed primary OHCA. Over the next five years, we found that survival of patients with a shockable rhythm was 17.7% in those treated with standard bystander CPR (mouth-to-mouth ventilations plus chest compression) compared to 33.7% for those who received bystander chest-compression-only CPR. This article on Cardiocerebral Resuscitation, by invitation following a presentation at the 2011 Danish Society Emergency Medical Conference, summarizes the results of therapy of patients with primary OHCA treated with Cardiocerebral Resuscitation, with requested emphasis on the EMS protocol. PMID:22980487

Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study.

PubMed

Pierrat, Veronique; Coquelin, Anaëlle; Cuttini, Marina; Khoshnood, Babak; Glorieux, Isabelle; Claris, Olivier; Durox, Mélanie; Kaminski, Monique; Ancel, Pierre-Yves; Arnaud, Catherine

2016-10-01

To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. Prospective national cohort study of all births before 32 weeks of gestation. Twenty-five French regions. All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). None. Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p < 0.001). Individual factors associated with kangaroo care initiation were gestational age (odds ratio, 5.79; 95% CI, 4.49-7.48 for babies born at 27-31 wk compared with babies born at 23-26 wk) and, to a lesser extent, single pregnancy, birthweight above the 10th centile, and mother's employment before pregnancy. At unit level, policies and training in neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p < 0.0001). Dissemination of neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies.

Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

PubMed

Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud

2017-01-01

Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities.

Lessons learned from employee fitness programs at the Marshfield Clinic.

PubMed

McCarty, Catherine A; Scheuer, Dave

2005-07-01

To describe and evaluate employee fitness programs at the Marshfield Clinic. A 16-week program was offered to employees from April-July 2004, and a 12-week program was offered from August-November, 2004. Weekly e-mails included suggestions to increase physical activity and eat a healthy diet. Incentives were offered for meeting program goals. A total of 1129 employees signed up for the first program (approximately 18% of all employees) and 610 for the second program. More than 95% of the participants in both programs were female. The activity program goal was met by 231 (20.5%) participants in the first program and 31% (n = 190) of participants in the second program. There was a significant increase in the percent of people with good or excellent fitness levels from baseline (46.4%, 95% CL = 40.5, 52.3) to follow-up (70.7%, 95% CL = 65.3, 76.0) in the first program. In the second program, there was a significant association between the number of program goals met and self-report of having increased energy, better weight control, and feeling better overall and about body image. Emphasis in future programs should be placed on increasing employee participation. Program evaluation could be expanded to include health care costs and employee absenteeism.

Group B Streptococcus prophylaxis in patients who report a penicillin allergy: a follow-up study.

PubMed

Critchfield, Agatha S; Lievense, Stacey P; Raker, Christina A; Matteson, Kristen A

2011-02-01

The purpose of this study was to compare adherence to the 2002 Centers for Disease Control (CDC) guidelines for the prevention of perinatal group B Streptococcus (GBS) disease in patients who are allergic to penicillin during the years 2004-2006 and 2008. Previous data from our institution revealed suboptimal adherence to the 2002 CDC guidelines for GBS prophylaxis among women who are allergic to penicillin. These data caused the hospital to implement a series of interventions. The original cohort (2004-2006) was compared with a cohort of women who delivered between April 2008 and January 2009 (n = 74) to determine whether the proportion of women who had antimicrobial sensitivity testing and who had received an appropriate antibiotic had improved. In 2008, 76% (95% confidence interval, 66-84%) of GBS-positive women who are allergic to penicillin received an appropriate antibiotic (compared with 16.2% in 2004-2006; P < .001). Antimicrobial sensitivity testing was performed in 79.4% of cases (95% confidence interval, 68-87%), compared with 11.4% in 2004-2006 (P < .001). With directed intervention, adherence to the 2002 CDC guidelines for GBS prophylaxis in women who are allergic to penicillin improved dramatically. Copyright © 2011 Mosby, Inc. All rights reserved.

Hawaii Island Groundwater Flow Model

DOE Data Explorer

Nicole Lautze

2015-01-01

Groundwater flow model for Hawaii Island. Data is from the following sources: Whittier, R.B., K. Rotzoll, S. Dhal, A.I. El-Kadi, C. Ray, G. Chen, and D. Chang. 2004. Hawaii Source Water Assessment Program Report – Volume II – Island of Hawaii Source Water Assessment Program Report. Prepared for the Hawaii Department of Health, Safe Drinking Water Branch. University of Hawaii, Water Resources Research Center. Updated 2008; and Whittier, R. and A.I. El-Kadi. 2014. Human and Environmental Risk Ranking of Onsite Sewage Disposal Systems For the Hawaiian Islands of Kauai, Molokai, Maui, and Hawaii – Final. Prepared by the University of Hawaii, Dept. of Geology and Geophysics for the State of Hawaii Dept. of Health, Safe Drinking Water Branch. September 2014.

East Maui Groundwater Flow Model

DOE Data Explorer

Nicole Lautze

2015-01-01

Groundwater flow model for East Maui. Data is from the following sources: Whittier, R. and A.I. El-Kadi. 2014. Human and Environmental Risk Ranking of Onsite Sewage Disposal Systems For the Hawaiian Islands of Kauai, Molokai, Maui, and Hawaii – Final. Prepared by the University of Hawaii, Dept. of Geology and Geophysics for the State of Hawaii Dept. of Health, Safe Drinking Water Branch. September 2014; and Whittier, R.B., K. Rotzoll, S. Dhal, A.I. El-Kadi, C. Ray, G. Chen, and D. Chang. 2004. Hawaii Source Water Assessment Program Report – Volume V – Island of Maui Source Water Assessment Program Report. Prepared for the Hawaii Department of Health, Safe Drinking Water Branch. University of Hawaii, Water Resources Research Center. Updated 2008.

West Maui Groundwater Flow Model

DOE Data Explorer

Nicole Lautze

2015-01-01

Groundwater flow model for West Maui. Data is from the following sources: Whittier, R. and A.I. El-Kadi. 2014. Human and Environmental Risk Ranking of Onsite Sewage Disposal Systems For the Hawaiian Islands of Kauai, Molokai, Maui, and Hawaii – Final. Prepared by the University of Hawaii, Dept. of Geology and Geophysics for the State of Hawaii Dept. of Health, Safe Drinking Water Branch. September 2014; and Whittier, R.B., K. Rotzoll, S. Dhal, A.I. El-Kadi, C. Ray, G. Chen, and D. Chang. 2004. Hawaii Source Water Assessment Program Report – Volume V – Island of Maui Source Water Assessment Program Report. Prepared for the Hawaii Department of Health, Safe Drinking Water Branch. University of Hawaii, Water Resources Research Center. Updated 2008.

Incidence and prevalence of idiopathic inflammatory myopathies among commercially insured, Medicare supplemental insured, and Medicaid enrolled populations: an administrative claims analysis

PubMed Central

2012-01-01

Background Idiopathic inflammatory myopathies (IIMs) are a rare group of autoimmune syndromes characterized by chronic muscle inflammation and muscle weakness with no known cause. Little is known about their incidence and prevalence. This study reports the incidence and prevalence of IIMs among commercially insured and Medicare and Medicaid enrolled populations in the US. Methods We retrospectively examined medical claims with an IIM diagnosis (ICD-9-CM 710.3 [dermatomyositis (DM)], 710.4 [polymyositis (PM)], 728.81[interstitial myositis]) in the MarketScan® databases to identify age- and gender-adjusted annual IIM incidence and prevalence for 2004–2008. Sensitivity analysis was performed for evidence of a specialist visit (rheumatologist/ neurologist/dermatologist), systemic corticosteroid or immunosuppressant use, or muscle biopsy. Results We identified 2,990 incident patients between 2004 and 2008 (67% female, 17% Medicaid enrollees, 27% aged ≥65 years). Overall adjusted IIM incidence for 2004–2008 for commercial and Medicare supplemental groups combined were 4.27 cases (95% CI, 4.09-4.44) and for Medicaid, 5.23 (95% CI 4.74-5.72) per 100,000 person-years (py). Disease sub-type incidence rates per 100,000-py were 1.52 (95% CI 1.42-1.63) and 1.70 (1.42-1.97) for DM, 2.46 (2.33-2.59) and 3.53 (3.13-3.94) for PM, and 0.73 (0.66-0.81) and 0.78 (0.58-0.97) for interstitial myositis for the commercial/Medicare and Medicaid cohorts respectively. Annual incidence fluctuated over time with the base MarketScan populations. There were 7,155 prevalent patients, with annual prevalence ranging from 20.62 to 25.32 per 100,000 for commercial/Medicare (83% of prevalent cases) and from 15.35 to 32.74 for Medicaid. Conclusions We found higher IIM incidence than historically reported. Employer turnover, miscoding and misdiagnosing, care seeking behavior, and fluctuations in database membership over time can influence the results. Further studies are needed to confirm the incidence and prevalence of IIM. PMID:22703603

The Sixth Great Mass Extinction

ERIC Educational Resources Information Center

Wagler, Ron

2012-01-01

Five past great mass extinctions have occurred during Earth's history. Humanity is currently in the midst of a sixth, human-induced great mass extinction of plant and animal life (e.g., Alroy 2008; Jackson 2008; Lewis 2006; McDaniel and Borton 2002; Rockstrom et al. 2009; Rohr et al. 2008; Steffen, Crutzen, and McNeill 2007; Thomas et al. 2004;…

What Parents Expect of Urban Alternative Schools and How These Schools Address Parents' Expectations to Make Needed Changes

ERIC Educational Resources Information Center

Gibson, Shirley Kaye

2010-01-01

Several studies have examined parent expectations of schools in general (Gewertz, 2008; Carney-Hall, 2008; Keller, 2008; Stelmach, 2005; Boal, 2004; Lawson 2003; Wherry, 2003; Cheney, 2002; Bomotti, 1996; Epstein & Hollifield, 1996). Other studies have more specifically addressed parents' expectations of urban schools and their reasons for…

The future of financing for HIV services in Uganda and the wider sub-Saharan Africa region: should we ask patients to contribute to the cost of their care?

PubMed

Kakaire, Tom; Schlech, Walter; Coutinho, Alex; Brough, Richard; Parkes-Ratanshi, Rosalind

2016-08-27

Whilst multi-lateral funding for HIV/AIDS dramatically increased from 2004 to 2008, it has largely plateaued in the last 8 years. Across sub-Saharan Africa, up to 20 % of total spending on health is used for HIV services, and of this over 85 % is estimated to come from international funding rather than in-country sources. In Uganda, the fiscal liability to maintain services for all those who are currently receiving it is estimated to be as much as 3 % of Gross Domestic Product (GDP). In order to meet the growing need of increased patient numbers and further ART coverage the projected costs of comprehensive HIV care and treatment services will increase substantially. Current access to HIV care includes free at point of delivery (provided by Ministry of Health clinics), as well as out-of-pocket financing and health insurance provided care at private for- and not for- profit facilities. The HIV response is funded through Ugandan Ministry of Health national budget allocations, as well as multilateral donations such as the President's Emergency Plan for AIDS in Africa (PEPFAR) and Global Fund (GF) and other international funders. We are concerned that current funding mechanism for HIV programs in Uganda may be difficult to sustain and as service providers we are keen to explore ways in which provide lifelong HIV care to as many people living with HIV (PLHIV) as possible. Until such time as the Ugandan economy can support universal, state-supported, comprehensive healthcare, bridging alternatives must be considered. We suggest that offering patients with the sufficient means to assume some of the financial burden for their care in return for more convenient services could be one component of increasing coverage and sustaining services for those living with HIV.

Rethinking collegiality: restratification in English general medical practice 2004-2008.

PubMed

McDonald, Ruth; Checkland, Kath; Harrison, Stephen; Coleman, Anna

2009-04-01

For Freidson [(1985). The reorganisation of the medical profession. Medical Care Review, 42(1), 11-35], collegiality, or ostensible equal status amongst members of the medical profession, serves a dual purpose. It socialises members into an attitude of loyalty to colleagues and presents an image to those outside the profession that all its members are competent and trustworthy. However, Freidson saw the use of formal standards developed by one (knowledge) elite within medicine and enforced by another (administrative) elite as threatening collegiality and professional unity. Drawing on two studies in English primary medical care this paper reports the emergence of new strata or elites, with groups of doctors involved in surveillance of others and action to improve compliance in deficient individuals and organizations. Early indications are that these developments have not led to the consequences which Freidson predicted. The increasing acceptance of the legitimacy of professional scrutiny and accountability that we identify suggests that new norms are emerging in English primary medical care, the possibility of which Freidson's analysis fails to take account.

Preparing medical students to care for older adults: the impact of a Senior Mentor Program.

PubMed

Eleazer, G Paul; Wieland, Darryl; Roberts, Ellen; Richeson, Nancy; Thornhill, Joshua T

2006-04-01

To provide alternative training experiences for medical students to improve the competencies needed to provide care for older adults. Part of a comprehensive approach to integrating geriatric content at the University of South Carolina (USC) School of Medicine, the Senior Mentor Program (SMP) was launched in 2000. The SMP links pairs of students with older community volunteers in the spring of the first year. Students visit their mentors throughout medical school, and execute assignments that complement materials covered in the traditional curriculum. To evaluate the feasibility and efficacy of the SMP, the authors describe the program's operation and outputs, the extent to which undergraduate medical education at USC and the SMP meet the core competencies for care of older adults promulgated by the American Geriatrics Society (AGS), and analyze the coverage of geriatrics content from 2000 to 2005 at USC, as indicated by responses to the Medical School Graduation Questionnaire. From 2000 to 2005, 379 students enrolled in the SMP; 133 graduates of the classes of 2004 and 2005 have completed the SMP. Students and mentors indicated high acceptance and enthusiasm. The program has been maintained with minimal administrative burden. USC covered only half of AGS competencies before the SMP, but now covers 100%, with nearly a third met specifically through the SMP. USC graduates reporting inclusion of geriatrics throughout their four years of training rose from 66% in 2002 to 96% in 2004-05. The SMP has had a substantial impact on students' preparation for dealing with an aging patient population.

Improvement and modification of the routing system for the health-care waste collection and transportation in Istanbul

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

Alagoez, Aylin Zeren; Kocasoy, Guenay

Handling of health-care wastes is among the most important environmental problems in Turkey as it is in the whole world. Approximately 25-30 tons of health-care wastes, in addition to the domestic and recyclable wastes, are generated from hospitals, clinics and other small health-care institutions daily on the European and the Asian sides of Istanbul [Kocasoy, G., Topkaya, B., Zeren, B.A., Kilic, M., et al., 2004. Integrated Health-care Waste Management in Istanbul, Final Report of the LIFE00 TCY/TR/054 Project, Turkish National Committee on Solid Wastes, Istanbul, Turkey; Zeren, B.A., 2004. The Health-care Waste Management of the Hospitals in the European Sidemore » of Istanbul, M.S. Thesis, Bogazici University, Istanbul, Turkey; Kilic, M., 2004. Determination of the Health-care Waste Handling and Final Disposal of the Infected Waste of Hospital-Medical Centers in the Anatolian Side of Istanbul. M.S. Thesis, Bogazici University, Istanbul, Turkey]. Unfortunately, these wastes are not handled, collected or temporarily stored at the institutions properly according to the published Turkish Medical Waste Control Regulation [Ministry of Environment and Forestry, 2005. Medical Waste Control Regulation. Official Gazette No. 25883, Ankara, Turkey]. Besides the inappropriate handling at the institutions, there is no systematic program for the transportation of the health-care wastes to the final disposal sites. The transportation of these wastes is realized by the vehicles of the municipalities in an uncontrolled, very primitive way. As a consequence, these improperly managed health-care wastes cause many risks to the public health and people who handle them. This study has been conducted to develop a health-care waste collection and transportation system for the city of Istanbul, Turkey. Within the scope of the study, the collection of health-care wastes from the temporary storage rooms of the health-care institutions, transportation of these wastes to the final disposal areas and the cost-benefit analyses of the existing and the proposed optimum transportation routes are investigated and the most feasible routes from the point of view of efficiency and economy have been determined. In order to solve the scheduling and route optimization problem, special software programs called MapInfo and Roadnet were used. For the program, the geocodes of hospital locations, data about the amount of the health-care wastes generated, the loading and unloading process times, and the capacity of the collecting vehicles were taken into account. The new systems developed aim at the daily collection of the health-care wastes from the institutions and their transportation directly to the final disposal area/facility by using the shortest and the most efficient routes to resolve the routing and scheduling problem and to reduce the cost arising from the transportation.« less

Improvement and modification of the routing system for the health-care waste collection and transportation in Istanbul.

PubMed

Alagöz, Aylin Zeren; Kocasoy, Günay

2008-01-01

Handling of health-care wastes is among the most important environmental problems in Turkey as it is in the whole world. Approximately 25-30tons of health-care wastes, in addition to the domestic and recyclable wastes, are generated from hospitals, clinics and other small health-care institutions daily on the European and the Asian sides of Istanbul [Kocasoy, G., Topkaya, B., Zeren, B.A., Kiliç, M., et al., 2004. Integrated Health-care Waste Management in Istanbul, Final Report of the LIFE00 TCY/TR/054 Project, Turkish National Committee on Solid Wastes, Istanbul, Turkey; Zeren, B.A., 2004. The Health-care Waste Management of the Hospitals in the European Side of Istanbul, M.S. Thesis, Boğaziçi University, Istanbul, Turkey; Kiliç, M., 2004. Determination of the Health-care Waste Handling and Final Disposal of the Infected Waste of Hospital-Medical Centers in the Anatolian Side of Istanbul. M.S. Thesis, Boğaziçi University, Istanbul, Turkey]. Unfortunately, these wastes are not handled, collected or temporarily stored at the institutions properly according to the published Turkish Medical Waste Control Regulation [Ministry of Environment and Forestry, 2005. Medical Waste Control Regulation. Official Gazette No. 25883, Ankara, Turkey]. Besides the inappropriate handling at the institutions, there is no systematic program for the transportation of the health-care wastes to the final disposal sites. The transportation of these wastes is realized by the vehicles of the municipalities in an uncontrolled, very primitive way. As a consequence, these improperly managed health-care wastes cause many risks to the public health and people who handle them. This study has been conducted to develop a health-care waste collection and transportation system for the city of Istanbul, Turkey. Within the scope of the study, the collection of health-care wastes from the temporary storage rooms of the health-care institutions, transportation of these wastes to the final disposal areas and the cost-benefit analyses of the existing and the proposed optimum transportation routes are investigated and the most feasible routes from the point of view of efficiency and economy have been determined. In order to solve the scheduling and route optimization problem, special software programs called MapInfo and Roadnet were used. For the program, the geocodes of hospital locations, data about the amount of the health-care wastes generated, the loading and unloading process times, and the capacity of the collecting vehicles were taken into account. The new systems developed aim at the daily collection of the health-care wastes from the institutions and their transportation directly to the final disposal area/facility by using the shortest and the most efficient routes to resolve the routing and scheduling problem and to reduce the cost arising from the transportation.

Wisconsin's forest, 2004: statistics and quality assurance

Treesearch

Mark H. Hansen; Charles H. Perry; Gary Brand; Ronald E. McRoberts

2008-01-01

The first full, annualized inventory of Wisconsin's forests was completed in 2004 after 6,478 forested plots were visited. An earlier publication summarized the results and presented issue - driven analyses (Perry et al. 2008) . This report includes detailed information on forest inventory methods...

Reviewing progress: 7 year trends in characteristics of adults and children enrolled at HIV care and treatment clinics in the United Republic of Tanzania.

PubMed

Nuwagaba-Biribonwoha, Harriet; Kilama, Bonita; Antelman, Gretchen; Khatib, Ahmed; Almeida, Annette; Reidy, William; Ramadhani, Gongo; Lamb, Matthew R; Mbatia, Redempta; Abrams, Elaine J

2013-10-27

To evaluate the on-going scale-up of HIV programs, we assessed trends in patient characteristics at enrolment and ART initiation over 7 years of implementation. Data were from Optimal Models, a prospective open cohort study of HIV-infected (HIV+) adults (≥15 years) and children (<15 years) enrolled from January 2005 to December 2011 at 44 HIV clinics in 3 regions of mainland Tanzania (Kagera, Kigoma, Pwani) and Zanzibar. Comparative statistics for trends in characteristics of patients enrolled in 2005-2007, 2008-2009 and 2010-2011 were examined. Overall 62,801 HIV + patients were enrolled: 58,102(92.5%) adults, (66.5% female); 4,699(7.5%) children.Among adults, pregnant women enrolment increased: 6.8%, 2005-2007; 12.1%, 2008-2009; 17.2%, 2010-2011; as did entry into care from prevention of mother-to-child HIV transmission (PMTCT) programs: 6.6%, 2005-2007; 9.5%, 2008-2009; 12.6%, 2010-2011. WHO stage IV at enrolment declined: 27.1%, 2005-2007; 20.2%, 2008-2009; 11.1% 2010-2011. Of the 42.5% and 29.5% with CD4+ data at enrolment and ART initiation respectively, median CD4+ count increased: 210 cells/μL, 2005-2007; 262 cells/μL, 2008-2009; 266 cells/μL 2010-2011; but median CD4+ at ART initiation did not change (148 cells/μL overall). Stavudine initiation declined: 84.9%, 2005-2007; 43.1%, 2008-2009; 19.7%, 2010-2011.Among children, median age (years) at enrolment decreased from 6.1(IQR:2.7-10.0) in 2005-2007 to 4.8(IQR:1.9-8.6) in 2008-2009, and 4.1(IQR:1.5-8.1) in 2010-2011 and children <24 months increased from 18.5% to 26.1% and 31.5% respectively. Entry from PMTCT was 7.0%, 2005-2007; 10.7%, 2008-2009; 15.0%, 2010-2011. WHO stage IV at enrolment declined from 22.9%, 2005-2007, to 18.3%, 2008-2009 to 13.9%, 2010-2011. Proportion initiating stavudine was 39.8% 2005-2007; 39.5%, 2008-2009; 26.1%, 2010-2011. Median age at ART initiation also declined significantly. Over time, the proportion of pregnant women and of adults and children enrolled from PMTCT programs increased. There was a decline in adults and children with advanced HIV disease at enrolment and initiation of stavudine. Pediatric age at enrolment and ART initiation declined. Results suggest HIV program maturation from an emergency response.

Fostering Character Education in an Urban Early Childhood Setting

ERIC Educational Resources Information Center

Kokoszka, Carla; Smith, Juliette

2016-01-01

This article describes the character education program in Donald Stewart School No. 51, in Elizabeth, NJ, a dual-language preschool serving 300 students that first opened its doors in 2004. Over the years this school has been committed to laying the foundation of character development with its preschoolers. Their pillar "Friends Care, Friends…

The National Tumor Association Foundation (ANT): A 30 year old model of home palliative care

PubMed Central

2010-01-01

Background Models of palliative care delivery develop within a social, cultural, and political context. This paper describes the 30-year history of the National Tumor Association (ANT), a palliative care organization founded in the Italian province of Bologna, focusing on this model of home care for palliative cancer patients and on its evaluation. Methods Data were collected from the 1986-2008 ANT archives and documents from the Emilia-Romagna Region Health Department, Italy. Outcomes of interest were changed in: number of patients served, performance status at admission (Karnofsky Performance Status score [KPS]), length of participation in the program (days of care provided), place of death (home vs. hospital/hospice), and satisfaction with care. Statistical methods included linear and quadratic regressions. A linear and a quadratic regressions were generated; the independent variable was the year, while the dependent one was the number of patients from 1986 to 2008. Two linear regressions were generated for patients died at home and in the hospital, respectively. For each regression, the R square, the unstandardized and standardized coefficients and related P-values were estimated. Results The number of patients served by ANT has increased continuously from 131 (1986) to a cumulative total of 69,336 patients (2008), at a steady rate of approximately 121 additional patients per year and with no significant gender difference. The annual number of home visits increased from 6,357 (1985) to 904,782 (2008). More ANT patients died at home than in hospice or hospital; this proportion increased from 60% (1987) to 80% (2007). The rate of growth in the number of patients dying in hospital/hospice was approximately 40 patients/year (p < 0.01), vs. approximately 177 patients/year for patients who died at home. The percentage of patients with KPS < 40 at admission decreased from 70% (2003) to 30% (2008); the percentage of patients with KPS > 40 increased. Mean days of care for patients with KPS > 40 exceeded mean days for patients with KPS < 40 (p < 0.001). Patients and caregivers reported high satisfaction with care in each year of assessment; in 2008, among 187 interviewed caregivers, 95% judged the quality of doctors' assistance, and 91% judged the quality of nurses' assistance, to be "optimal." Conclusions The ANT home care model of palliative care delivery has been well-received, with progressively growing numbers of patients served. It has resulted in a greater proportion of home deaths and in patients' accessing palliative care at an earlier point in the disease trajectory. Changes in ANT chronicle palliative care trends in general. PMID:20529310

[Shortened hospital stay for elective cesarean section after initiation of a fast-track program and midwifery home-care].

PubMed

Gunnarsdottir, Johanna; Bjornsdottir, Thorbjörg Edda; Halldorsson, Thorhallur Ingi; Halldorsdottir, Gudrun; Geirsson, Reynir Tomas

2011-07-01

To audit whether hospital stay shortened without increasing readmissions after implementation of fast-track methodology for elective cesarean section and characterize what influences length of stay. A fast-track program was initiated in November 2008, with a one year clinical audit and satisfaction survey. Discharge criteria were predefined and midwife home visits included if discharge was within 48 hours. Hospital stay by parity for women with elective section for singleton pregnancy between 1.11. 2008 - 31.10. 2009 (n=213, fast-track 182) was compared to 2003 (n=199) and 2007 (n=183). Readmissions and outpatient visits 2007 and 2008-9 were counted. Reasons for longer stay were recorded in fast-track, and body mass index. Median hospital stay decreased significantly from 81 to 52 hours between 2007 and 2008-9. Readmissions were four in each period and outpatient visit rates similar. In 2008-9, 66% of all women were discharged within 48 hours. Women in the fast-track program were satisfied with early discharge. Hospital stay for parous women was shorter in 2007 compared to 2003, but unchanged for nulliparas. Parity had a minimal influence on length of stay in 2008-9, although nulliparous women ≤ 25 years were more likely to stay >48 hours. Body mass index did not correlate with length of stay. Pain was rarely the reason for a longer stay in the fast-track program and 90% were satisfied with pain-medication after discharge. Most healthy women can be discharged early after singleton birth by elective cesarean, without increasing readmissions.

Patients With Brain Tumors: Who Receives Postacute Occupational Therapy Services?

PubMed

Chan, Vincy; Xiong, Chen; Colantonio, Angela

2015-01-01

Data on the utilization of occupational therapy among patients with brain tumors have been limited to those with malignant tumors and small samples of patients outside North America in specialized palliative care settings. We built on this research by examining the characteristics of patients with brain tumors who received postacute occupational therapy services in Ontario, Canada, using health care administrative data. Between fiscal years 2004-2005 and 2008-2009, 3,199 patients with brain tumors received occupational therapy services in the home care setting after hospital discharge; 12.4% had benign brain tumors, 78.2% had malignant brain tumors, and 9.4% had unspecified brain tumors. However, patients with benign brain tumors were older (mean age=63.3 yr), and a higher percentage were female (65.2%). More than 90% of patients received in-home occupational therapy services. Additional research is needed to examine the significance of these differences and to identify factors that influence access to occupational therapy services in the home care setting. Copyright © 2015 by the American Occupational Therapy Association, Inc.

The Association between Medicare Advantage Market Penetration and Diabetes in the United States

PubMed Central

Howard, Steven W.; Bernell, Stephanie Lazarus; Wilmott, Jennifer; Casim, M. Faizan; Wang, Jing; Pearson, Lindsey; Byler, Caitlin M.; Zhang, Zidong

2015-01-01

The objective of this study is to explore the extent to which managed care market penetration in the United States is associated with the presence of chronic disease. Diabetes was selected as the chronic disease of interest due to its increasing prevalence as well as the disease management protocols that can lessen disease complications. We hypothesized that greater managed care market penetration would be associated with (1) lower prevalence of diabetes and (2) lower prevalence of diabetes-related comorbidities (DRCs) among diabetics. Data for this analysis came from two sources. We merged Medicare Advantage (MA) market penetration data from the Centers for Medicare and Medicaid Services (CMS) with data from the Medical Expenditure Panel Survey (MEPS) (2004–2008). Results suggest that county-level MA market penetration is not significantly associated with prevalence of diabetes or DRCs. That finding is quite interesting in that managed care market penetration has been shown to have an effect on utilization of inpatient services. It may be that managed care protocols do not offer the same benefits beyond the inpatient setting. PMID:26501052

The Association between Medicare Advantage Market Penetration and Diabetes in the United States.

PubMed

Howard, Steven W; Bernell, Stephanie Lazarus; Wilmott, Jennifer; Casim, M Faizan; Wang, Jing; Pearson, Lindsey; Byler, Caitlin M; Zhang, Zidong

2015-01-01

The objective of this study is to explore the extent to which managed care market penetration in the United States is associated with the presence of chronic disease. Diabetes was selected as the chronic disease of interest due to its increasing prevalence as well as the disease management protocols that can lessen disease complications. We hypothesized that greater managed care market penetration would be associated with (1) lower prevalence of diabetes and (2) lower prevalence of diabetes-related comorbidities (DRCs) among diabetics. Data for this analysis came from two sources. We merged Medicare Advantage (MA) market penetration data from the Centers for Medicare and Medicaid Services (CMS) with data from the Medical Expenditure Panel Survey (MEPS) (2004-2008). Results suggest that county-level MA market penetration is not significantly associated with prevalence of diabetes or DRCs. That finding is quite interesting in that managed care market penetration has been shown to have an effect on utilization of inpatient services. It may be that managed care protocols do not offer the same benefits beyond the inpatient setting.

Improved constraints on the estimated size and volatile content of the Mount St. Helens magma system from the 2004-2008 history of dome growth and deformation

USGS Publications Warehouse

Mastin, Larry G.; Lisowski, Mike; Roeloffs, Evelyn; Beeler, Nick

2009-01-01

The history of dome growth and geodetic deflation during the 2004-2008 Mount St. Helens eruption can be fit to theoretical curves with parameters such as reservoir volume, bubble content, initial overpressure, and magma rheology, here assumed to be Newtonian viscous, with or without a solid plug in the conduit center. Data from 2004-2008 are consistent with eruption from a 10-25 km3 reservoir containing 0.5-2% bubbles, an initial overpressure of 10-20 MPa, and no significant, sustained recharge. During the eruption we used curve fits to project the eruption's final duration and volume. Early projections predicted a final volume only about half of the actual value; but projections increased with each measurement, implying a temporal increase in reservoir volume or compressibility. A simple interpretation is that early effusion was driven by a 5-10 km3, integrated core of fluid magma. This core expanded with time through creep of semi-solid magma and host rock.

Improved constraints on the estimated size and volatile content of the Mount St. Helens magma system from the 2004-2008 history of dome growth and deformation

USGS Publications Warehouse

Mastin, L.G.; Lisowski, M.; Roeloffs, E.; Beeler, N.

2009-01-01

The history of dome growth and geodetic deflation during the 2004-2008 Mount St. Helens eruption can be fit to theoretical curves with parameters such as reservoir volume, bubble content, initial overpressure, and magma rheology, here assumed to be Newtonian viscous, with or without a solid plug in the conduit center. Data from 2004-2008 are consistent with eruption from a 10-25 km3 reservoir containing 0.5-2% bubbles, an initial overpressure of 10-20 MPa, and no significant, sustained recharge. During the eruption we used curve fits to project the eruption's final duration and volume. Early projections predicted a final volume only about half of the actual value; but projections increased with each measurement, implying a temporal increase in reservoir volume or compressibility. A simple interpretation is that early effusion was driven by a 5-10 km3, integrated core of fluid magma. This core expanded with time through creep of semi-solid magma and host rock. Copyright 2009 by the American Geophysical Union.

State-Level Estimates of Cancer-Related Absenteeism Costs

PubMed Central

Tangka, Florence K.; Trogdon, Justin G.; Nwaise, Isaac; Ekwueme, Donatus U.; Guy, Gery P.; Orenstein, Diane

2016-01-01

Background Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. Methods In analyses of data from the 2004–2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. Results We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. Conclusions The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population. PMID:23969498

State-level estimates of cancer-related absenteeism costs.

PubMed

Tangka, Florence K; Trogdon, Justin G; Nwaise, Isaac; Ekwueme, Donatus U; Guy, Gery P; Orenstein, Diane

2013-09-01

Cancer is one of the top five most costly diseases in the United States and leads to substantial work loss. Nevertheless, limited state-level estimates of cancer absenteeism costs have been published. In analyses of data from the 2004-2008 Medical Expenditure Panel Survey, the 2004 National Nursing Home Survey, the U.S. Census Bureau for 2008, and the 2009 Current Population Survey, we used regression modeling to estimate annual state-level absenteeism costs attributable to cancer from 2004 to 2008. We estimated that the state-level median number of days of absenteeism per year among employed cancer patients was 6.1 days and that annual state-level cancer absenteeism costs ranged from $14.9 million to $915.9 million (median = $115.9 million) across states in 2010 dollars. Absenteeism costs are approximately 6.5% of the costs of premature cancer mortality. The results from this study suggest that lost productivity attributable to cancer is a substantial cost to employees and employers and contributes to estimates of the overall impact of cancer in a state population.

Republic of the Marshall Islands assessment for a continuing health care professional development program.

PubMed

Langidrik, Justina R; Riklon, Sheldon; Lanwi, Salome; Gunawardane, Kamal; Soe, Tin; Jack, Tom; Balaoing, Grace Ann; Buenconsejo-Lum, Lee E

2007-03-01

In 2003, the University of Hawai'i Department of Family Medicine and Community Health entered a 4-year cooperative agreement with the U.S. Health Resources and Services Administration to establish the "Pacific Association for Clinical Training" (PACT). PACT's goal is to develop effective distance education methods to improve the education and skills of healthcare professionals in the U.S.-Affiliated Pacific Island nations. To determine the situation existing in 2004, one of PACT's first projects was to perform site visits to each jurisdiction, conducting needs assessments through interviews with key health care professionals, hospital administrators, and government officials. This article highlights findings of PACT's assessment of Republic of the Marshall Islands. Meant to establish a baseline for future reference, all data are those collected in 2004/2005 and have not been updated.

Actualizing a provider alliance to expand health services access to a low-income urban community.

PubMed

Tataw, David; Bazargan-Hejazi, Shahrzad; James, Frederick W

2011-01-01

Social change to facilitate health care access for vulnerable populations sometimes involves model-driven innovative structures and innovative planning and implementation approaches. This paper described and analyzed the rationale, conceptual framework, program components, and implementation of the South Central Health Care Alliance (SCHCA) implemented in South Los Angeles from January 2002 to December 2004. The program development and implementation was guided by an integrated framework linking the Open Systems Theory, the Social Cognitive Theory, the Health Belief Model, and the Preventive Health Education and Medical Home Project. The performance of the SCHCA as a social system, partnership, and participatory implementation program is also presented. While the SCHCA was found to be a dynamic social system that responded well to contingencies, its performance as a partnership and participatory implementation program was wanting in many respects.

Quality of groundwater at and near an aquifer storage and recovery site, Bexar, Atascosa, and Wilson Counties, Texas, June 2004-August 2008

USGS Publications Warehouse

Otero, Cassi L.; Petri, Brian L.

2010-01-01

The U.S. Geological Survey, in cooperation with the San Antonio Water System, did a study during 2004-08 to characterize the quality of native groundwater from the Edwards aquifer and pre- and post-injection water from the Carrizo aquifer at and near an aquifer storage and recovery (ASR) site in Bexar, Atascosa, and Wilson Counties, Texas. Groundwater samples were collected and analyzed for selected physical properties and constituents to characterize the quality of native groundwater from the Edwards aquifer and pre- and post-injection water from the Carrizo aquifer at and near the ASR site. Geochemical and isotope data indicated no substantial changes in major-ion, trace-element, and isotope chemistry occurred as the water from the Edwards aquifer was transferred through a 38-mile pipeline to the aquifer storage and recovery site. The samples collected from the four ASR recovery wells were similar in major-ion and stable isotope chemistry compared to the samples collected from the Edwards aquifer source wells and the ASR injection well. The similarity could indicate that as Edwards aquifer water was injected, it displaced native Carrizo aquifer water, or, alternatively, if mixing of Edwards and Carrizo aquifer waters was occurring, the major-ion and stable isotope signatures for the Carrizo aquifer water might have been obscured by the signatures of the injected Edwards aquifer water. Differences in the dissolved iron and dissolved manganese concentrations indicate that either minor amounts of mixing occurred between the waters from the two aquifers, or as Edwards aquifer water displaced Carrizo aquifer water it dissolved the iron and manganese directly from the Carrizo Sand. Concentrations of radium-226 in the samples collected at the ASR recovery wells were smaller than the concentrations in samples collected from the Edwards aquifer source wells and from the ASR injection well. The smaller radium-226 concentrations in the samples collected from the ASR recovery wells likely indicate some degree of mixing of the two waters occurred rather than continued decay of radium-226 in the injected water. Geochemical and isotope data measured in samples collected in May 2005 from two Carrizo aquifer monitoring wells and in July 2008 from the three ASR production-only wells in the northern section of the ASR site indicate that injected Edwards aquifer water had not migrated to these five sites. Geochemical and isotope data measured in samples collected from Carrizo aquifer wells in 2004, 2005, and 2008 were graphically analyzed to determine if changes in chemistry could be detected. Major-ion, trace element, and isotope chemistry varied spatially in the samples collected from the Carrizo aquifer. With the exception of a few samples, major-ion concentrations measured in samples collected in Carrizo aquifer wells in 2004, 2005, and 2008 were similar. A slightly larger sulfate con-centration and a slightly smaller bicarbonate concentration were measured in samples collected in 2005 and 2008 from well NC1 compared to samples collected at well NC1 in 2004. Larger sodium concentrations and smaller calcium, magnesium, bicarbonate, and sulfate concentrations were measured in samples collected in 2008 from well WC1 than in samples collected at this well in 2004 and 2005. Larger calcium and magnesium concentrations and a smaller sodium concentration were measured in the samples collected in 2008 at well EC2 compared to samples collected at this well in 2004 and 2005. While in some cases the computed percent differences (compared to concentrations from June 2004) in dissolved iron and dissolved manganese concentrations in 11 wells sampled in the Carrizo aquifer in 2005 and 2008 were quite large, no trends that might have been caused by migration of injected Edwards aquifer water were observed. Because of the natural variation in geochemical data in the Carrizo aquifer and the small data set collected for this study, differences in major-ion and

Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care.

PubMed

Laiteerapong, Neda; Kirby, James; Gao, Yue; Yu, Tzy-Chyi; Sharma, Ravi; Nocon, Robert; Lee, Sang Mee; Chin, Marshall H; Nathan, Aviva G; Ngo-Metzger, Quyen; Huang, Elbert S

2014-10-01

To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004-2008). HC patients were defined as those with ≥50 percent of outpatient visits at HCs in the first panel year. Outcomes included utilization and preventive care receipt from the second panel year. We used negative binomial and logistic regression models with propensity score adjustment for confounding differences between HC and non-HC patients. Compared to non-HC patients, HC patients had fewer office visits (adjusted incidence rate ratio [aIRR], 0.63) and hospitalizations (aIRR, 0.43) (both p < .001). HC patients were more likely to receive breast cancer screening than non-HC patients (adjusted odds ratio [aOR] 2.78, p < .01). In subgroup analyses, uninsured HC patients had fewer outpatient and emergency room visits and were more likely to receive dietary advice and breast cancer screening compared to non-HC patients. Health centers add value to the health care system by providing socially and medically disadvantaged patients with care that results in lower utilization and maintained or improved preventive care. © Health Research and Educational Trust.

Measuring Racial/Ethnic Disparities in Health Care: Methods and Practical Issues

PubMed Central

Cook, Benjamin Lê; McGuire, Thomas G; Zaslavsky,, Alan M

2012-01-01

Objective To review methods of measuring racial/ethnic health care disparities. Study Design Identification and tracking of racial/ethnic disparities in health care will be advanced by application of a consistent definition and reliable empirical methods. We have proposed a definition of racial/ethnic health care disparities based in the Institute of Medicine's (IOM) Unequal Treatment report, which defines disparities as all differences except those due to clinical need and preferences. After briefly summarizing the strengths and critiques of this definition, we review methods that have been used to implement it. We discuss practical issues that arise during implementation and expand these methods to identify sources of disparities. We also situate the focus on methods to measure racial/ethnic health care disparities (an endeavor predominant in the United States) within a larger international literature in health outcomes and health care inequality. Empirical Application We compare different methods of implementing the IOM definition on measurement of disparities in any use of mental health care and mental health care expenditures using the 2004–2008 Medical Expenditure Panel Survey. Conclusion Disparities analysts should be aware of multiple methods available to measure disparities and their differing assumptions. We prefer a method concordant with the IOM definition. PMID:22353147

[From the asylums to the community: the reform process of National Colony "Dr. Manuel A. Montes de Oca"].

PubMed

Rossetto, Jorge

2009-01-01

Since 2004, a profound transformation of the asylum care model, characterized by overcrowding, lack of discharge and absence of rehabilitation programs, and social reinsertion, has been developed at National Colony "Dr. Manuel A. Montes de Oca". During this period, a plan that contemplates several programs and projects aimed at restoring the rights of institutionalized people with mental disabilities and promoting opportunities for social inclusion has been implemented.

Environmental Laws: Summaries of Major Statutes Administered by the Environmental Protection Agency (EPA)

DTIC Science & Technology

2007-02-28

EPA to conduct health risk reduction and cost analyses for most new standards, authorized a state revolving loan fund (SRF) program to help public water...toxic substances; maintain an inventory of literature, research, and studies on the health effects of toxic substance contamination; provide medical care ...Working Families Tax Relief Act of 2004 (P.L. 108-311), and through 2007 by the Tax Relief and Health Care Act of 2006 (P.L. 109-432). Table 16. Major

Explaining variations in state foster care maintenance rates and the implications for implementing new evidence-based programs

PubMed Central

Goldhaber-Fiebert, Jeremy D.; Babiarz, Kimberly S.; Garfield, Rachel L.; Wulczyn, Fred; Landsverk, John; Horwitz, Sarah M.

2013-01-01

Background U.S. Child Welfare systems are involved in the lives of millions of children, and total spending exceeds $26 billion annually. Out-of-home foster care is a critical and expensive Child Welfare service, a major component of which is the maintenance rate paid to support housing and caring for a foster child. Maintenance rates vary widely across states and over time, but reasons for this variation are not well understood. As evidence-based programs are disseminated to state Child Welfare systems, it is important to understand what may be the important drivers in the uptake of these practices including state spending on core system areas. Data and methods We assembled a unique, longitudinal, state-level panel dataset (1990–2008) for all 50 states with annual data on foster care maintenance rates and measures of child population in need, poverty, employment, urbanicity, proportion minority, political party control of the state legislature and governorship, federal funding, and lawsuits involving state foster care systems. All monetary values were expressed in per-capita terms and inflation adjusted to 2008 dollars. We used longitudinal panel regressions with robust standard errors and state and year fixed effects to estimate the relationship between state foster care maintenance rates and the other factors in our dataset, lagging all factors by one year to mitigate the possibility that maintenance rates influenced their predictors. Exploratory analyses related maintenance rates to Child Welfare outcomes. Findings State foster care maintenance rates have increased in nominal terms, but in many states, have not kept pace with inflation, leading to lower real rates in 2008 compared to those in 1991 for 54% of states for 2 year-olds, 58% for 9 year-olds, and 65% for 16 year-olds. In multivariate analyses including socioeconomic, demographic, and political factors, monthly foster care maintenance rates declined $15 for each 1% increase in state unemployment and declined $40 if a state's governorship and legislature became Republican, though significance was marginal. In analyses also examining state revenue, federal funding, and legal challenges, maintenance rates increased as the federal share of maximum TANF payments increased. However, >50% of variation in foster care maintenance rates was explained by unobserved state-level factors as measured by state fixed effects. These factors did not appear to be strongly related to 2008 Child Welfare outcomes like foster care placement stability and maltreatment which were also not correlated with foster care maintenance rates. Conclusions Despite being part of a social safety net, foster care maintenance rates have declined in real terms since 1991 in many states, and there is no strong evidence that they increase in response to harsher economic climates or to federal programs or legal reviews. State variation in maintenance rates was not related to Child Welfare outcomes, though further analysis of this important relationship is needed. Variability in state foster care maintenance rates appears highly idiosyncratic, an important contextual factor to consider when designing and disseminating evidence-based services. PMID:24659842

Evaluation of the relationship between a chronic disease care management program and california pay-for-performance diabetes care cholesterol measures in one medical group.

PubMed

Cutler, Timothy W; Palmieri, James; Khalsa, Maninder; Stebbins, Marilyn

2007-09-01

Pay for performance (P4P) is a business model in which health plans pay provider organizations (medical groups) financial incentives based on attainment of clinical quality, patient experience, and use of information technology. The California P4P program is the largest P4P program in the united states and represents a potential revenue source for all participating medical groups. The clinical specifications for the California P4P program are based on the national Committee for Quality assurance (NCQA), Health Plan Employer Data, and information set (HEDIS), and each clinical measure has its own benchmark. in 2005, participating medical groups were paid on the basis of 9 clinical measures that were evaluated in the 2004 measurement year. The cholesterol testing measure represented 4.44%-7.14% of the total P4P dollars available to participating medical groups from the health plans. To (1) compare the percentage of medical group members aged 18 to 75 years with diabetes (type 1 or type 2) who received a low-density lipoprotein cholesterol (LDL-C) test and attained LDL-C control (<130 mg per dl) after enrolling in a chronic disease care management (CDCM) program with similar members managed by routine care, and to (2) assess the potential effect of CDCM on the quality performance ranking and financial reimbursement of a medical group reporting these measures in the 2004 California P4P measurement year. This is a retrospective database review of electronic laboratory (lab) values, medical and hospital claims, and encounter data collected between january 1, 2003 and December 31, 2004 at 1 California medical group comprising 160 multispecialty providers. Requirements were continuous patient enrollment in 1 of the 7 health plans participating in P4P during the measurement year (2004) with no more than 1 gap in enrollment of up to 45 days. Patients aged 18 to 75 years were included in the diabetes cholesterol measure (denominator) if they had at least 2 outpatient encounters coded for a primary, secondary, or tertiary diagnosis of diabetes (International Classification of Diseases, Ninth Revision, Clinical Modification code 250.xx, 357.2, 362.0, 366.41, 648.0) or 1 acute inpatient (Diagnosis Related Group code 294 or 295) or emergency room visit for diabetes. Lab values were obtained from multiple sources, including archived lab databases during the same measurement period (numerator). The CDCM program provided education and recommendations for diet, lifestyle, and medication modification delivered by a multidisciplinary team of nurses, pharmacists, and dieticians, and this intervention was compared with routine care for patients not enrolled in the CDCM program. Of the 54,000 health plan members enrolled in this medical group under capitated reimbursement, 1,859 patients (3.4%) met the California P4P specifications for eligibility for the diabetes cholesterol measures and were evaluated. Of these, 8.9% (165/1,859) were followed by the CDCM program and 91.1% (1,694/1,859) by routine care. The LDL-C lab testing rate for patients in the CDCM program was 91.5% (151/165), and the LDL-C goal rate was 78.2% (129/165) compared with 67.8% (1,148/1,694) and 55.7%, respectively, for routine care (P < 0.001 for both comparisons). if the LDL-C lab testing and goal attainment rates for the CDCM group were compared with rates for peer medical groups, this medical group would have scored in the 75th and 90th percentiles, respectively, corresponding to an annual revenue potential of $28,512 for this medical group if the total incentive payment from the health plan was $1 per member per month (PMPM), or $57,024 if the total incentive P4P payment was $2 PMPM. Preliminary data from 165 patients with diabetes managed in a CDCM program in a medical group operating under a small P4P financial incentive showed higher rates of LDL-C lab testing and goal attainment than from patients managed by routine care. Had these rates of LDL-C testing and goal attainment achieved in the CDCM program been extended to the entire P4P population with diabetes, this medical group would have generated incentive payments under the P4P program and ranked higher in publicly available quality scores.

Epidemiological investigation of scarlet fever in Hefei City, China, from 2004 to 2008.

PubMed

Wang, Jing; Zhang, Jun-Qing; Pan, Hai-Feng; Zhu, Yu; He, Qian

2010-10-01

This study aims to explore the epidemiological characteristics of scarlet fever in Hefei City, China, and to provide a scientific basis for the prevention and control of the disease. A total of 731 cases were recruited from 2004 to 2008. The average incidence was 3.159 per 100,000 population. Our results indicated that the major risk factors for scarlet fever were: gender (male); age (3-6 years); time of disease onset (March to June); and area of residence (urban areas). Knowledge of these factors could help clinicians to provide the appropriate interventions for scarlet fever.

Estimated cost savings associated with the transfer of office-administered specialty pharmaceuticals to a specialty pharmacy provider in a Medical Injectable Drug program.

PubMed

Baldini, Christopher G; Culley, Eric J

2011-01-01

A large managed care organization (MCO) in western Pennsylvania initiated a Medical Injectable Drug (MID) program in 2002 that transferred a specific subset of specialty drugs from physician reimbursement under the traditional "buy-and-bill" model in the medical benefit to MCO purchase from a specialty pharmacy provider (SPP) that supplied physician offices with the MIDs. The MID program was initiated with 4 drugs in 2002 (palivizumab and 3 hyaluronate products/derivatives) growing to more than 50 drugs by 2007-2008. To (a) describe the MID program as a method to manage the cost and delivery of this subset of specialty drugs, and (b) estimate the MID program cost savings in 2007 and 2008 in an MCO with approximately 4.6 million members. Cost savings generated by the MID program were calculated by comparing the total actual expenditure (plan cost plus member cost) on medications included in the MID program for calendar years 2007 and 2008 with the total estimated expenditure that would have been paid to physicians during the same time period for the same medication if reimbursement had been made using HCPCS (J code) billing under the physician "buy-and-bill" reimbursement rates. For the approximately 50 drugs in the MID program in 2007 and 2008, the drug cost savings in 2007 were estimated to be $15.5 million (18.2%) or $290 per claim ($0.28 per member per month [PMPM]) and about $13 million (12.7%) or $201 per claim ($0.23 PMPM) in 2008. Although 28% of MID claims continued to be billed by physicians using J codes in 2007 and 22% in 2008, all claims for MIDs were limited to the SPP reimbursement rates. This MID program was associated with health plan cost savings of approximately $28.5 million over 2 years, achieved by the transfer of about 50 physician-administered injectable pharmaceuticals from reimbursement to physicians to reimbursement to a single SPP and payment of physician claims for MIDs at the SPP reimbursement rates.

General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model.

PubMed

Schulte, Timothy J; Isley, Elayne; Link, Nancy; Shealy, Craig N; Winfrey, LaPearl Logan

2004-10-01

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace. Copyright 2004 Wiley Periodicals, Inc.

Improving diabetic foot care in a nurse-managed safety-net clinic.

PubMed

Peterson, Joann M; Virden, Mary D

2013-05-01

This article is a description of the development and implementation of a Comprehensive Diabetic Foot Care Program and assessment tool in an academically affiliated nurse-managed, multidisciplinary, safety-net clinic. The assessment tool parallels parameters identified in the Task Force Foot Care Interest Group of the American Diabetes Association's report published in 2008, "Comprehensive Foot Examination and Risk Assessment." Review of literature, Silver City Health Center's (SCHC) 2009 Annual Report, retrospective chart review. Since the full implementation of SCHC's Comprehensive Diabetic Foot Care Program, there have been no hospitalizations of clinic patients for foot-related complications. The development of the Comprehensive Diabetic Foot Assessment tool and the implementation of the Comprehensive Diabetic Foot Care Program have resulted in positive outcomes for the patients in a nurse-managed safety-net clinic. This article demonstrates that quality healthcare services can successfully be developed and implemented in a safety-net clinic setting. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.

Engaging Students with Behavior Disorders in Mathematics Practice Using the High-"p" Strategy

ERIC Educational Resources Information Center

Vostal, Brooks R.

2011-01-01

Students with emotional and behavioral disorders (EBD) demonstrate significant academic deficits across content areas (Coutinho, 1986; Lane, Barton-Arwood, Nelson, & Wehby, 2008; Nelson, Benner, Lane, & Smith, 2004; Reid, Gonzalez, Nordness, Trout, & Epstein, 2004; Ruhl & Berlinghoff, 1992). Mathematics, however, appears to be especially…

Employer Partnership Program Analysis of Alternatives

DTIC Science & Technology

2012-01-01

downloaded many more job listings. These results suggest that there is room for improvement in outreach to RC service members and attracting return visits to...Area of Concentration ARNG Army National Guard ATA American Trucking Association CBRN Chemical, Biological, Radiological, and Nuclear CMF Career...Association ( ATA ) and Inova Health Systems, a nonprofit health care provider in Northern Virginia. In July 2008, the program signed its first agreement

Health insurance instability among older immigrants: region of origin disparities in coverage.

PubMed

Reyes, Adriana M; Hardy, Melissa

2015-03-01

We provide a detailed analysis of how the dynamics of health insurance coverage (HIC) at older ages differs among Latino, Asian, and European immigrants in the United States. Using Survey of Income and Program Participation data from the 2004 and 2008 panels, we estimate discrete-time event history models to examine first and second transitions into and out of HIC, highlighting substantial differences in hazard rates among immigrants aged 50-64 from Asia, Latin America, and Europe. We find that the likelihood of having HIC at first observation and the rates of gaining and losing coverage within a relatively short time frame are least favorable for older Latino immigrants, although immigrants from all three regions are at a disadvantage relative to native-born non-Hispanic Whites. This disparity among immigrant groups persists even when lower rates of citizenship, greater difficulty with English, and low-skill job placements are taken into account. Factors that have contributed to the lower rates and shorter durations of HIC among older immigrants, particularly those from Latin America, may not be easily resolved by the Affordable Care Act. The importance of region of origin and assimilation characteristics for the risk of being uninsured in later life argues that immigration and health care policy should be jointly addressed. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Policy improves what beverages are served to young children in child care.

PubMed

Ritchie, Lorrene D; Sharma, Sushma; Gildengorin, Ginny; Yoshida, Sallie; Braff-Guajardo, Ellen; Crawford, Patricia

2015-05-01

During 2008, we conducted a statewide survey on beverages served to preschool-aged children in California child care that identified a need for beverage policy. During 2011, the US Department of Agriculture began requiring that sites participating in the Child and Adult Care Food Program (CACFP) make drinking water available throughout the day and serve only low-fat or nonfat milk to children aged 2 years and older. During 2012, the California Healthy Beverages in Childcare law additionally required that all child-care sites eliminate all beverages with added sweetener and limit 100% juice to once daily. To assess potential policy effects, we repeated the statewide survey in 2012. During 2008 and 2012, a cross-sectional sample of ∼1,400 licensed child-care sites was randomly selected after stratifying by category (ie, Head Start, state preschool, other CACFP center, non-CACFP center, CACFP home, and non-CACFP home). Responses were obtained from 429 sites in 2008 and 435 in 2012. After adjustment for child-care category, significant improvements in 2012 compared with 2008 were found; more sites served water with meals/snacks (47% vs 28%; P=0.008) and made water available indoors for children to self-serve (77% vs 69%; P=0.001), and fewer sites served whole milk usually (9% vs 22%; P=0.006) and 100% juice more than once daily (20% vs 27%; P=0.038). During 2012, 60% of sites were aware of beverage policies and 23% were judged fully compliant with the California law. A positive effect occurred on beverages served after enactment of state and federal policies. Efforts should continue to promote beverage policies and support their implementation. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Health Reform Redux: Learning From Experience and Politics

PubMed Central

2009-01-01

The 2008 presidential campaign season featured health care reform proposals. I discuss 3 approaches to health care reform and the tools for bringing about reform, such as insurance market reforms, tax credits, subsidies, individual and employer mandates, and public program expansions. I also discuss the politics of past and current health care reform efforts. Market-based reforms and mandates have been less successful than public program expansions at expanding coverage and controlling costs. New divisions among special interest groups increase the likelihood that reform efforts will succeed. Federal support for state efforts may be necessary to achieve national health care reform. History suggests that state-level success precedes national reform. History also suggests that an organized social movement for reform is necessary to overcome opposition from special interest groups. PMID:19299668

78 FR 75581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-12

... Mental Health Parity and Addiction Equity Act of 2008; Technical Amendment to External Review for Multi... for the Federal external review process under section 2719(b)(2) of the PHS Act and paragraph (d) of...

Awareness and use of California's Paid Family Leave Insurance among parents of chronically ill children.

PubMed

Schuster, Mark A; Chung, Paul J; Elliott, Marc N; Garfield, Craig F; Vestal, Katherine D; Klein, David J

2008-09-03

In 2004, California's Paid Family Leave Insurance Program (PFLI) became the first state program to provide paid leave to care for an ill family member. To assess awareness and use of the program by employed parents of children with special health care needs, a population likely to need leave. Telephone interviews with successive cohorts of employed parents before (November 21, 2003-January 31, 2004; n = 754) and after (November 18, 2005-January 31, 2006; n = 766) PFLI began, randomly sampled from 2 children's hospitals, one in California (with PFLI) and the other in Illinois (without PFLI). Response rates were 82% before and 81% after (California), and 80% before and 74% after (Illinois). Taking leave, length of leave, unmet need for leave, and awareness and use of PFLI. Similar percentages of parents at the California site reported taking at least 1 day of leave to care for their ill child before (295 [81%]) and after (327 [79%]) PFLI, taking at least 4 weeks before (64 [21%]) and after (74 [19%]) PFLI, and at least once in the past year not missing work despite believing their child's illness necessitated it before (152 [41%]) and after (156 [41%]) PFLI. Relative to Illinois, parents at the California site reported no change from before to after PFLI in taking at least 1 day of leave (difference of differences, -3%; 95% confidence interval [CI], -13% to 7%); taking at least 4 weeks of leave (1%; 95% CI, -9% to 10%); or not missing work, despite believing their child's illness necessitated it (-1%; 95% CI, -13% to 10%). Only 77 parents (18%) had heard of PFLI approximately 18 months after the program began, and only 20 (5%) had used it. Even among parents without other access to paid leave, awareness and use of PFLI were minimal. Parents of children with special health care needs receiving care at a California hospital were generally unaware of PFLI and rarely used it. Among parents of children with special health care needs, taking leave in California did not increase after PFLI implementation compared with Illinois.

Vending and School Store Snack and Beverage Trends: Minnesota Secondary Schools, 2002–2010

PubMed Central

Kubik, Martha Y.; Davey, Cynthia; Nanney, Marilyn S.; MacLehose, Richard F.; Nelson, Toben F.; Coombes, Brandon

2013-01-01

Background The Child Nutrition and WIC Reauthorization Act of 2004 (hereafter called the 2004 Reauthorization Act) was federal legislation that required school districts participating in the federally funded school meal program to develop and implement policies addressing nutrition guidelines for all foods and beverages available on school campuses by the onset of the 2006/2007 school year. Purpose Vending machine and school store (VMSS) availability and low-nutrient, energy-dense snacks and beverages in VMSS were assessed in a statewide sample of Minnesota secondary schools before and after the 2004 Reauthorization Act was implemented in 2006/2007. Methods The CDC School Health Profiles principal survey was collected from a representative sample of middle (n=170) and high (n=392) schools biennially from 2002 to 2010. Trends were estimated using general linear models with a logit link and linear spline modeling. Analyses were conducted in 2012. Results Among high schools, VMSS (p=0.001) and sugar-sweetened beverages (p=0.004), high-fat salty snacks (p=0.001), and candy (p=0.001) in VMSS decreased from 2002 to 2008. In 2008, a change in slope direction from negative to positive occurred for all food practices and an increase in VMSS (p=0.014) and sugar-sweetened beverages (p=0.033) was seen. Among middle schools, VMSS (p=0.027), sugar-sweetened beverages (p=0.001), high-fat salty snacks (p=0.001), and candy (p=0.029) decreased from 2002 to 2010. Conclusions This study supports a link between policy and sustainable decreases in some food practices but not others and a differential effect that favors middle schools over high schools. Policy-setting is a dynamic process requiring ongoing surveillance to identify shifting trends. PMID:23683975

Vending and school store snack and beverage trends: Minnesota secondary schools, 2002-2010.

PubMed

Kubik, Martha Y; Davey, Cynthia; Nanney, Marilyn S; MacLehose, Richard F; Nelson, Toben F; Coombes, Brandon

2013-06-01

The Child Nutrition and WIC Reauthorization Act of 2004 (hereafter called the 2004 Reauthorization Act) was federal legislation that required school districts participating in the federally funded school meal program to develop and implement policies addressing nutrition guidelines for all foods and beverages available on school campuses by the onset of the 2006/2007 school year. Vending machine and school store (VMSS) availability and low-nutrient, energy-dense snacks and beverages in VMSS were assessed in a statewide sample of Minnesota secondary schools before and after the 2004 Reauthorization Act was implemented in 2006/2007. The CDC School Health Profiles principal survey was collected from a representative sample of middle (n=170) and high (n=392) schools biennially from 2002 to 2010. Trends were estimated using general linear models with a logit link and linear spline modeling. Analyses were conducted in 2012. Among high schools, VMSS (p=0.001) and sugar-sweetened beverages (p=0.004), high-fat salty snacks (p=0.001), and candy (p=0.001) in VMSS decreased from 2002 to 2008. In 2008, a change in slope direction from negative to positive occurred for all food practices and an increase in VMSS (p=0.014) and sugar-sweetened beverages (p=0.033) was seen. Among middle schools, VMSS (p=0.027), sugar-sweetened beverages (p=0.001), high-fat salty snacks (p=0.001), and candy (p=0.029) decreased from 2002 to 2010. This study supports a link between policy and sustainable decreases in some food practices but not others and a differential effect that favors middle schools over high schools. Policy-setting is a dynamic process requiring ongoing surveillance to identify shifting trends. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Putting out the welcome mat-targeting outreach efforts under the Affordable Care Act: Evidence from the Minnesota Community Application Agent Program.

PubMed

Dybdal, Kristin; Blewett, Lynn A; Pintor, Jessie Kemmick; Johnson, Kelli

2015-01-01

An evaluation of the Minnesota Community Application Agent (MNCAA) Program was conducted for the MN Minnesota Department of Human Services and funded by the Health Resources and Services Administration's State Health Access Program grant. The MNCAA evaluation assessed effectiveness in reaching disparate populations, explored overall program value, and sought lessons applicable to the Navigator programs required under the Affordable Care Act. Mixed-methods approach using quantitative analysis of tracking and payment data and interviews with key informants to elicit "lessons learned" about the MNCAA program. The MNCAA program offers incentive payments and technical assistance to community partner organizations that assist individuals in applying for public health care coverage. A total of 140 unique community organizations participated in the MNCAA program in 2008 to 2012. Outreach staff and directors from participating MNCAAs and state/local government officials were interviewed. The article highlights a strategy for targeting outreach to individuals eligible for Medicaid coverage or subsidies under the Affordable Care Act by presenting evaluation findings from a unique outreach program to increase access to care for vulnerable populations in Minnesota. Almost two-thirds of applicants were successfully enrolled but lengthy waiting periods persisted. Seventy percent of applications came from health care organizations. Only 13% of applicants assisted by MNCAAs were new to public health care programs. Most MNCAAs believed that the incentive payment-$25 per successful enrollee-was insufficient. Significant expertise in enrolling individuals in public health care programs exists within a core group of community organizations. Incentives to leverage the capacity of community organizations must be accompanied by recruiting and training. Outreach providers and navigators also need timely access to client information. More investment in financial incentives will be required.

Reduction in inappropriate prevention of urinary tract infections in long-term care facilities.

PubMed

Rummukainen, Maija-Liisa; Jakobsson, Aino; Matsinen, Maire; Järvenpää, Salme; Nissinen, Antti; Karppi, Pertti; Lyytikäinen, Outi

2012-10-01

Urinary tract infection (UTI) is the most common diagnosis made in prescribing antimicrobials in long-term care facilities (LTCF). The diagnostic criteria for UTI vary among institutions and prescribers. Our aim was to reduce the inappropriate use of antimicrobials in LTCFs. A team comprising infectious disease consultant, infection control nurse, and geriatrician visited all LTCFs for older persons (2,321 patients in 25 primary care hospitals and 39 nursing homes and dementia units) in the Central Finland Healthcare District (population 267,000) during 2004-2005. The site visits consisted of a structured interview concerning patients, ongoing systematic antimicrobials, and diagnostic practices for UTI. Following the visits, regional guidelines for prudent use of antimicrobials in LTCFs were published, and the use of antimicrobials was followed up by an annual questionnaire. The proportions of patients receiving antimicrobials in 2005, 2006, 2007, and 2008 were 19.9%, 16.9%, 16.2%, and 15.4%, respectively. Most of the antibiotics were used for UTI (range by year, 66.6%-81.1%). From 2005 through 2008, the proportion of patients on antibiotic prophylaxis for UTI decreased from 13% to 6%. The decrease was statistically significant in both types of settings. The visits and guidelines were associated with a reduction in the usage of antimicrobials. To sustain this, UTI surveillance and close collaboration between infection control experts and LTCFs are crucial. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Effect of smoke-free legislation on the incidence of sudden circulatory arrest in the Netherlands.

PubMed

de Korte-de Boer, Dianne; Kotz, Daniel; Viechtbauer, Wolfgang; van Haren, Emiel; Grommen, Devina; de Munter, Michelle; Coenen, Harry; Gorgels, Anton P M; van Schayck, Onno C P

2012-07-01

To investigate whether smoke-free legislation in the Netherlands led to a decreased incidence of out-of-hospital sudden circulatory arrest (SCA). Smoke-free legislation was implemented in two phases: a workplace ban in 2004 and an extension of this ban to the hospitality sector on 1 July 2008. Weekly incidence data on SCA were obtained from the ambulance registry of South Limburg, the Netherlands. Three time periods were distinguished: the pre-ban period (1 January 2002-1 January 2004), the first post-ban period (1 January 2004-1 July 2008) and the second post-ban period (1 July 2008-1 May 2010). Trends in absolute SCA incidence were analysed using Poisson regression, adjusted for population size, ambient temperature, air pollution and influenza rates. A total of 2305 SCA cases were observed (mean weekly incidence 5.3±2.3 SD). The adjusted Poisson regression model showed a small but significant increase in SCA incidence during the pre-ban period (+0.20% cases per week, p=0.044). This trend changed significantly after implementation of the first ban (with -0.24% cases per week, p=0.043), translating into a 6.8% (22 cases) reduction in the number of SCA cases after 1 year of smoke-free legislation. No further decrease was seen after the second smoking ban. After introduction of a nationwide workplace smoking ban in 2004, a significant decrease in the incidence of out-of-hospital SCA was seen in South Limburg. Poor enforcement of the 2008 hospitality sector ban may account for the fact that no further decrease in the incidence of SCA was seen at this time.

Atmospheric Effects of Energetic Particle Precipitation in the Arctic Winter 1978-1979 Revisited

NASA Technical Reports Server (NTRS)

Holt, L. A.; Randall, C. E.; Harvey, V. L.; Remsberg, E. E.; Stiller, G. P.; Funke, B.; Bernath, P. F.; Walker, K. A.

2012-01-01

The Limb Infrared Monitor of the Stratosphere (LIMS) measured polar stratospheric enhancements of NO2 mixing ratios due to energetic particle precipitation (EPP) in the Arctic winter of 1978-1979. Recently reprocessed LIMS data are compared to more recent measurements from the Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) and the Atmospheric Chemistry Experiment Fourier transform spectrometer (ACE-FTS) to place the LIMS measurements in the context of current observations. The amount of NOx (NO + NO2) entering the stratosphere that has been created by EPP in the mesosphere and lower thermosphere (EPP-NOx) has been quantified for the 1978-1979 and 2002-2003 through 2008-2009 Arctic winters. The NO2 enhancements in the LIMS data are similar to those in MIPAS and ACE-FTS data in the Arctic winters of 2002-2003, 2004-2005, 2006-2007, and 2007-2008. The largest enhancement by far is in 2003-2004 (approximately 2.2 Gmol at 1500 K), which is attributed to a combination of elevated EPP and unusual dynamics that led to strong descent in the upper stratosphere/lower mesosphere in late winter. The enhancements in 2005-2006 and 2008-2009, during which large stratospheric NOx enhancements were caused by a dynamical situation similar to that in 2003 2004, are larger than in all the other years (except 2003-2004) at 3000 K. However, by 2000 K the enhancements in 2005-2006 (2008-2009) are on the same order of magnitude as (smaller than) all other years. These results highlight the importance of the timing of the descent in determining the potential of EPP-NOx for reaching the middle stratosphere.

Geology and assessment of undiscovered oil and gas resources of the Yukon Flats Basin Province, 2008

USGS Publications Warehouse

Bird, Kenneth J.; Stanley, Richard G.; Moore, Thomas E.; Gautier, Donald L.

2017-12-22

The hydrocarbon potential of the Yukon Flats Basin Province in Central Alaska was assessed in 2004 as part of an update to the National Oil and Gas Assessment. Three assessment units (AUs) were identified and assessed using a methodology somewhat different than that of the 2008 Circum-Arctic Resource Appraisal (CARA). An important difference in the methodology of the two assessments is that the 2004 assessment specified a minimum accumulation size of 0.5 million barrels of oil equivalent (MMBOE), whereas the 2008 CARA assessment specified a minimum size of 50 MMBOE. The 2004 assessment concluded that >95 percent of the estimated mean undiscovered oil and gas resources occur in a single AU, the Tertiary Sandstone AU. This is also the only AU of the three that extends north of the Arctic Circle.For the CARA project, the number of oil and gas accumulations in the 2004 assessment of the Tertiary Sandstone AU was re-evaluated in terms of the >50-MMBOE minimum accumulation size. By this analysis, and assuming the resource to be evenly distributed across the AU, 0.23 oil fields and 1.20 gas fields larger than 50 MMBOE are expected in the part of the AU north of the Arctic Circle. The geology suggests, however, that the area north of the Arctic Circle has a lower potential for oil and gas accumulations than the area to the south where the sedimentary section is thicker, larger volumes of hydrocarbons may have been generated, and potential structural traps are probably more abundant. Because of the low potential implied for the area of the AU north of the Arctic Circle, the Yukon Flats Tertiary Sandstone AU was not quantitatively assessed for the 2008 CARA.

Improving Olympic health services: what are the common health care planning issues?

PubMed

Kononovas, Kostas; Black, Georgia; Taylor, Jayne; Raine, Rosalind

2014-12-01

Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care planning issues for future hosts. A structured, critical, qualitative analysis of all available Olympic health care reports was conducted. Recommendations and issues with implications for future Olympic host cities were extracted from each report. The six identified themes were: (1) the importance of early planning and relationship building: clarifying roles early to agree on responsibility and expectations, and engaging external and internal groups in the planning process from the start; (2) the development of appropriate medical provision: most health care needs are addressed inside Olympic venues rather than by hospitals which do not experience significant increases in attendance during the Games; (3) preparing for risks: gastrointestinal and food-borne illnesses are the most common communicable diseases experienced during the Games, but the incidence is still very low; (4) addressing the security risk: security arrangements are one of the most resource-demanding tasks; (5) managing administration and logistical issues: arranging staff permission to work at Games venues ("accreditation") is the most complex administrative task that is likely to encounter delays and errors; and (6) planning and assessing health legacy programs: no previous Games were able to demonstrate that their health legacy initiatives were effective. Although each report identified similar health care planning issues, subsequent Olympic host cities did not appear to have drawn on the transferable experiences of previous host cities. Repeated recommendations and lessons from host cities show that similar health care planning issues occur despite different health systems. To improve health care planning and delivery, host cities should pay heed to the specific planning issues that have been highlighted. It is also advisable to establish good communication with organizers from previous Games to learn first-hand about planning from previous hosts.

Smoking ban and small-for-gestational age births in Ireland.

PubMed

Kabir, Zubair; Daly, Sean; Clarke, Vanessa; Keogan, Sheila; Clancy, Luke

2013-01-01

Ireland introduced a comprehensive workplace smoke-free legislation in March, 2004. Smoking-related adverse birth outcomes have both health care and societal cost implications. The main aim of this study was to determine the impact of the Irish smoke-free legislation on small-for-gestationa- age (SGA) births. We developed a population-based birthweight (BW) percentile curve based on a recent study to compute SGA (BW <5(th) percentile) and very SGA (vSGA - BW<3(rd) percentile) for each gestational week. Monthly births born between January 1999 and December 2008 were analyzed linking with monthly maternal smoking rates from a large referral maternity university hospital. We ran individual control and CUSUM charts, with bootstrap simulations, to pinpoint the breakpoint for the impact of ban implementation ( = April 2004). Monthly SGA rates (%) before and after April 2004 was considered pre and post ban period births, respectively. Autocorrelation was tested using Durbin Watson (DW) statistic. Mixed models using a random intercept and a fixed effect were employed using SAS (v 9.2). A total of 588,997 singleton live-births born between January 1999 and December 2008 were analyzed. vSGA and SGA monthly rates declined from an average of 4.7% to 4.3% and from 6.9% to 6.6% before and after April 2004, respectively. No auto-correlation was detected (DW = ~2). Adjusted mixed models indicated a significant decline in both vSGA and SGA rates immediately after the ban [(-5.3%; 95% CI -5.43% to -5.17%, p<0.0001) and (-0.45%; 95% CI: -0.7% to -0.19%, p<0.0007)], respectively. Significant gradual effects continued post the ban periods for vSGA and SGA rates, namely, -0.6% (p<0.0001) and -0.02% (p<0.0001), respectively. A significant reduction in small-for-gestational birth rates both immediately and sustained over the post-ban period, reinforces the mounting evidence of the positive health effect of a successful comprehensive smoke-free legislation in a vulnerable population group as pregnant women.

Prevalence of HIV infection in pregnant women in Mumbai, India: Experience from 1993-2004 and 2008.

PubMed

Shah, Ira; Lala, Mamatha; Damania, Kaizad

2017-01-01

Prevalence of HIV among pregnant women in India is of great concern, especially to prevent HIV in children. Mother-to-child transmission of HIV is the most common cause of transmission of HIV in children. Prevalence of HIV infection in pregnant women in India has ranged from 0.7% to 1.2%. Thus, estimating prevalence of HIV in pregnant women would aid in developing and prioritizing prevention of parent-to-child transmission of HIV programs. All pregnant women referred to the antenatal clinic from 1993 onward were tested for HIV infection by ELISA test after pretest counseling. A woman was diagnosed to be HIV infected if she tested positive on more than two HIV ELISA tests. Prevalence of HIV infection in them was calculated and also whether there was an increasing trend was determined. A total of 123,439 pregnant women were tested for HIV from 1993 to 2004, of which 1797 women were HIV infected. Overall, the prevalence rate was found to be 1.4%. Prevalence rose from 0.76% in 1993 to 2.37% in 1998. However, from 2004, the prevalence has decreased to 0.6%. Prevalence of HIV in pregnant women in Mumbai is decreasing.

[Coverage of cervical cancer screening in Catalonia, Spain (2008-2011)].

PubMed

Rodríguez-Salés, Vanesa; Roura, Esther; Ibáñez, Raquel; Peris, Mercè; Bosch, F Xavier; Coma E, Ermengol; Silvia de Sanjosé

2014-01-01

To estimate cervical cytology coverage for the period 2008-2011 by age groups and health regions from data recorded in the medical records of women attending centers within the Catalan national health system. The data used to estimate coverage were obtained from the primary care information system. This information was anonymous and included age, center, date, and the results of cytological smears for a total of 2,292,564 women aged 15 years or more. A total of 758,690 smears were performed in 595,868 women. Among women aged 25-65 years, the estimated coverage was 32.4% of the assigned population and was 40.8% in the population attended. Geographical variation was observed, with higher coverage among health regions closer to Barcelona. Abnormal Pap smears increased slightly from 2008 to 2011 (from 3% to 3.5%, respectively, p <0.001). In women with a negative first smear, the mean interval until the second smear was 2.4 years, but only 50% of women with a negative first smear in 2008 attended a second round during the study period. Cervical screening coverage in the National Health Service of Catalonia includes one in three women. Second round participation was poor. Existing computer systems in primary care centers can ensure monitoring of population-based screening programs for cervical cancer. These systems could be used to plan an organized screening program to ensure wider coverage and better follow-up. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Quantifying the Relationship Among Hospital Design, Satisfaction, and Psychosocial Functioning in a Pediatric Hematology-Oncology Inpatient Unit

PubMed Central

Sherman-Bien, Sandra A.; Malcarne, Vanessa L.; Roesch, Scott; Varni, James W.; Katz, Ernest R.

2013-01-01

Increasingly, empirical support demonstrates that the built environment may affect the physical and psychosocial well-being of patients, their families, and hospital staff (Beauchemin & Hays, 1996; Rubin, Owens, & Golden, 1998; Sherman, Varni, Ulrich, & Malcarne, 2005; Ulrich, 1991; Varni et al., 2004; Whitehouse et al., 2001). Investigators posit two mechanisms through which the built environment can impact patients: indirectly, by enhancing the quality of care and helping a patient feel more relaxed; and/or directly, by altering the physiological recovery process (Malcolm, 1992). Several literature reviews have been published on the relationship between the hospital built environment and patient outcomes (Joseph, Keller, & Kronick, 2008; Rubin et al., 1998; Sherman, Shepley, & Varni, 2005; Ulrich, Quan, Zimring, Joseph, & Choudhary, 2004). In their 1998 review, Rubin et al. found studies linking environment with a number of health and satisfaction outcomes but little research that had been conducted in a scientifically valid manner. Ulrich et al.'s 2004 review of the role of the physical environment in hospital design identified a number of more rigorously conducted studies, focusing mainly on adult environments and on issues of medical safety and hospital-acquired infection rates. Their conclusions linked environmental features such as noise to an increase in perceived stress and physiological arousal; exposure to natural light to reductions in depression, length of hospital stay, and pain medications and to improved sleep; and hospital gardens to improved physical and psychosocial functioning (Ulrich et al., 2004). PMID:21960191

Report to the nation finds continuing declines in cancer death rates

Cancer.gov

Death rates from all cancers combined for men, women, and children continued to decline in the United States between 2004 and 2008, according to the Annual Report to the Nation on the Status of Cancer, 1975-2008. The overall rate of new cancer diagnoses,

National TAFE Workforce Study 2008

ERIC Educational Resources Information Center

Nechvoglod, Lisa; Mlotkowski, Peter; Guthrie, Hugh

2010-01-01

The purpose of this report is to provide national data on the technical and further education (TAFE) workforce in 2008 and, where possible, compare this with 2002 data collected for the report "Profiling the national vocational education and training workforce" (NCVER 2004). Currently, there is no regular consistent national collection…

Implementation of the American College of Cardiology/American Heart Association 2008 Guidelines for the Management of Adults With Congenital Heart Disease.

PubMed

Goossens, Eva; Fernandes, Susan M; Landzberg, Michael J; Moons, Philip

2015-08-01

Although different guidelines on adult congenital heart disease (ACHD) care advocate for lifetime cardiac follow-up, a critical appraisal of the guideline implementation is lacking. We investigated the implementation of the American College of Cardiology/American Heart Association 2008 guidelines for ACHD follow-up by investigating the type of health care professional, care setting, and frequency of outpatient visits in young adults with CHD. Furthermore, correlates for care in line with the recommendations or untraceability were investigated. A cross-sectional observational study was conducted, including 306 patients with CHD who had a documented outpatient visit at pediatric cardiology before age 18 years. In all, 210 patients (68.6%) were in cardiac follow-up; 20 (6.5%) withdrew from follow-up and 76 (24.9%) were untraceable. Overall, 198 patients were followed up in tertiary care, 1/4 (n = 52) of which were seen at a formalized ACHD care program and 3/4 (n = 146) remained at pediatric cardiology. Of those followed in formalized ACHD and pediatric cardiology care, the recommended frequency was implemented in 94.2% and 89%, respectively (p = 0.412). No predictors for the implementation of the guidelines were identified. Risk factors for becoming untraceable were none or lower number of heart surgeries, health insurance issues, and nonwhite ethnicity. In conclusion, a significant number of adults continue to be cared for by pediatric cardiologists, indicating that transfer to adult-oriented care was not standard practice. Frequency of follow-up for most patients was in line with the ACC/AHA 2008 guidelines. A considerable proportion of young adults were untraceable in the system, which makes them vulnerable for discontinuation of care. Copyright © 2015 Elsevier Inc. All rights reserved.

USAC Annual Report, 2008

ERIC Educational Resources Information Center

Universal Service Administrative Company, 2009

2009-01-01

The Universal Service Administrative Company (USAC) is an independent, not-for-profit corporation designated as the administrator of the federal Universal Service Fund (USF) by the Federal Communications Commission (FCC). USAC administers the Universal Service Fund and the four Universal Service programs: High Cost, Low Income, Rural Health Care,…

Geographic assessment of access to health care in patients with cardiovascular disease in South Africa.

PubMed

Kapwata, Thandi; Manda, Samuel

2018-03-22

Noncommunicable diseases (NCDs) including cardiovascular diseases (CVDs), diabetes, cancer and chronic lung disease are increasingly emerging as major contributors to morbidity and mortality in developing countries. For example, in South Africa, 195 people died per day between 1997 and 2004 from CVDs related causes. Access to efficient and effective health facility and care is an important contributing factor to overall population health and addressing prognosis, care and management CVD disease burden. This study aimed to spatially evaluate geographic health care access of people diagnosed with CVD to health facilities and to evaluate the density of the existing health facility network in South Africa. Data was obtained from the National Income Dynamics Study (NIDS) conducted in 4 waves (phases) between 2008 and 2014. The participants who responded as having heart problems that were diagnosed by a health practitioner were extracted for use in this study. Network analyst in ArcGIS ® was used to generate a least-cost path, which refers to the best path that one can travel. The residential locations of participants diagnosed with heart problems were put into the network analysis model as origins and the location of health facilities were destinations. District averages were used to protect the identity of studied participants. There were a total of 51, 42, 43, 43 health districts out the 52 that had recorded subjects with a heart condition in the 2008, 2010-2011, 2012 and 2014-2015 waves, respectively. The mean distance from a case household to a health facility per wave was 2, 2.3, 2.1 and 2.1 km in 2008, 2010-2011 and 2014-2015 respectively. The maximum individual distances travelled per wave were 41.4 km, 40,5 km, 44,2 km and 39.6 km for the 2008, 2010-2011, 2012 and 2014-2015 waves respectively. For district level analysis, participants with CVD residing in the districts found to be among the poorest in the country travelled the longest distances. These were located in the provinces of Limpopo and KwaZulu Natal. It was also found that districts with large proportions of their population living in rural settings had among the lowest densities of health facilities. Significant percentages of study participants were exposed to numerous CVD risk factors, the commonly reported one being high blood pressure. A lack of regular exercise was also commonly reported in each of the waves. A lack of accessible healthcare in already impoverished municipalities could result in an increase lack of timely diagnosis, CVD case management. This could result in increased CVD-related morbidity and mortality. GIS methods have the potential to assist national health programs to develop policies that target issues such as areas or populations being underserved by health facilities and populations that must travel long distances to receive healthcare. These policies will be key in preventing and controlling the emerging CVD burden through an accessible primary healthcare system for early detection and case management.

Bridging the Gap: Using School-Based Health Services to Improve Chlamydia Screening Among Young Women

PubMed Central

Provost, Jackie M.

2010-01-01

Objectives. We implemented a chlamydia screening program targeted at young women accessing reproductive health care services in a school-based setting, and we assessed racial/ethnic factors associated with infection. Methods. The California Family Health Council partnered with 9 health care agencies receiving federal Title X family planning funding and 19 educational institutions to implement the Educational Partnerships to Increase Chlamydia Screening (EPICS) program from January 2008 through December 2008. Results. EPICS agencies provided reproductive health services to 3396 unique sexually active females, 85% of whom self-reported no other source for reproductive health care. Chlamydia screening was provided to 3026 clients (89.1% chlamydia screening coverage). Of those screened for chlamydia, 5.6% tested positive. Clients who were African American (odds ratio [OR] = 7.5; 95% confidence interval [CI] = 3.9, 14.3), Pacific Islander (OR = 4.1; 95% CI = 1.1, 15.5), or Asian (OR = 3.3; 95% CI = 1.4, 8.1) were more likely to have a positive test than were White clients. Conclusions. Chlamydia screening programs implemented in school-based settings have the capacity to identify and treat a significant amount of asymptomatic infection in a population that otherwise may not be reached. To facilitate screening, school-based clinics should implement outreach strategies that target their school population and clinical strategies that maximize opportunities for screening. PMID:20634446

Health financing for the poor produces promising short-term effects on utilization and out-of-pocket expenditure: evidence from Vietnam

PubMed Central

Axelson, Henrik; Bales, Sarah; Minh, Pham Duc; Ekman, Björn; Gerdtham, Ulf-G

2009-01-01

Background Vietnam introduced the Health Care Fund for the Poor in 2002 to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities. It is often argued that effects of financing reforms take a long time to materialize. This study evaluates the short-term impact of the program to determine if pro-poor financing programs can achieve immediate effects on health care utilization and out-of-pocket expenditure. Method Considering that the program is a non-random policy initiative rolled out nationally, we apply propensity score matching with both single differences and double differences to data from the Vietnam Household Living Standards Surveys 2002 (pre-program data) and 2004 (first post-program data). Results We find a small, positive impact on overall health care utilization. We find evidence of two substitution effects: from private to public providers and from primary to secondary and tertiary level care. Finally, we find a strong negative impact on out-of-pocket health expenditure. Conclusion The results indicate that the Health Care Fund for the Poor is meeting its objectives of increasing utilization and reducing out-of-pocket expenditure for the program's target population, despite numerous administrative problems resulting in delayed and only partial implementation in most provinces. The main lessons for low and middle-income countries from Vietnam's early experiences with the Health Care Fund for the Poor are that it managed to achieve positive outcomes in a short time-period, the need to ensure adequate and sustained funding for targeted programs, including marginal administrative costs, develop effective targeting mechanisms and systems for informing beneficiaries and providers about the program, respond to the increased demand for health care generated by the program, address indirect costs of health care utilization, and establish and maintain routine and systematic monitoring and evaluation mechanisms. PMID:19473518

Caring for the new uninsured: Hospital charity care for older people without coverage.

PubMed

DeLia, Derek

2006-12-01

Despite near-universal coverage through Medicare, a number of elderly residents in the United States do not have health insurance coverage. To the author's knowledge, this study is the first to document trends in the use of hospital charity care by uninsured older people. Data from the New Jersey Charity Care Program, which subsidizes hospitals for services provided to low-income uninsured people, were used to analyze trends in charity care utilization by older people from 1999 to 2004. Charity care charges are standardized to uniform Medicaid reimbursement rates and inflation adjusted using the Medical Care Consumer Price Index. From 1999 to 2004, use of charity care by older people grew much faster than it did for younger patients. As a result, older people now account for a greater share of hospital charity care in New Jersey than children. Elderly users of charity care generated higher costs per patient than their younger counterparts. Cost differences were especially salient at the upper end of the distribution, where high-cost elderly patients used significantly more resources than high-cost patients in other age groups. These results highlight an emerging source of strain on the healthcare safety net and point to a growing population of uninsured residents who have costly and complex medical needs. Similar experiences are likely to be found in other states, especially those that have growing populations of elderly immigrants who are likely to lack health insurance.

[Assessment of three-level selective perinatal care based on the analysis of early perinatal death rates and cesarean sections in Poland in 2008].

PubMed

Troszyński, Michał; Niemiec, Tomasz; Wilczyńska, Anna

2009-09-01

The aim of the following work was to assess three-level selective perinatal care in Polish voivodeships in 2008 on the basis of the following parameters: birth rates as well as perinatal death rates, divided into three classes of neonatal weights, in hospitals on each of the three levels. The goal of selective perinatal care is, among other things, to diagnose threats to the mother and/or fetus and direct women with high-risk pregnancies to higher level obstetrics and neonatology clinics and units. The structure of a regional three-level perinatal care, as well as the rules and procedures governing the process of redirecting patients to different levels of perinatal care have been defined in great detail. Perinatal death rates analysis has been carried out on the basis of data received from Voivodeship Public Health Centers in sixteen voivodeships in Poland in 2008. The main document constituted MZ-29 form section X, modified by the authors and subdivided into levels of perinatal care. All data contained in the form have been verified: the numbers concerning birth and death rates as well as perinatal deaths and birth weight subgroups from given voivodeship hospitals. Statistic analysis was limited to the presentation of result tables and graphs within voivodeships. Birth rates and perinatal death rates revealed that in the course of ten years the level of perinatal care, introduced gradually in Poland between the years 1997-1999, resulted in its improvement. Perinatal death rates decreased in the course of ten years from 9.5% in 1999 to 6.45% in 2008, i.e. by 0.3% annually. On the first level, the rate of neonates with very low birth weight, 500-999g, decreased by 5.5% and was 21.1% in 2008 and 36.6% in 1999, whereas on the third level, the birth rate in the same group (500-999g) increased by 12.7% and was 47.7% in 2008 and 35.5% in 1999. There is a growing and alarming tendency to perform cesarean sections. The increase amounted up to 1.2% annually (18.2% in 19999 and 30.5% in 2008), with vast differences among hospitals and voivodeships. In 2008 there were 28.4% of cesarean sections in level one-hospitals, 29.3% in level two-hospitals and 40.6% in level three-hospitals. The results of an overall decrease in perinatal deaths rate and an increase in birth rates in the group of neonates with very low birth weight on the third level are not satisfactory. Reintroduction of the program and strategy from the years 1995 and 1997 will enable us to improve the situation. Particularly this should be the case on the basic level perinatal care. In the context of three-level selective strategy the reintroduction of periodical analysis of perinatal care results is essential.

The palliative care knowledge questionnaire for PEACE: reliability and validity of an instrument to measure palliative care knowledge among physicians.

PubMed

Yamamoto, Ryo; Kizawa, Yoshiyuki; Nakazawa, Yoko; Morita, Tatsuya

2013-11-01

In Japan, a nationwide palliative care education program for primary palliative care (the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education: PEACE) was established in 2008. Effective delivery of such programs relies on adequate evaluations of program efficacy; however, such an instrument does not exist. This study aimed to develop and validate a measurement tool to quantify knowledge level of physicians about broader areas of palliative care, by which the effect of an education program could be measured. We conducted a cross-sectional, anonymous, self-administered questionnaire survey with a group of 801 conveniently sampled physicians in October 2010. To examine the test-retest reliability of items and domains, the questionnaire was reissued two weeks after the first survey was completed. This study used psychometric methods, including item response theory, intraclass correlation coefficients, and known-group validity. The response rate was 54% (n=434). We included 33 items across the following 9 domains: (1) philosophy of palliative care, (2) cancer pain, (3) side effects of opioids, (4) dyspnea, (5) nausea and vomiting, (6) psychological distress, (7) delirium, (8) communication regarding palliative care, and (9) community-based palliative care. For these items, the intraclass correlation was 0.84 and the Kuder-Richardson Formula 20 (KR-20) test of internal consistency was 0.87. There was a significant difference in the scores between palliative care specialists and other physicians. We successfully validated a newly developed palliative care knowledge questionnaire to evaluate PEACE effectiveness (PEACE-Q). The PEACE-Q could be useful for evaluating both palliative care knowledge among physicians and education programs in primary palliative care.

Delay to mental healthcare in a cohort of Canadian Armed Forces personnel with deployment-related mental disorders, 2002–2011: a retrospective cohort study

PubMed Central

Boulos, David; Zamorski, Mark A

2016-01-01

Objective To assess whether the delay to care among Canadian Armed Forces (CAF) personnel who sought care for a mental disorder changed over time and in association with CAF mental health system augmentations. Design A stratified, random sample (n=2014) was selected for study from an Afghanistan-deployed cohort (N=30 513) and the 415 (weighted N=4108) individuals diagnosed with an Afghanistan service-related mental disorder were further assessed. Diagnosis-related data were abstracted from medical records (22 June 2010 to 30 May 2011). Other data were extracted from administrative databases. Delay to care was assessed across five mental health system eras: 2002/2004, 2005/2006, 2007, 2008 and 2009/2010. Weighted Cox proportional hazards regression assessed the association between era, handled as a time-dependent covariate, and the outcome while controlling for a broad range of potential confounders (ie, sociodemographic, military and clinical characteristics). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. Primary outcome The outcome was the delay to mental healthcare, defined as the latency from most recent Afghanistan deployment return date to diagnosis date, among individuals with an Afghanistan service-related mental disorder diagnosis. Results Mean delay to care was 551 days (95% CI 501 to 602); the median was 400 days. Delay to care decreased in subsequent eras relative to 2002/2004; however, only the most recent era (2009/2010) was statistically significant (adjusted HR (aHR): 3.01 (95% CI 1.91 to 4.73)). Men, operations support occupations, higher ranks, non-musculoskeletal comorbidities and fewer years of military service were also independently associated with longer delays to care. Conclusions CAF mental health system changes were associated with reduced delays to mental healthcare. Further evaluation research is needed to identify the key system changes that were most impactful. PMID:27609855

Cost-effectiveness of 'Program We Care' for patients with chronic obstructive pulmonary disease: A case-control study.

PubMed

Wong, Eliza Mi Ling; Lo, Shuk Man; Ng, Ying Chu; Lee, Larry Lap Yip; Yuen, T M Y; Chan, Jimmy Tak Shing; Chair, Sek Ying

2016-07-01

To evaluate the effectiveness of a discharge program for patients with chronic obstructive pulmonary disease (COPD) patients on discharge from an emergency medical ward on discharge home rate, hospital length of stay (LOS), inpatient admission rate and cost. Frequent visits to the emergency department (ED) and subsequent hospital admission are common among patients with COPD, which adds a burden to ED and hospital care. A discharge program was implemented in an ED emergency medical ward. The program consisted of multidisciplinary care, discharge planning, discharge health education on disease management, and continued support from the community nursing services. A retrospective case-control study was used. Data were retrieved and compared between 478 COPD program cases and 478 COPD non-program cases. No significant difference was found in age, gender, and triage category, LOS in ED, and readmission rate between the program and non-program groups. The program group demonstrated a significantly higher discharge home rate from the ED (33.89% vs. 20.08%) and fewer medical admissions (40.59% vs. 55.02%) compared with the non-program group, resulting in lower total medical costs after the program was implemented. The program provides insight on the strategic planning for discharge care in a short stay unit of emergency department. Copyright © 2015 Elsevier Ltd. All rights reserved.

Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study

PubMed Central

Coquelin, Anaëlle; Cuttini, Marina; Khoshnood, Babak; Glorieux, Isabelle; Claris, Olivier; Durox, Mélanie; Kaminski, Monique; Ancel, Pierre-Yves; Arnaud, Catherine

2016-01-01

Objectives: To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. Design: Prospective national cohort study of all births before 32 weeks of gestation. Setting: Twenty-five French regions. Participants: All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). Interventions: None. Measurements and Main Results: Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p < 0.001). Individual factors associated with kangaroo care initiation were gestational age (odds ratio, 5.79; 95% CI, 4.49–7.48 for babies born at 27–31 wk compared with babies born at 23–26 wk) and, to a lesser extent, single pregnancy, birthweight above the 10th centile, and mother’s employment before pregnancy. At unit level, policies and training in neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8–7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p < 0.0001). Conclusions: Dissemination of neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies. PMID:27518584

Review of the Applications of Formosat-2 on Rapidly Responding to Global Disasters and Monitoring Earth Environment

NASA Astrophysics Data System (ADS)

Liu, C.

2009-12-01

Formosat-2 is the first satellite with high-spatial-resolution sensor deployed in a daily-revisit orbit in the world. Together with its agility of pointing ±45 degree both across and along track, we are able to observe each accessible scene from the same angle under the similar illumination conditions. These characteristics make Formosat-2 an ideal satellite for site surveillance. We developed a Formosat-2 automatic image processing system (F-2 AIPS) that can accurately and rapidly process a large amount of Formosat-2 images to produce the higher levels of products, including rigorous band-to-band coregistration, automatic orthorectification, multi-temporal image coregistration and radiance normalization, and pan-sharpening. This system has been successfully employed to rapidly respond to many international disaster events in the past five years, including flood caused by Typhoon Mindulle (2004), landslide caused by Typhoon Aere (2004), South Asia earthquake and tsunami (2004), Hurricane Katrina (2005), California wildfire (2007), Sichuan Earthquake (2008), Typhoon Kalmaegi (2008), Typhoon Sinlaku (2008), Mountain Ali wildfire (2009), Victoria bushfire in Australia (2009), Honduras earthquake (2009), Typhoon Morakot (2009). This paper reviews the applications of Formosat-2 on rapidly responding to global disasters and monitoring earth environment.

Geomorphic Responses to Stream Channel Restoration at Minebank Run, Baltimore County, Maryland, 2002--2008

EPA Science Inventory

Data collected from 2002 through 2008 were used to assess geomorphic characteristics and geomorphic changes over time in a selected reach of Minebank Run, a small urban watershed near Towson, Maryland, prior to and after its physical restoration in 2004 and 2005. Data collected ...

Student Distraction in a 1:1 Learning Environment

ERIC Educational Resources Information Center

Tagsold, Jennifer Tingen

2012-01-01

K-12 education research has become increasingly concerned with technology's impact on students' attention in the classroom, particularly with regard to laptop computers and other mobile devices (Gay & Hembrooke, 2004; Jackson, 2008; Mann, 2008; Kraushaar & Novak, 2010). While this classroom technology has created many positive…

Students' Perception of Engagement in a Third-Grade Writing Classroom

ERIC Educational Resources Information Center

Spinks, James D., Jr.

2012-01-01

Educators have been challenged for many years to engage their students, but often students still seem to be disengaged (Klem & Connell, 2004). Research indicates student engagement is critical to student achievement and success in school (Appleton, 2008; Connell, Spencer, & Aber, 1994; Easton, 2008; Fredricks, Blumenfeld, & Paris,…

Decreasing Intestinal Parasites in Recent Northern California Refugees

PubMed Central

Chang, Alicia H.; Perry, Sharon; Du, Jenny N. T.; Agunbiade, Abdulkareem; Polesky, Andrea; Parsonnet, Julie

2013-01-01

Beginning in 2005, the Centers for Disease Control and Prevention (CDC) expanded the overseas presumptive treatment of intestinal parasites with albendazole to include refugees from the Middle East. We surveyed the prevalence of helminths and protozoa in recent Middle Eastern refugees (2008–2010) in comparison with refugees from other geographical regions and from a previous survey (2001–2004) in Santa Clara County, California. Based on stool microscopy, helminth infections decreased, particularly in Middle Eastern refugees (0.1% versus 2.3% 2001–2004, P = 0.01). Among all refugees, Giardia intestinalis was the most common protozoan found. Protozoa infections also decreased somewhat in Middle Eastern refugees (7.2%, 2008–2010 versus 12.9%, 2001–2004, P = 0.08). Serology for Strongyloides stercoralis and Schistosoma spp. identified more infected individuals than stool exams. Helminth infections are increasingly rare in refugees to Northern California. Routine screening stool microscopy may be unnecessary in all refugees. PMID:23149583

Vibrio cholerae O1 El Tor from southern Vietnam in 2010 was molecularly distinct from that present from 1999 to 2004.

PubMed

Nguyen, V H; Pham, H T; Diep, T T; Phan, C D H; Nguyen, T Q; Nguyen, N T N; Ngo, T C; Nguyen, T V; Do, Q K; Phan, H C; Nguyen, B M; Ehara, M; Ohnishi, M; Yamashiro, T; Nguyen, L T P; Izumiya, H

2016-04-01

The Vibrio cholerae O1 (VCO1) El Tor biotype appeared during the seventh cholera pandemic starting in 1961, and new variants of this biotype have been identified since the early 1990s. This pandemic has affected Vietnam, and a large outbreak was reported in southern Vietnam in 2010. Pulsed-field gel electrophoresis (PFGE) and multilocus variable-number tandem-repeat analyses (MLVA) were used to screen 34 VCO1 isolates from the southern Vietnam 2010 outbreak (23 patients, five contact persons, and six environmental isolates) to determine if it was genetically distinct from 18 isolates from outbreaks in southern Vietnam from 1999 to 2004, and two isolates from northern Vietnam (2008). Twenty-seven MLVA types and seven PFGE patterns were identified. Both analyses showed that the 2008 and 2010 isolates were distinctly clustered and separated from the 1999-2004 isolates.

Is a Baccalaureate in Nursing Worth It? The Return to Education, 2000–2008

PubMed Central

Spetz, Joanne; Bates, Timothy

2013-01-01

Objective. A registered nurse (RN) license can be obtained by completing a baccalaureate degree (BSN), an associate degree (AD), or a diploma program. The aim of this article is to examine the return to baccalaureate education from the perspective of the nurse. Data Sources. National Sample Survey of Registered Nurses, 2000, 2004, and 2008. Study Design. The effect of education on RN wages is estimated using multivariate regression, both for initial education and for completing a second degree. The coefficients are used to calculate lifetime expected earnings. Multinomial logistic regression is used to examine the relationship between education and job title. Principal Findings. Lifetime earnings for nurses whose initial education is the BSN are higher than those of AD nurses only if the AD program requires 3 years and the discount rate is 2 percent. For individuals who enter nursing with an AD, lifetime earnings are higher if they complete a BSN. The BSN is associated with higher likelihood of being an advanced practice registered nurse, having an academic title, and having a management title. Conclusions. Because baccalaureate education confers benefits both for RNs and their patients, policies to encourage the pursuit of BSN degrees need to be supported. PMID:24102422

[Development of a distance education program in the public health system in Chile, 2004-2009].

PubMed

Carabantes C, Jorge; Guerra U, Manuel; Guillou, Michèle

2010-09-01

This paper reports the gradual development and results achieved in the distance education program set up in the Public Health System in Chile in 2004. Up to date, more than 22,000 students from 29 different health divisions have been trained. This strategy was designed to provide more flexibility and diversity to the training programs of the Health System within the framework of a deep and complex organizational change promoted by Health Reform. The main results show that the integration of organizational, teaching, logistic and budgetary aspects has turned out to be a key element in its success, validating the relevance of the provided solutions. The access to training by means of e-learning or blended learning (electronic education that includes traditional and distance learning activities) allowed employees to choose more independently what, where and when to study. This fact accounts for the high demand for this program. Through this initiative, the National Health System, introduced a wider scope of responses to training needs, which will mean a better adaptation to the challenges associated to health care.

Progressivity of health care financing and incidence of service benefits in Ghana.

PubMed

Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

2012-03-01

The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

78 FR 50113 - Distribution of 2004, 2005, 2006, 2007, 2008, and 2009 Cable Royalty Funds

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-16

... allowing distant retransmission of over-the-air television and radio broadcast signals by cable system operators. The funds to be distributed are those relating to broadcast years 2004, 2005, 2006, 2007, 2006... Twice each calendar year, cable system operators must deposit royalty payments with the Copyright Office...

Characteristics of the original patient navigation programs to reduce disparities in the diagnosis and treatment of breast cancer.

PubMed

Vargas, Roberto B; Ryan, Gery W; Jackson, Catherine A; Rodriguez, Rian; Freeman, Harold P

2008-07-15

Patient navigation is an intervention developed to reduce disparities in cancer care that is being widely replicated and receiving considerable support for demonstration projects and research to test its effectiveness. In the current study, the authors present an in-depth descriptive analysis of the original patient navigation programs to inform current and future program development. A qualitative multistakeholder case study using interviews and site visits of the first patient navigation site and 2 sites subsequently developed by the leadership of the original site were evaluated. At these sites, patient navigation is a system, as opposed to a person, comprised primarily of navigators and directors that work together to remove barriers and facilitate access in a well-defined course of care; navigators were from the community or were culturally similar to the patient population served but were also paid employees of the clinical care site with detailed knowledge of the clinical course patients must traverse to complete care plans. Directors had administrative authority over the clinical facility and social capital across institutions, and communicated regularly and openly with navigators to implement system level changes to remove barriers to care. Contextual factors such as policies supporting breast cancer care also influenced the implementation of these programs. The first patient navigation programs combined community and culturally sensitive care-coordination with aspects of disease management programs to reduce racial, ethnic, and poverty-driven disparities in care. Future efforts to replicate and evaluate patient navigation should take into account these unique aspects of the original patient navigation programs. (c) 2008 American Cancer Society.

Effects of High-Flow Experiments from Glen Canyon Dam on Abundance, Growth, and Survival Rates of Early Life Stages of Rainbow Trout in the Lees Ferry Reach of the Colorado River

USGS Publications Warehouse

Korman, Josh; Kaplinski, Matthew; Melis, Theodore S.

2010-01-01

High-flow experiments (HFEs) from Glen Canyon Dam are primarily intended to conserve fine sediment and improve habitat conditions for native fish in the Colorado River as it flows through Grand Canyon National Park, Arizona. These experimental flows also have the potential to affect the rainbow trout (Oncorhynchus mykiss) population in the Lees Ferry tailwater reach immediately below the dam, which supports a highly valued recreational fishery and likely influences the abundance of rainbow trout in Grand Canyon. Understanding how flow regimes affect the survival and growth of juvenile rainbow trout is critical to interpreting trends in adult abundance. This study reports on the effects of HFEs in 2004 and 2008 on early life stages of rainbow trout in the Lees Ferry reach on the basis of monthly sampling of redds (egg nests) and the abundance of the age-0 trout (fertilization to about 1 to 2 months from emergence) and their growth during a 7-year period between 2003 and 2009. Multiple lines of evidence indicate that the March 2008 HFE resulted in a large increase in early survival rates of age-0 trout because of an improvement in habitat conditions. A stock-recruitment analysis demonstrated that age-0 abundance in July 2008 was more than fourfold higher than expected, given the number of viable eggs that produced these fish. A hatch-date analysis showed that early survival rates were much higher for cohorts that hatched about 1 month after the 2008 HFE (about April 15, 2008) relative to those fish that hatched before this date. These cohorts, fertilized after the 2008 HFE, would have emerged into a benthic invertebrate community that had recovered, and was possibly enhanced by, the HFE. Interannual differences in growth of age-0 trout, determined on the basis of otolith microstructure, support this hypothesis. Growth rates in the summer and fall of 2008 (0.44 mm/day) were virtually the same as in 2006 (0.46 mm/day), the highest recorded during 6 years, even though abundance was eightfold greater in 2008. We speculate that the 60-hour-long 2008 HFE (with peak magnitude about twice that of the annual peak flow during the previous 4 years) increased interstitial spaces in the gravel bed substrate and food availability or quality, leading to higher early survival of recently emerged trout and better growth of these fish through summer and fall. Abundance in 2009 was more than twofold higher than expected, given the estimated number of viable eggs deposited in that year, perhaps indicating that the effect of the 2008 HFE on early life stages was somewhat persistent. In a 3-week interval that spanned the November 2004 HFE, abundance of age-0 trout that were approximately 7 months old from hatch experienced about a threefold decline, compared to the approximately twofold decrease observed between November and December 2008. Abundance of age-0 trout that were approximately 10 months old from hatch was very similar across sampling trips that spanned the March 2008 HFE. It is uncertain whether the decline in abundance after the November 2004 HFE was the result of higher flow-induced mortality or higher flow-induced downstream dispersal. A focused monitoring effort in Marble Canyon (the reach immediately downstream of the Lees Ferry tailwater) before and after future HFEs is recommended to resolve this uncertainty. Relatively detailed monitoring of early life stages-such as the program described in this study-is essential to establish linkages between Glen Canyon Dam operations, or possibly other factors, and trends in the abundance of important nonnative and native fish populations living downstream within Grand Canyon National Park.

Parents Returning to Work: Evaluation of Grant Recipient Outcomes 2004-05, 2005-06

ERIC Educational Resources Information Center

Ferrier, Fran; Kellock, Peter; Burke, Gerald

2007-01-01

The Parents Returning to Work Program (PRTW) is a Victorian government initiative which commenced in 2003. It provides grants to assist eligible parents who wish to return to paid employment after a period of caring for children to participate in training that will increase their work skills and job prospects. This evaluation aimed to review the…

Cultural Competence Integration in the Nursing Curriculum

ERIC Educational Resources Information Center

Stegman, Boniface C.

2013-01-01

With an increasingly diverse population, it is important to ensure that graduates of nursing programs are able to deliver culturally competent care (Krainovich-Miller et al., 2008; Allen, 2010). This study was undertaken to address this call to include cultural competence integration into nursing curriculum. The purpose of this study was to…

A Review of Successful Health Care Coalitions and Partnerships

DTIC Science & Technology

2011-03-01

status in communities, and are often viewed as financial commodities which derive their importance solely as entities and players in the free market ...Quake Likely to Strike Within the Next 30 Years?" UCGS Fact Sheet 039-03, 2003. 35 Hospital Preparedness Program 2008 End of Year data. 36

Annual Report to the Nation on the Status of Cancer, 1975–2008, Featuring Cancers Associated With Excess Weight and Lack of Sufficient Physical Activity

PubMed Central

Eheman, Christie; Henley, S. Jane; Ballard-Barbash, Rachel; Jacobs, Eric J.; Schymura, Maria J.; Noone, Anne-Michelle; Pan, Liping; Anderson, Robert N.; Fulton, Janet E.; Kohler, Betsy A.; Jemal, Ahmedin; Ward, Elizabeth; Plescia, Marcus; Ries, Lynn A. G.; Edwards, Brenda K.

2015-01-01

BACKGROUND Annual updates on cancer occurrence and trends in the United States are provided through collaboration between the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR). This year’s report highlights the increased cancer risk associated with excess weight (overweight or obesity) and lack of sufficient physical activity (<150 minutes of physical activity per week). METHODS Data on cancer incidence were obtained from the CDC, NCI, and NAACCR; data on cancer deaths were obtained from the CDC’s National Center for Health Statistics. Annual percent changes in incidence and death rates (age-standardized to the 2000 US population) for all cancers combined and for the leading cancers among men and among women were estimated by joinpoint analysis of long-term trends (incidence for 1992–2008 and mortality for 1975–2008) and short-term trends (1999–2008). Information was obtained from national surveys about the proportion of US children, adolescents, and adults who are overweight, obese, insufficiently physically active, or physically inactive. RESULTS Death rates from all cancers combined decreased from 1999 to 2008, continuing a decline that began in the early 1990s, among men and among women in most racial and ethnic groups. Death rates decreased from 1999 to 2008 for most cancer sites, including the 4 most common cancers (lung, colorectum, breast, and prostate). The incidence of prostate and colorectal cancers also decreased from 1999 to 2008. Lung cancer incidence declined from 1999 to 2008 among men and from 2004 to 2008 among women. Breast cancer incidence decreased from 1999 to 2004 but was stable from 2004 to 2008. Incidence increased for several cancers, including pancreas, kidney, and adenocarcinoma of the esophagus, which are associated with excess weight. CONCLUSIONS Although improvements are reported in the US cancer burden, excess weight and lack of sufficient physical activity contribute to the increased incidence of many cancers, adversely affect quality of life for cancer survivors, and may worsen prognosis for several cancers. The current report highlights the importance of efforts to promote healthy weight and sufficient physical activity in reducing the cancer burden in the United States. PMID:22460733

The positive financial impact of using an Intensive Care Information System in a tertiary Intensive Care Unit.

PubMed

Levesque, Eric; Hoti, Emir; de La Serna, Sofia; Habouchi, Houssam; Ichai, Philippe; Saliba, Faouzi; Samuel, Didier; Azoulay, Daniel

2013-03-01

In the French healthcare system, the intensive care budget allocated is directly dependent on the activity level of the center. To evaluate this activity level, it is necessary to code the medical diagnoses and procedures performed on Intensive Care Unit (ICU) patients. The aim of this study was to evaluate the effects of using an Intensive Care Information System (ICIS) on the incidence of coding errors and its impact on the ICU budget allocated. Since 2005, the documentation on and monitoring of every patient admitted to our ICU has been carried out using an ICIS. However, the coding process was performed manually until 2008. This study focused on two periods: the period of manual coding (year 2007) and the period of computerized coding (year 2008) which covered a total of 1403 ICU patients. The time spent on the coding process, the rate of coding errors (defined as patients missed/not coded or wrongly identified as undergoing major procedure/s) and the financial impact were evaluated for these two periods. With computerized coding, the time per admission decreased significantly (from 6.8 ± 2.8 min in 2007 to 3.6 ± 1.9 min in 2008, p<0.001). Similarly, a reduction in coding errors was observed (7.9% vs. 2.2%, p<0.001). This decrease in coding errors resulted in a reduced difference between the potential and real ICU financial supplements obtained in the respective years (€194,139 loss in 2007 vs. a €1628 loss in 2008). Using specific computer programs improves the intensive process of manual coding by shortening the time required as well as reducing errors, which in turn positively impacts the ICU budget allocation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The cost of Medicaid annuities.

PubMed

Levy, Robert A; Nyman, John A; Gabay, Mary; Riley, William; Feldman, Roger

2006-01-01

Medicaid annuities are annuities that long-term care recipients use to shelter assets, thereby qualifying them early for Medicaid eligibility. As such, these annuities have the potential to increase Medicaid costs. This study estimates the cost of annuities to the Medicaid program. From a sample of Medicaid applications in five states, we found the rate at which annuities were used and simulated their cost to Medicaid. We estimated that in 2004, Medicaid annuities cost Medicaid about 197 million dollars, which represented a small proportion of Medicaid's almost 50 billion dollars cost for nursing home care.

U.S. Air Force Operational Medicine: Using the Enterprise Estimating Supplies Program to Develop Materiel Solutions for the Operational Requirements of the EMEDS Specialty Care Augmentation Team

DTIC Science & Technology

2011-06-28

EXTERNA NOS 5 075 INFECTIOUS MONONUCLEOSIS 1 864.01 LIVER HEMATOMA/CONTUSION 1 928.8 MULT CRUSHING INJURY LEG 4 817.0 MULTIPLE FX HAND-CLOSED 1 782.1...medical assets since 2004. Air Force medical modeling capabilities currently capture care and treatment of the sick and injured from the first...begins with the identification of likely patient types to be encountered by a particular type of medical treatment asset, including combat wounds

Epidemiology of Mixed, Stress & Urgency Urinary Incontinence in Mid-Aged/Older Women: Importance of Incontinence History

PubMed Central

Komesu, Yuko M.; Schrader, Ronald M.; Ketai, Loren H.; Rogers, Rebecca G.; Dunivan, Gena C.

2016-01-01

Introduction & Hypothesis Urinary incontinence (UI) is common and the relationship between its subtypes is complex. Our objective was to describe the natural history and predictors of incontinence subtypes, Stress, Urgency and Mixed, in mid-aged and older U.S. women. We hypothesized that past UI subtype history predicted future UI subtype status and sought to determine the extent to which this occurred. Methods We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women ≥50 in the 2004–2010 Health and Retirement Study database. Mixed, Stress, Urgency incontinence prevalence (2004,2006,2008,2010) and 2-year cumulative incidence and remissions (2004–6,2006–8 2008–10) were estimated. Patient characteristics and incontinence subtype status 2004–2008 were entered into a multivariable model to determine predictors for incontinence subtype occurrence in 2010. Results Prevalence of each subtype in this population (median age 63–66) was 2.6%–8.9%. Subtype incidence equaled 2.1–3.5% and remissions for each varied between 22.3–48.7%. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, functional limitations. Compared to White women, Black women had decreased odds of incident Stress Incontinence, Hispanic women had increased odds of Stress Incontinence remission. Age 80–90 and severe obesity predicted incident Mixed Incontinence. Functional limitations predicted Mixed and Urgency Incontinence. The strongest predictor of incontinence subtypes was incontinence subtype history. Presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence [Odds Ratio (OR) Stress Incontinence=30.7, Urgency OR=47.4, Mixed OR=42.1]. Conclusions Although remissions were high, prior history of incontinence subtypes predicted recurrence. Incontinence status is dynamic but tends to recur over the longer term. PMID:26670573

Researcher development program of the primary health care research, evaluation and development strategy.

PubMed

McIntyre, Ellen; Brun, Lyn; Cameron, Helen

2011-01-01

The Research Development Program (RDP) was initiated in 2004 under the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy to increase the number and range of people with knowledge and skills in primary health care research and evaluation. RDP Fellows were invited to participate in an online survey about the effect the program had on their research knowledge, attitudes and practice. The response rate was 42% (105/248). Most were female (88%) with 66% aged between 31 and 50 years. Over two-thirds (72%) were health practitioners. Activities undertaken during the RDP ranged from literature reviews, developing a research question, preparing ethics submissions, attending and presenting at conferences and seminars, preparing papers and reports, and submitting grant applications. Despite the fact that only 52% agreed that the RDP time was adequate, 94% agreed that the RDP was a valuable experience, with 89% expressing interest in undertaking further research. These results indicate that this program has had a positive effect on the RDP Fellows in terms of their knowledge about research, their attitude to research, and the way they use research in their work.

Comprehensive attention to oral health in early childhood: a longitudinal evaluation of the Infant Clinic Program of the Federal University of Rio Grande do Sul, Brazil.

PubMed

Figueiredo, Márcia Cançado; Guarienti, Cinthya Aline D; Michel, Jorge Artur; Sampaio, Mircelei Saldanha

2008-01-01

The Infant Clinic Program believes that oral care should begin within the first days of life in order to guarantee good oral health throughout life; however it has been observed that many dental professionals are not trained attend to this segment of the population. The purpose of the Infant Clinic course is to offer the theoretical and practical knowledge that dentists need to know in order to offer education, prevention and curative treatments, providing comprehensive attention to infants and young children. To evaluate the effectiveness of this Program, a longitudinal study was conducted with the children who participated in the Program during 2004 and 2005. The analysis was performed by first defining the profiles of 303 children before they came to the Infant Clinic, and comparing their oral status in 2004 and at the end of 2005 (12 months, Chi-square test, p < 0.01). Of the 303 children observed in 2004, 72.87% came to the clinic for maintenance of oral health, compared to 14.83% who had caries lesions. During the first clinical examination (2004), it was observed that 57% of the children had good plaque control, while 33% of children had poor or very bad plaque control. After 12 months (2005), an increase in good plaque control was observed in the children (77.28% with good plaque control, and 22.72%poor or very bad plaque control) (p < 0.01). Through the treatment of active lesions, we verified a decrease in active lesions (from 82% to 32%) (p < 0.01). These results show the effectiveness of the program's education, preventive and curative procedures. In addition to the positive experience of the Infant Clinic program, it was concluded that, with the support of treatment and parental education regarding healthy diet and oral hygiene for children, preventive procedures and curative treatment of existing lesions, oral health promotion for very young children was in fact achieved.

Design, Recruitment and Start Up of a Primary Care Weight Loss Trial Targeting African American and Hispanic Adults

PubMed Central

Kumanyika, Shiriki; Fassbender, Jennifer; Phipps, Etienne; Tan-Torres, Susan; Localio, Russell; Morales, Knashawn H.; Sarwer, David B.; Harralson, Tina; Allison, Kelly; Wesby, Lisa; Kessler, Ronni; Tsai, Adam Gilden; Wadden, Thomas A.

2011-01-01

Primary care offices are critical access points for obesity treatment, but evidence for approaches that can be implemented within these settings is limited. The Think Health! (¡Vive Saludable!) Study was designed to assess the feasibility and effectiveness of a behavioral weight loss program, adapted from the Diabetes Prevention Program, for implementation in routine primary care. Recruitment of clinical sites targeted primary care practices serving African American and Hispanic adults. The randomized design compares (a) a moderate-intensity treatment consisting of primary care provider counseling plus additional counseling by an auxiliary staff member (i.e., lifestyle coach), with (b) a low-intensity, control treatment involving primary care provider counseling only. Treatment and follow up duration are 1 to 2 years. The primary outcome is weight change from baseline at 1 and 2 years post-randomization. Between November 2006 and January 2008, 14 primary care providers (13 physicians; 1 physician assistant) were recruited at five clinical sites. Patients were recruited between October 2007 and November 2008. A total of 412 patients were pre-screened, of whom 284 (68.9%) had baseline assessments and 261 were randomized, with the following characteristics: 65% African American; 16% Hispanic American; 84% female; mean (SD) age of 47.2 (11.7) years; mean (SD) BMI of 37.2(6.4) kg/m2; 43.7% with high blood pressure; and 18.4% with diabetes. This study will provide insights into the potential utility of moderate-intensity lifestyle counseling delivered by motivated primary care clinicians and their staff. The study will have particular relevance to African Americans and women. PMID:21062645

Early detection of cervical cancer according to the discourses of primary care midwives in Segovia, Spain.

PubMed

Otero, Laura; Sanz, Belén; Blasco, Teresa

2011-10-01

To analyze the discourses of primary care midwives on access to and utilization of the Cervical Cancer Prevention Program. A qualitative study was conducted in an area of low population density with a high proportion of rural population in Segovia, Spain, between 2008 and 2009. Semi-structured interviews were carried out. Ten primary care midwives were interviewed covering the 16 basic health districts of the city. Data analysis was based on grounded theory methodology. Access to and utilization of the Cervical Cancer Prevention Program was associated with attendance to midwife visits, women's experiences with cervical smears and their perception of risk of cervical cancer. Geographic distance to the health center, difficult access to immigrant women who have no health insurance, and being unaware of the program offered are some of the perceived barriers. Social exclusion is also perceived as a barrier of access to and utilization of the program. The recommendation to participate in the program made by the primary care physician was identified as the main facilitator. The midwives perceived inequalities in access to and utilization of the Cervical Cancer Prevention Program that are associated to individual characteristics of women, and contextual characteristics such as the geographical environment where they live and Program's infrastructure. There is inequality of access to care of underrepresented groups of women such as immigrant women and those residing in rural areas.

Clinical Use of Mood Stabilizers With Antidepressants in Asia: Report From the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) Projects in 2004 and 2013.

PubMed

Rajaratnam, Kamini; Xiang, Yu-Tao; Tripathi, Adarsh; Chiu, Helen F K; Si, Tian-Mei; Chee, Kok-Yoon; Avasthi, Ajit; Grover, Sandeep; Chong, Mian-Yoon; Kuga, Hironori; Kanba, Shigenobu; He, Yan-Ling; Lee, Min-Soo; Yang, Shu-Yu; Udomratn, Pichet; Kallivayalil, Roy A; Tanra, Andi J; Maramis, Margarita M; Shen, Winston W; Sartorius, Norman; Kua, Ee-Heok; Tan, Chay-Hoon; Mahendran, Rathi; Shinfuku, Naotaka; Sum, Min Yi; Baldessarini, Ross J; Sim, Kang

2017-04-01

As most reports concerning treatment with combinations of mood stabilizer (MS) with antidepressant (AD) drugs are based in the West, we surveyed characteristics of such cotreatment in 42 sites caring for the mentally ill in 10 Asian countries. This cross-sectional, pharmacoepidemiologic study used 2004 and 2013 data from the REAP-AD (Research Study on Asian Psychotropic Prescription Patterns for Antidepressants) to evaluate the rates and doses of MSs given with ADs and associated factors in 4164 psychiatric patients, using standard bivariate methods followed by multivariable logistic regression modeling. Use of MS + AD increased by 104% (5.5% to 11.2%) between 2004 and 2013 and was much more associated with diagnosis of bipolar disorder than major depression or anxiety disorder, as well as with hospitalization > outpatient care, psychiatric > general-medical programs, and young age (all P < 0.001), but not with country, sex, or AD dose. The findings provide a broad picture of contemporary use of MSs with ADs in Asia, support predictions that such treatment increased in recent years, and was associated with diagnosis of bipolar disorder, treatment in inpatient and psychiatric settings, and younger age.

The development of sustainable emergency care in ghana: physician, nursing and prehospital care training initiatives.

PubMed

Martel, John; Oteng, Rockefeller; Mould-Millman, Nee-Kofi; Bell, Sue Anne; Zakariah, Ahmed; Oduro, George; Kowalenko, Terry; Donkor, Peter

2014-10-01

Ghana's first Emergency Medicine residency and nursing training programs were initiated in 2009 and 2010, respectively, at Komfo Anokye Teaching Hospital in the city of Kumasi in association with Kwame Nkrumah University of Science and Technology and the Universities of Michigan and Utah. In addition, the National Ambulance Service was commissioned initially in 2004 and has developed to include both prehospital transport services in all regions of the country and Emergency Medical Technician training. Over a decade of domestic and international partnership has focused on making improvements in emergency care at a variety of institutional levels, culminating in the establishment of comprehensive emergency care training programs. We describe the history and status of novel postgraduate emergency physician, nurse, and prehospital provider training programs as well as the prospect of creating a board certification process and formal continuing education program for practicing emergency physicians. Significant strides have been made in the development of emergency care and training in Ghana over the last decade, resulting in the first group of Specialist-level emergency physicians as of late 2012, as well as development of accredited emergency nursing curricula and continued expansion of a national Emergency Medical Service. This work represents a significant move toward in-country development of sustainable, interdisciplinary, team-based emergency provider training programs designed to retain skilled health care workers in Ghana and may serve as a model for similar developing nations. Copyright © 2014 Elsevier Inc. All rights reserved.

Land Area Change and Overview of Major Hurricane Impacts in Coastal Louisiana, 2004-08

USGS Publications Warehouse

Barras, John A.

2009-01-01

The U.S. Geological Survey (USGS) assessed changes in land and water coverage in coastal Louisiana within 2 months of Hurricane Gustav (September 1, 2008) and Hurricane Ike (September 13, 2008) by using Landsat Thematic Mapper (TM) satellite imagery. The purpose of this study was twofold: (1) to provide preliminary information on land-water area changes in coastal Louisiana shortly after Hurricanes Ike and Gustav made landfall and (2) to contrast these changes with prior, widespread land area changes caused by Hurricane Katrina (August 29, 2005) and Hurricane Rita (September 24, 2005) 3 years earlier. Hurricane Gustav's physical surge impacts were not as severe as those observed from Hurricane Katrina. The largest observed changes were the reversion of recovery vegetation in Upper Breton Sound to an immediate post-Katrina appearance. Hurricane Ike's surge impacts were similar, although of somewhat lesser magnitude than Hurricane Rita's surge impacts. Major surge-removed marsh occurred in similar locations with similar morphologies from the two westward tracking storms. Although the net reduction in land from 2004 to 2008 (849.5 km2) exceeded that from 1978 to 2004 (743.3 km2), it is likely that the 2004-08 estimate will decrease, given time for the coast to recover from those hurricane seasons. Nevertheless, it is likely that the cumulative loss from these hurricane seasons will remain significant. Estimation of permanent losses cannot be made until several growing seasons have passed and the transitory impacts of the hurricanes are accounted for.

Electronic medical record in cardiology: a 10-year Italian experience.

PubMed

Carpeggiani, Clara; Macerata, Alberto; Morales, Maria Aurora

2015-08-01

the aim of this study was to report a ten years experience in the electronic medical record (EMR) use. An estimated 80% of healthcare transactions are still paper-based. an EMR system was built at the end of 1998 in an Italian tertiary care center to achieve total integration among different human and instrumental sources, eliminating paper-based medical records. Physicians and nurses who used EMR system reported their opinions. In particular the hospital activity supported electronically, regarding 4,911 adult patients hospitalized in the 2004- 2008 period, was examined. the final EMR product integrated multimedia document (text, images, signals). EMR presented for the most part advantages and was well adopted by the personnel. Appropriateness evaluation was also possible for some procedures. Some disadvantages were encountered, such as start-up costs, long time required to learn how to use the tool, little to no standardization between systems and the EMR technology. the EMR is a strategic goal for clinical system integration to allow a better health care quality. The advantages of the EMR overcome the disadvantages, yielding a positive return on investment to health care organization.

Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

PubMed

Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

2015-04-01

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008–2014

PubMed Central

Bleich, Sara N.; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce

2015-01-01

Introduction Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. Methods We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Results Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Conclusions Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients. PMID:26564013

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008-2014.

PubMed

Bleich, Sara N; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Chang, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce; Anderson, Gerard

2015-11-12

Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care - care and case management and disease management - reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.

The Impact of Child Care Subsidy Use on Child Care Quality

PubMed Central

Ryan, Rebecca M.; Johnson, Anna; Rigby, Elizabeth; Brooks-Gunn, Jeanne

2010-01-01

In 2008, the federal government allotted $7 billion in child care subsidies to low-income families through the state-administered Child Care and Development Fund (CCDF), now the government’s largest child care program (US DHHS, 2008). Although subsidies reduce costs for families and facilitate parental employment, it is unclear how they impact the quality of care families purchase. This study investigates the impact of government subsidization on parents’ selection of child care quality using multivariate regression and propensity score matching approaches to account for differential selection into subsidy receipt and care arrangements. Data were drawn from the Child Care Supplement to the Fragile Families and Child Wellbeing Study (CCS-FFCWS), conducted in 2002 and 2003 in 14 of the 20 FFCWS cities when focal children were 3 years old (N = 456). Our results indicate that families who used subsidies chose higher quality care than comparable mothers who did not use subsidies, but only because subsidy recipients were more likely to use center-based care. Subgroup analyses revealed that families using subsidies purchased higher-quality home-based care but lower-quality center-based care than comparable non-recipients. Findings suggest that child care subsidies may serve as more than a work support for low-income families by enhancing the quality of nonmaternal care children experience but that this effect is largely attributable to recipients’ using formal child care arrangements (versus kith and kin care) more often than non-recipients. PMID:21874092

Estimated cost of a health visitor-led protocol for perinatal mental health.

PubMed

Oluboyede, Yemi; Lewis, Anne; Ilott, Irene; Lekka, Chrysanthi

2010-06-01

Anecdotally, protocols, care pathways and clinical guidelines are time consuming to develop and sustain, but there is little research about the actual costs of their development, use and audit.This is a notable gap considering the pervasiveness of such documents that are intended to reduce unacceptable variations in practice by standardising care processes. A case study research design was used to calculate the resource use costs of a protocol for perinatal mental health, part of the core programme for health visitors in a primary care trust in the west of England. The methods were in-depth interviews with the operational lead for the protocol (a health visitor) and documentary analysis. The total estimated cost of staff time over a five-year period (2004 to 2008) was Euro 73,598, comprising Euro 36,162 (49%) for development and Euro 37,436 (51%) for implementation. Although these are best estimates dependent upon retrospective data, they indicate the opportunity cost of staff time for a single protocol in one trust over five years. When new protocols, care pathways or clinical guidelines are proposed, the costs need to be considered and weighed against the benefits of engaging frontline staff in service improvements.

The HLA dictionary 2008: a summary of HLA-A, -B, -C, -DRB1/3/4/5, and -DQB1 alleles and their association with serologically defined HLA-A, -B, -C, -DR, and -DQ antigens.

PubMed

Holdsworth, R; Hurley, C K; Marsh, S G E; Lau, M; Noreen, H J; Kempenich, J H; Setterholm, M; Maiers, M

2009-02-01

The 2008 report of the human leukocyte antigen (HLA) data dictionary presents serologic equivalents of HLA-A, -B, -C, -DRB1, -DRB3, -DRB4, -DRB5, and -DQB1 alleles. The dictionary is an update of the one published in 2004. The data summarize equivalents obtained by the World Health Organization Nomenclature Committee for Factors of the HLA System, the International Cell Exchange, UCLA, the National Marrow Donor Program, recent publications, and individual laboratories. The 2008 edition includes information on 832 new alleles (685 class I and 147 class II) and updated information on 766 previously listed alleles (577 class I and 189 class II). The tables list the alleles with remarks on the serologic patterns and the equivalents. The serological equivalents are listed as expert assigned types, and the data are useful for identifying potential stem cell donors who were typed by either serology or DNA-based methods. The tables with HLA equivalents are available as a searchable form on the IMGT/HLA database Web site (http://www.ebi.ac.uk/imgt/hla/dictionary.html).

Educating residents in behavioral health care and collaboration: integrated clinical training of pediatric residents and psychology fellows.

PubMed

Pisani, Anthony R; leRoux, Pieter; Siegel, David M

2011-02-01

Pediatric residency practices face the challenge of providing both behavioral health (BH) training for pediatricians and psychosocial care for children. The University of Rochester School of Medicine and Dentistry and Rochester General Hospital developed a joint training program and continuity clinic infrastructure in which pediatric residents and postdoctoral psychology fellows train and practice together. The integrated program provides children access to BH care in a primary care setting and gives trainees the opportunity to integrate collaborative BH care into their regular practice routines. During 1998-2008, 48 pediatric residents and 8 psychology fellows trained in this integrated clinical environment. The program's accomplishments include longevity, faculty and fiscal stability, sustained support from pediatric leadership and community payers, the development in residents and faculty of greater comfort in addressing BH problems and collaborating with BH specialists, and replication of the model in two other primary care settings. In addition to quantitative program outcomes data, the authors present a case example that illustrates how the integrated program works and achieves its goals. They propose that educating residents and psychology trainees side by side in collaborative BH care is clinically and educationally valuable and potentially applicable to other settings. A companion report published in this issue provides results from a study comparing the perceptions of pediatric residents whose primary care continuity clinic took place in this integrated setting with those of residents from the same pediatric residency who had their continuity clinic training in a nonintegrated setting.

Retrospective analysis of use and distribution of resources in otolaryngology wards in Romanian hospitals between 2003 and 2008 to improve provision and financial performance of healthcare services.

PubMed

Stamate, Marian; Chiriac, Nona Delia

2010-06-01

To analyze use and distribution of resources by otolaryngology (ENT) hospital wards in Romania between 2003 and 2008, in order to plan the improvement of patient access to health care services and health care services' financial performance. Clinical electronic records were searched for all patients discharged from all public hospitals funded on a per-case basis by the government between January 2003 and September 2008. Adult and pediatric ENT wards, as well as ENT wards from different counties, were compared. The number of ENT hospital beds and the number of specialists decreased from 2003 to 2004, the number of specialists declined, and specialists were distributed unevenly among the hospitals and counties. The total number of ENT wards was over 100 for almost the entire study period, but there were only about 15 pediatric ENT wards in all 42 counties. ENT wards recorded more cases and hospitalization days than oral-maxillofacial surgery and neurosurgery wards, but fewer cases than general surgery or obstetrics wards. ENT wards had the lowest mortality rates. Until the second half of 2007, adult ENT wards had a lower surgical index, higher complexity of cases, and longer average length of stay than pediatric ENT wards (P<0.001, t-test). After 2007, pediatric ENT wards treated more complex cases (P=0.004, t -test) that were less surgical in nature; this result was due to the shift from the Health Care Finance Administration classification diagnostic-related group (DRG) system to the Australian Refined DGR system, as well as to improper use of codes. ENT wards in different counties differed in the number of cases, average length of stay, and case mix index. Statistics and case mix clinical data may be a good starting point for informing hospital management to assess ENT service coverage, but they should be supplemented with data on hospitalization costs.

The inequity of inpatient services in rural areas and the New-Type Rural Cooperative Medical System (NRCMS) in China: repeated cross sectional analysis.

PubMed

Pan, Bingbing; Towne, Samuel D; Chen, Yuxing; Yuan, ZhaoKang

2017-06-01

The main aim of the New-type Rural Cooperative Medical System (NRCMS) put into effect in 2003 was to reduce financial barriers in accessing health care services among vulnerable populations. The aim of this study was to assess the association between NRCMS and income related inequality in hospital utilization among rural inhabitants in Jiangxi Province, China. A multistage stratified random cluster sampling method was adopted to select 1838, 1879, and 1890 households as participants in 2003/2004, 2008 and 2014, respectively. The Erreygers Concentration index (EI) of two measures of hospital inpatient care including admission to hospital and hospital avoidance, were calculated to measure income-related inequality. The decomposition of the EI was performed to characterize the contributions of socioeconomic and need factors to the measured inequality. An affluent-focused (pro-rich) inequity was observed for hospital admission adjusting for need factors over time. The level of inequity for hospital admission decreased dramatically, while hospital avoidance decreased marginally, and with a high value (EI, -0.0176) in 2008. The implementation of the NRCMS was associated with decreased inequity in 2008 and in 2014, but the associations were limited. Income contributed the most to the inequality of hospital utilization each year. The coverage of the NRCMS expanded to cover nearly all rural inhabitants in Jiangxi province by 2014 and was associated with a very small reduction in inequalities in admission to hospital. In order to increase equitable access to health care, additional financial protections for vulnerable populations are needed. Improving the relatively low level of medical services in township hospitals, and low rate of reimbursement and financial assistance with the NRCMS is recommended. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Jet Fuel Hedging Strategies for the Department of Defense Through Use of Financial Derivatives

DTIC Science & Technology

2009-03-01

W. (n.d.). Warren Buffett Quotes. Retrieved November 2008, from Brainy Quote: http://www.brainyquote.com/quotes/authors/w/warren_buffett.html...Prices Tough to Swallow. Retrieved August 2008, from Washington Post: http://www.washingtonpost.com/wp- dyn/articles/A11303-2004Jun2.html Buffett

Peer Observation of Teaching: A Practical Tool in Higher Education

ERIC Educational Resources Information Center

Fletcher, Jeffrey A.

2018-01-01

There are limited viewpoints in the literature about peer observation of teaching in higher education and how it can be an effective tool to improve the quality of instruction in the classroom (Bell, 2001; Bell, 2005; Bell & Mladenovic, 2008; Brancato, 2003; Chism, 2007; Huston & Weaver, 2008; Shortland, 2004; Shortland, 2010; Smith,…

Application of the fractional Levy motion to precipitation data

NASA Astrophysics Data System (ADS)

Kuzuha, Y.; Tachinami, S.; Gomi, C.

2012-12-01

We applied the fractional Lévy motion model to precipitation data, referring to Lavallée (2004) and Lavallée (2008). The data we used were from the Global Preciptiation Climatology Centre (GPCC) monthly precipitation dataset. These data consist of 360 (longitude) × 180 (latitude) × 1336 (monthly, 1901-2012). First, we constructed four datasets: time series of average monthly precipitation of the top (maximum) 1000 precipitation observation stations, top 10, top 100, and top 500. Next, according to Lavallée (2004) and Lavallée (2008), using Fourier transformation, convolution (filtering) and inverse Fourier transformation, we obtained random variables Xt (Lavallée, 2004) from Yt (precipitation). We transformed from Yt to Xt. Finally, we fitted the Lévy law to Xt. As a preliminary result, we present examples of the values of the Lévy law parameters: alpha, beta, gamma, and delta for the "top 100" dataset. Parameters obtained were (1.17, 0.0, 257.6, 0.28; maximum likelihood), (1.10, 0.0, 250.0, -0.99; quantile algorithm), and (1.20, 0.0, 265.1, 0.57; empirical characteristic function algorithm). We used J. P. Nolan's algorithm. The values are quite sensitive to the algorithm that is used. At the Fall meeting, we will present considerations and results obtained using precipitation data other than those of the GPCC. J. P. Nolan, http://academic2.american.edu/~jpnolan/stable/stable.html Lavallée (2004), Stochastic modeling of climatic variability in dendrochronology, GRL, 31, L15202. Lavallée (2008), On the random nature of earthquake sources and ground motions; a unified theory, Advances in Geophysics, 50, chapter 16. Acknowledgement: We thank Dr. D. Lavallee for his comments and suggestions.; An example of results which we obtained. On a log-log plot, PDF of the Lévy law (red line) is more appropriate than the Gaussian law (blue line) in terms of heavy tail or extreme values. This is consistent with Lavallée (2004) and Lavallée (2008) who used slip distribution and climate (dendrochronology) data.

Pre-exposure Prophylaxis (PrEP) Use, Seroadaptation, and Sexual Behavior Among Men Who Have Sex with Men, San Francisco, 2004-2014.

PubMed

Chen, Yea-Hung; Snowden, Jonathan M; McFarland, Willi; Raymond, H Fisher

2016-12-01

The Food and Drug Administration approved pre-exposure prophylaxis (PrEP) to prevent HIV infection, and the Centers for Disease Control and Prevention has presented PrEP as a prevention option for groups at high risk such as men who have sex with men (MSM). Intervention data provide some information on how PrEP affects sexual behavior of MSM in trials, open label extensions, or clinics. However, it is unclear whether sexual risk and preventive behavioral patterns are changing in the population as a whole as PrEP becomes more widely available, whether due to PrEP use or other factors. We examined trends in PrEP use, numbers of condomless anal sex partners, consistent condom use, and seroadaptive strategies in San Francisco-a city which has actively promoted PrEP-using data from National HIV Behavioral Surveillance (NHBS). NHBS recruited 1211, 383, 373, and 268 HIV-negative MSM in 2004, 2008, 2011, and 2014, respectively. PrEP use increased from zero in 2004, 2008, and 2011 to 9.6 % in 2014. The proportion of men with no condomless anal sex partners dropped from 60.6 % in 2004, to 58.2 % in 2008, to 54.2 % in 2011, to 40.2 % in 2014. Consistent condom use decreased from 36.8 % in 2004, and 30.5 % in 2008 and 2011, to 18.3 % in 2014. PrEP's introduction and scale-up enters in a pre-existing trend of decreasing condom use and increasing sexually transmitted infections among MSM which may be accelerating in recent years. While PrEP use should be scaled up as a prevention option among those who would benefit most, we believe that public health officials need to be realistic about the possibility that condom use could very well continue to decline as PrEP use increases, and to an extent that may not be directly or indirectly offset by PrEP.

Undergraduate Program: New Orleans

NASA Astrophysics Data System (ADS)

Betsock, Lori

2008-03-01

Undergraduate chemical science students—join us in New Orleans on April 6-7, 2008 for an educational program designed specifically for you. Attend symposia on chemistry in sports and health and learn how it impacts your life everyday; meet with graduate school recruiters. Focus on your professional future in chemistry by learning more about careers in public health and how to communicate and work effectively with cross-functional teams. Hear eminent scientist Richard B. Silverman (John Evans Professor of Chemistry, Northwestern University and author of The Organic Chemistry of Drug Design and Drug Action 2004) speak about "Drug Discovery: Ingenuity or Serendipity?" All events will take place at the Hilton Riverside Hotel in New Orleans, except the Undergraduate Research Poster Sessions and Sci-Mix, both of which will be held in Hall A of the Ernest N. Morial Convention Center.

Reducing barriers to breast cancer care through Avon patient navigation programs.

PubMed

Stanley, Sandte; Arriola, Kimberly Jacob; Smith, Shakiyla; Hurlbert, Marc; Ricci, Carolyn; Escoffery, Cam

2013-01-01

Avon Foundation for Women grantees provide breast cancer services through patient navigation (PN) in an effort to alleviate barriers to care among underserved women. To gain a better understanding of how PN programs function, this study explores variations in the use of navigators, types of services offered, description of clients they serve, tracking of treatment completion, and evaluation mechanisms. Fifty-six Avon PN programs funded since 2008 throughout the United States were contacted. An online survey was distributed to the grantees of which 44 (81%) complete responses were collected and analyzed. Clients were racially and ethnically diverse, mostly in the 40- to 64-year old age range (64%) and 91.6% with an average income of less than $30 000. Women were either uninsured (50.7%) or receiving Medicaid (32.4%). PN programs were both community and hospital-based (22.5%); many hospitals (35.2%) were described as safety nets (eg, provide a significant level of care to low-income, uninsured, vulnerable populations). On-site services included breast screening (eg, mammography and breast ultrasound) and treatment (eg, breast surgery and radiation therapy). Some barriers to care identified by the programs included transportation, access to appointments, language, and financial issues (eg, cost of screening and treatment specifically for those uninsured). More than 39% of programs provided care across the cancer continuum. Many Avon PN programs incorporated navigation services that span the cancer care continuum. They addressed disparities by offering navigation and on-site medical services to reduce multiple systems barriers and social issues related to breast care.

Effect of Medicaid Disease Management Programs on Emergency Admissions and Inpatient Costs

PubMed Central

Conti, Matthew S

2013-01-01

Objective To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. Data National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. Study Design A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Data Extraction Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. Principal Findings In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. Conclusions States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. PMID:23278435

Effect of Medicaid disease management programs on emergency admissions and inpatient costs.

PubMed

Conti, Matthew S

2013-08-01

To determine the impact of state Medicaid diabetes disease management programs on emergency admissions and inpatient costs. National InPatient Sample sponsored by the Agency for Healthcare Research and Quality Project for the years from 2000 to 2008 using 18 states. A difference-in-difference methodology compares costs and number of emergency admissions for Washington, Texas, and Georgia, which implemented disease management programs between 2000 and 2008, to states that did not undergo the transition to managed care (N = 103). Costs and emergency admissions were extracted for diabetic Medicaid enrollees diagnosed in the reform and non-reform states and collapsed into state and year cells. In the three treatment states, the implementation of disease management programs did not have statistically significant impacts on the outcome variables when compared to the control states. States that implemented disease management programs did not achieve improvements in costs or the number of emergency of admissions; thus, these programs do not appear to be an effective way to reduce the burden of this chronic disease. © Health Research and Educational Trust.

2004/06 Beginning Postsecondary Students Longitudinal Study (BPS:04/06). Methodology Report. NCES 2008-184

ERIC Educational Resources Information Center

Cominole, Melissa; Wheeless, Sara; Dudley, Kristin; Franklin, Jeff; Wine, Jennifer

2007-01-01

The "2004/06 Beginning Postsecondary Students Longitudinal Study (BPS:04/06)" is sponsored by the U.S. Department of Education to respond to the need for a national, comprehensive database concerning issues students may face in enrollment, persistence, progress, and attainment in postsecondary education and in consequent early rates of…

Unaccusativity and Word Order in Mexican Spanish: An Examination of Syntactic Interfaces and the Split Intransitivity Hierarchy

ERIC Educational Resources Information Center

Roggia, Aaron B.

2011-01-01

Recent research in language contact has investigated bilingual deviations from monolingual norms where syntax interfaces with the lexical and discourse components of the grammar (e.g. Iverson & Rothman 2008; Lozano 2006; Montrul 2004, 2005; Sorace & Filiaci 2006; Tsimpli et al. 2004). Such studies generally show that the…

Geochemistry of seafloor hydrothermal vent fluids at EPR 9°50'N: Time series data from 2004-2016

NASA Astrophysics Data System (ADS)

Scheuermann, P.; Pester, N. J.; Tutolo, B. M.; Simmons, S. F.; Seyfried, W. E., Jr.

2017-12-01

Hydrothermal fluids were collected from vent sites along the East Pacific Rise (EPR) at 9°50'N in 2004, 2008 and 2016 in isobaric gas-tight titanium samplers. These dates bracket the seafloor eruption that occurred at EPR 9°50'N between 2005 and 2006. The reported data focus on P vent and Bio9, as these vents were active during all three sampling periods. The concentration of aqueous volatiles reached maxima at both vents in 2008. At P vent, CO2, H2, and H2S were 124 mM/kg, 0.55 mM/kg and 12.2 mM/kg, respectively. The concentrations at Bio9 in 2008 were, 106 mM/kg CO2, 1.1 mM/kg H2, and 12.6 mM/kg H2S. Fe and Mn concentrations were the highest at both vent sites in 2004, and then decreased in 2008 and again in 2016. The range at P vent was 1.5-6.3 mM/kg Fe and 315-1212 uM/kg Mn, while at Bio9 the concentrations were 1.6-3.7 mM/kg Fe and 301-650 uM/kg Mn. The trends in CO2, H2, and H2S at P vent (2008 and 2016) and Bio9 (all years) are consistent with changes in subsurface pressure and temperature as a result of the eruption that alter the conditions at which dissolved components partition between vapor and liquid phases in the NaCl-H2O system. The trend in Fe and Mn concentrations is surprising and highlights the complex partitioning behavior of these elements in systems in which the concentrations are controlled by fluid-mineral equilibria as well as phase separation. Between 2004 and 2008, fluids at P vent transitioned from single-phase (535 mM/kg Cl) to a low-density vapor (370 mM/kg). Upon phase separation, the concentrations of H2S and H2 increased, while Fe and Mn concentrations decreased considerably. These changes highlight the importance of phase separation on controlling mass transfer from the crust to overlying ocean. In contrast to the other aqueous volatiles, CH4 concentrations in 2008 (47 µM) were lower or equal to concentrations in 2004 or 2016, 50-100 µM. CH4 is decoupled from the effects of phase separation, and is likely extracted from fluid inclusions in the host rock by circulating fluids. Li and CH4 concentrations follow similar patterns over time, supporting a rock-based source for CH4. That CO2 concentrations are elevated (relative to pre-eruption and 2016 values) up to two years after the eruption informs our understanding of the rates of heat and mass transfer in MOR hydrothermal systems.

Temporal variation in life-history traits of the clam Tivela mactroides (Bivalvia: Veneridae): Density-dependent processes in sandy beaches

NASA Astrophysics Data System (ADS)

Turra, Alexander; Petracco, Marcelo; Amaral, A. Cecilia Z.; Denadai, Márcia R.

2014-10-01

Temporal variation in the structure and dynamics of a population of Tivela mactroides was examined over two periods (2003-2004 and 2007-2008) in the southern part of Caraguatatuba Bay, southeastern Brazil. During the first period from January 2003 to October 2004, sampling was conducted monthly. Sampling in the second period was performed in the summer (January and February 2007 and 2008) and winter (July and August 2007 and 2008). The von Bertalanffy growth function was applied to estimate growth parameters for both periods from length-frequency distributions. Production was determined using the mass-specific growth rate method. Results indicated that the mean abundance (±SE) of T. mactroides varied sharply between the two periods, with an increase of almost 150 times from 2003 to 2004 (8.67·102 ± 0.83·102 ind m-1) to 2007-2008 (1.25·105 ± 3.33·104 ind m-1). The higher abundance in the second period was related to successful recruitment events. While the mean biomass and the production were higher in the second (5.43 ± 0.87 kg AFDM m-1 and 7.89 kg AFDM m-1 yr-1) than in the first period (0.18 ± 0.02 kg AFDM m-1 and 0.18 kg AFDM m-1 yr-1), lower values of shell length, curvature parameter, asymptotic length of the VBGF, and the growth index phi-prime in 2007-2008 (17.57 ± 1.35 mm; K = 0.40 yr-1; L∞ = 38.60 mm, ϕ‧ = 2.78) than in 2003-2004 (26.21 ± 1.21 mm; K = 1.00 yr-1; L∞ = 40.75 mm, ϕ‧ = 3.22) were related to a strongly density-dependent growth process in the second period. The oscillation in growth observed in the second, but not in the first period also indicates a process of density-dependent growth. These sharp temporal variations in population parameters of T. mactroides suggest the occurrence of density-dependent processes, and reinforce the importance of these processes in structuring sandy-beach populations.

Agenda-setting for Canadian caregivers: using media analysis of the maternity leave benefit to inform the compassionate care benefit

PubMed Central

2014-01-01

The Compassionate Care Benefit was implemented in Canada in 2004 to support employed informal caregivers, the majority of which we know are women given the gendered nature of caregiving. In order to examine how this policy might evolve over time, we examine the evolution of a similar employment insurance program, Canada’s Maternity Leave Benefit. National media articles were reviewed (n = 2,698) and, based on explicit criteria, were analyzed using content analysis. Through the application of Kingdon’s policy agenda-setting framework, the results define key recommendations for the Compassionate Care Benefit, as informed by the developmental trajectory of the Maternity Leave Benefit. Recommendations for revising the Compassionate Care Benefit are made. PMID:24758563

Agenda-setting for Canadian caregivers: using media analysis of the maternity leave benefit to inform the compassionate care benefit.

PubMed

Dykeman, Sarah; Williams, Allison M

2014-04-24

The Compassionate Care Benefit was implemented in Canada in 2004 to support employed informal caregivers, the majority of which we know are women given the gendered nature of caregiving. In order to examine how this policy might evolve over time, we examine the evolution of a similar employment insurance program, Canada's Maternity Leave Benefit. National media articles were reviewed (n = 2,698) and, based on explicit criteria, were analyzed using content analysis. Through the application of Kingdon's policy agenda-setting framework, the results define key recommendations for the Compassionate Care Benefit, as informed by the developmental trajectory of the Maternity Leave Benefit. Recommendations for revising the Compassionate Care Benefit are made.

Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: a randomized controlled trial.

PubMed

Gordon, James S; Staples, Julie K; Blyta, Afrim; Bytyqi, Murat; Wilson, Amy T

2008-09-01

To determine whether participation in a mind-body skills group program based on psychological self-care, mind-body techniques, and self-expression decreases symptoms of posttraumatic stress disorder (PTSD). Eighty-two adolescents meeting criteria for PTSD according to the Harvard Trauma Questionnaire (which corresponds with 16 of the 17 diagnostic criteria for PTSD in DSM-IV) were randomly assigned to a 12-session mind-body group program or a wait-list control group. The program was conducted by high school teachers in consultation with psychiatrists and psychologists and included meditation, guided imagery, and breathing techniques; self-expression through words, drawings, and movement; autogenic training and biofeedback; and genograms. Changes in PTSD symptoms were measured using the Harvard Trauma Questionnaire. The study was conducted from September 2004 to May 2005 by The Center for Mind-Body Medicine at a high school in the Suhareka region of Kosovo. Students in the immediate intervention group had significantly lower PTSD symptom scores following the intervention than those in the wait-list control group (F = 29.8, df = 1,76; p < .001). Preintervention and postintervention scores (mean [SD]) for the intervention group were 2.5 (0.3) and 2.0 (0.3), respectively, and for the control group, 2.5 (0.3) and 2.4 (0.4), respectively. The decreased PTSD symptom scores were maintained in the initial intervention group at 3-month follow-up. After the wait-list control group received the intervention, there was a significant decrease (p < .001) in PTSD symptom scores compared to the preintervention scores. Mind-body skills groups can reduce PTSD symptoms in war-traumatized high school students and can be effectively led by trained and supervised schoolteachers. Copyright 2008 Physicians Postgraduate Press, Inc.

Utilization of maternal health care services among married adolescent women: insights from the Nigeria Demographic and Health Survey, 2008.

PubMed

Rai, Rajesh Kumar; Singh, Prashant Kumar; Singh, Lucky

2012-01-01

An ongoing social catastrophe of very poor performance in maternal health coupled with an unacceptably high number of maternal deaths is evident in Nigeria, especially among adolescent women. This study examines the factors associated with selected maternity services-married adolescent women who have had at least four antenatal care (ANC) visits, those who have undergone safe delivery care, and those who received postnatal care within 42 days of delivery. Data from Nigeria Demographic and Health Survey, 2008, were used. An eligible sample of 2,434 married adolescent (aged 15-19 years) women was included in the analysis. Pearson chi-square test and binary logistic regression were performed to fulfill the study objective. It was found that about 35% of adolescent women had at least four ANC visits, a little over 25% had undergone safe delivery care, and nearly 32% received postnatal care within 42 days of delivery. Women's education, husband's education, wealth quintile, and region of residence were documented as the most important factors associated with maternal healthcare service utilization. The ANC visit was found to be vital in the utilization of safe delivery and postnatal care. Findings indicate that programs to improve maternal healthcare have not succeeded in overcoming the socioeconomic obstacles in the way of adolescents' utilizing maternity services. In the long run, the content and service delivery strategy of maternity programs must be designed in keeping with the socioeconomic context with special attention to adolescent women who are uneducated, poor, and residing in rural areas. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Duplicate Federal Payments for Dual Enrollees in Medicare Advantage Plans and the Veterans Affairs Health Care System

PubMed Central

Trivedi, Amal N.; Grebla, Regina C.; Jiang, Lan; Yoon, Jean; Mor, Vincent; Kizer, Kenneth W.

2013-01-01

Context Some veterans are eligible to enroll simultaneously in a Medicare Advantage (MA) plan and the Veterans Affairs health care system (VA). This scenario produces the potential for redundant federal spending because MA plans would receive payments to insure veterans who receive care from the VA, another taxpayer-funded health plan. Objective To quantify the prevalence of dual enrollment in VA and MA, the concurrent use of health services in each setting, and the estimated costs of VA care provided to MA enrollees. Design Retrospective analysis of 1 245 657 veterans simultaneously enrolled in the VA and an MA plan between 2004–2009. Main Outcome Measures Use of health services and inflation-adjusted estimated VA health care costs. Results Among individuals who were eligible to enroll in the VA and in an MA plan, the number of persons dually enrolled increased from 485 651 in 2004 to 924 792 in 2009. In 2009, 8.3% of the MA population was enrolled in the VA and 5.0% of MA beneficiaries were VA users. The estimated VA health care costs for MA enrollees totaled $13.0 billion over 6 years, increasing from $1.3 billion in 2004 to $3.2 billion in 2009. Among dual enrollees, 10% exclusively used the VA for outpatient and acute inpatient services, 35% exclusively used the MA plan, 50% used both the VA and MA, and 4% received no services during the calendar year. The VA financed 44% of all outpatient visits (n=21 353 841), 15% of all acute medical and surgical admissions (n=177 663), and 18% of all acute medical and surgical inpatient days (n=1 106 284) for this dually enrolled population. In 2009, the VA billed private insurers $52.3 million to reimburse care provided to MA enrollees and collected $9.4 million (18% of the billed amount; 0.3% of the total cost of care). Conclusions The federal government spends a substantial and increasing amount of potentially duplicative funds in 2 separate managed care programs for the care of same individuals. PMID:22735360

Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?

PubMed

Pulok, Mohammad Habibullah; Sabah, Md Nasim-Us; Uddin, Jalal; Enemark, Ulrika

2016-07-29

Universal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011. The data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services. The concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004-2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women's and their husbands' education were significantly associated with greater use of maternal health care services. In addition, women's exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services. Bangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.

Quality of care in palliative sedation: audit and compliance monitoring of a clinical protocol.

PubMed

Benitez-Rosario, Miguel Angel; Castillo-Padrós, Manuel; Garrido-Bernet, Belén; Ascanio-León, Belen

2012-10-01

The European Association for Palliative Care and the U.S. National Hospice and Palliative Care Organization have published statements that recommend an audit of palliative sedation practices. The aim was to assess the feasibility of a quality care project in palliative sedation. We carried out an audit of adherence to a guideline regarding palliative sedation, undertaken as a yearly assessment during two years, of a sample of patient charts. With an audit tool, the charts were evaluated as to the presence of the ethical sedation checklist, information that justified palliative sedation, patient and/or family agreement, and the appropriateness of treatment in concordance with the clinical protocol. An educational program and result feedback meetings were used as the implementation strategy. Roughly 25% of the medical charts of patients who died in the palliative care unit were evaluated, 94 in 2007 and 110 in 2008. In 2007 and 2008, 63% and 57% of the patients, respectively, whose median age was 65 years, were sedated, with a median length of two days. The main reason for sedation was agitation concomitant with respiratory failure in roughly 60% and 75% of the cases in 2007 and 2008, respectively. Agreement of the patient/family about sedation was collected from 100% of the cases. The concordance of procedures with the sedation guideline was 100% in both years. Our quality-of-care strategy was shown to obtain a higher level of compliance with the palliative sedation guideline for at least two years. Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Otorhinolaryngological patient injuries in Finland.

PubMed

Lehtivuori, Tuuli; Palonen, Reima; Mussalo-Rauhamaa, Helena; Holi, Tarja; Henriksson, Markus; Aaltonen, Leena-Maija

2013-10-01

Otorhinolaryngology (ORL) is considered a specialty associated with few serious patient injuries. Research data that support this belief are, however, scarce. We analyzed claims associated with ORL to determine the number of Finnish cases and the possible common denominators. Register study of ORL cases in the Patient Insurance Centre (PIC), the Regional State Administrative Agencies (RSAA), and the National Supervisory Authority for Welfare and Care (Valvira) during the years 2004 to 2008. These three agencies are the main actors in the field of patient injury in Finland. We analyzed compensated ORL patient injury cases from the PIC and cases associated with the ORL specialty for Valvira and RSAA from 2004 to 2008 and surveyed patient treatment files, statements from specialists, and compensation decisions. Injuries were usually associated with operations; three patients who experienced injuries during these procedures died. Common ORL operations such as tonsillectomy, septoplasty, and paranasal sinus surgery were most often associated with compensated injuries. Serious injuries were few, with a total of 110 out of 422 (26.1%) claims compensated by the PIC. Of the 110 compensated cases, 30 (27.3%) were related to tumor surgery. The most usual compensated case had iatrogenic nerve injury affecting the facial or trigeminal nerves. Of the compensated cases, 79 (71.8%) were treated by specialists, 15 (13.6%) by residents, and the rest by other medical professionals. Patient injuries in ORL are seldom severe and are strongly associated with surgery. A typical compensated injury was one that occurred in a central hospital during working hours. N/A. Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.

Examining the Statistical Rigor of Test and Evaluation Results in the Live, Virtual and Constructive Environment

DTIC Science & Technology

2011-06-01

Committee Meeting. 23 June 2008. Bjorkman, Eileen A. and Frank B. Gray . “Testing in a Joint Environment 2004-2008: Findings, Conclusions and...the LVC joint test environment to evaluate system performance and joint mission effectiveness (Bjorkman and Gray 2009a). The LVC battlespace...attack (Bjorkman and Gray 2009b). Figure 3 - JTEM Methodology (Bjorkman 2008) A key INTEGRAL FIRE lesson learned was realizing the need for each

Methow and Columbia Rivers studies: summary of data collection, comparison of database structure and habitat protocols, and impact of additional PIT tag interrogation systems to survival estimates, 2008-2012

USGS Publications Warehouse

Martens, Kyle D.; Tibbits, Wesley T.; Watson, Grace A.; Newsom, Michael A.; Connolly, Patrick J.

2014-01-01

The U.S. Geological Survey (USGS) received funding from the Bureau of Reclamation (Reclamation) to provide monitoring and evaluation on the effectiveness of stream restoration efforts by Reclamation in the Methow River watershed. This monitoring and evaluation program is designed to partially fulfill Reclamation’s part of the 2008 Biological Opinion for the Federal Columbia River Power System that includes a Reasonable and Prudent Alternative (RPA) to protect listed salmon and steelhead across their life cycle. The target species in the Methow River for the restoration effort include Upper Columbia River (UCR) spring Chinook salmon (Oncorhynchus tshawytscha), UCR steelhead (Oncorhynchus mykiss), and bull trout (Salvelinus confluentus), which are listed as threatened or endangered under the Endangered Species Act. Since 2004, the USGS has completed two projects of monitoring and evaluation in the Methow River watershed. The first project focused on the evaluation of barrier removal and steelhead recolonization in Beaver Creek with Libby and Gold Creeks acting as controls. The majority of this work was completed by 2008, although some monitoring continued through 2012. The second project (2008–2012) evaluated the use and productivity of the middle Methow River reach (rkm 65–80) before the onset of multiple off-channel restoration projects planned by the Reclamation and Yakama Nation. The upper Methow River (upstream of rkm 80) and Chewuch River serve as reference reaches and the Methow River downstream of the Twisp River (downstream of rkm 65) serves as a control reach. Restoration of the M2 reach was initiated in 2012 and will be followed by a multi-year, intensive post-evaluation period. This report is comprised of three chapters covering different aspects of the work completed by the USGS. The first chapter is a review of data collection that documents the methods used and summarizes the work done by the USGS from 2008 through 2012. This data summary was designed to show some initial analysis and to disseminate summary information that could potentially be used in ongoing modeling efforts by USGS, Reclamation, and University of Idaho. The second chapter documents the database of fish and habitat data collected by USGS from 2004 through 2012 and compares USGS habitat protocols to the Columbia Habitat Monitoring Program (CHaMP) protocol. The third chapter is a survival analysis of fish moving through Passive Integrated Transponder (PIT) tag interrogation systems in the Methow and Columbia Rivers. It examines the effects of adding PIT tags and/or PIT tag interrogation systems on survival estimates of juvenile steelhead and Chinook salmon.

Factors associated with participation in and benefits of a worksite wellness program.

PubMed

Merrill, Ray M; Hull, John D

2013-08-01

The objective of this study was to describe employees most likely to participate in a Personal Wellness Profile (PWP) and/or in a worksite Wellness Program (WP), and to identify whether an association exists between participation and trends in number of health care services and cost of services per person. A retrospective cohort study was conducted using medical claims data from the Deseret Mutual Benefit Administrators, 2004 through 2009. The PWP and WP involved more than 30% of employee contract holders. Participation in the PWP and WP were lower in the older age group and higher among women, married people, and those with an annual income of at least $40,000. Average annual cost per person during 2004-2006 was significantly positively associated with completing the PWP in 2007-2009. Those in the highest quartile for average annual cost per person in 2004-2006 were significantly less likely to participate in the WP in 2007-2009. During 2004-2009, a significantly increasing trend in average annual cost per person was similar, but at a lower level for PWP participants. The trend line also was lower for WP participants, and increased at a lower rate. The lower rate of increase in the trends for average cost per person among those in the WP indicates that the intervention is effective at slowing escalating costs. Additional years of data should be assessed, when available, to confirm this pattern.

Consumption of systemic antifungal agents among acute care hospitals in Catalonia (Spain), 2008-2013.

PubMed

Fondevilla, Esther; Grau, Santiago; Mojal, Sergi; Palomar, Mercedes; Matas, Lurdes; Gudiol, Francesc

2016-01-01

Objective To know the patterns and consumption trends (2008-2013) of antifungal agents for systemic use in 52 acute care hospitals affiliated to VINCat Program in Catalonia (Spain). Methods Consumption was calculated in defined daily doses (DDD)/100 patient-days and analyzed according to hospital size and complexity and clinical departments. Results Antifungal consumption was higher in intensive care units (ICU) (14.79) than in medical (3.08) and surgical departments (1.19). Fluconazole was the most consumed agent in all type of hospitals and departments. Overall antifungal consumption increased by 20.5%during the study period (p = 0.066); a significant upward trend was observed in the consumption of both azoles and echinocandins. In ICUs, antifungal consumption increased by 12.4% (p = 0.019). Conclusions The study showed a sustained increase in the overall consumption of systemic antifungals in a large number of acute care hospitals of different characteristics in Catalonia. In ICUs there was a trend towards the substitution of older agents by the new ones.

Public reporting and market area exit decisions by home health agencies.

PubMed

Jung, Kyoungrae; Feldman, Roger

2012-01-01

To examine whether home health agencies selectively discontinue services to areas with socio-economically disadvantaged people after the introduction of Home Health Compare (HHC), a public reporting program initiated by Medicare in 2003. We focused on agencies' initial responses to HHC and examined selective market-area exits by agencies between 2002 and 2004. We measured HHC effects by the percentage of quality indicators reported in public HHC data in 2003. Socio-economic status was measured by per capita income and percent college-educated at the market-area level. 2002 and 2004 Outcome and Assessment Information Set (OASIS); 2000 US Census file; 2004 Area Resource File; and 2002 Provider of Service File. WE FOUND A SMALL AND WEAK EFFECT OF PUBLIC REPORTING ON SELECTIVE EXITS: a 10-percent increase in reporting (reporting one more indicator) increased the probability of leaving an area with less-educated people by 0.3 percentage points, compared with leaving an area with high education. The small level of market-area exits under public reporting is unlikely to be practically meaningful, suggesting that HHC did not lead to a disruption in access to home health care through selective exits during the initial year of the program.

[Coverage by the Family Health Strategy and diagnosis of syphilis in pregnancy and congenital syphilis].

PubMed

Saraceni, Valéria; Miranda, Angélica Espinosa

2012-03-01

This paper aimed to correlate syphilis in pregnancy and congenital syphilis with coverage of the Family Health Strategy (FHS), based on available data in the national health information systems. The syphilis notification estimates were calculated according to the Sentinel Childbirth Study for 2004 under the Ministry of Health and the data were obtained from the websites of the Health Surveillance Secretariat and Healthcare Secretariat, for the year 2008. The ratios between observed and estimated gestational syphilis and congenital syphilis were not statistically correlated with population coverage by the FHS (r = -0.28 and r = -0.40, respectively). The FHS is a privileged area for prenatal care and logically a source of compulsory notification of syphilis in pregnancy. By combining diagnosis with adequate treatment of syphilis in pregnant women and their partners, the FHS becomes a prime instrument for eliminating congenital syphilis in Brazil. Expanding the FHS coverage and quality of care are essential for achieving this goal.

Awareness and Use of California's Paid Family Leave Insurance Among Parents of Chronically Ill Children

PubMed Central

Schuster, Mark A.; Chung, Paul J.; Elliott, Marc N.; Garfield, Craig F.; Vestal, Katherine D.; Klein, David J.

2016-01-01

Context In 2004, California's Paid Family Leave Insurance Program (PFLI) became the first state program to provide paid leave to care for an ill family member. Objective To assess awareness and use of the program by employed parents of children with special health care needs, a population likely to need leave. Design, Setting, and Participants Telephone interviews with successive cohorts of employed parents before (November 21, 2003-January 31, 2004; n=754) and after (November 18, 2005-January 31, 2006; n=766) PFLI began, randomly sampled from 2 children's hospitals, one in California (with PFLI) and the other in Illinois (without PFLI). Response rates were 82% before and 81% after (California), and 80% before and 74% after (Illinois). Main Outcome Measures Taking leave, length of leave, unmet need for leave, and awareness and use of PFLI. Results Similar percentages of parents at the California site reported taking at least 1 day of leave to care for their ill child before (295 [81%]) and after (327 [79%]) PFLI, taking at least 4 weeks before (64 [21%]) and after (74 [19%]) PFLI, and at least once in the past year not missing work despite believing their child's illness necessitated it before (152 [41%]) and after (156 [41%]) PFLI. Relative to Illinois, parents at the California site reported no change from before to after PFLI in taking at least 1 day of leave (difference of differences, −3%; 95% confidence interval [CI], −13% to 7%); taking at least 4 weeks of leave (1%; 95% CI, −9% to 10%); or not missing work, despite believing their child's illness necessitated it (−1%; 95% CI, −13% to 10%). Only 77 parents (18%) had heard of PFLI approximately 18 months after the program began, and only 20 (5%) had used it. Even among parents without other access to paid leave, awareness and use of PFLI were minimal. Conclusions Parents of children with special health care needs receiving care at a California hospital were generally unaware of PFLI and rarely used it. Among parents of children with special health care needs, taking leave in California did not increase after PFLI implementation compared with Illinois. PMID:18768416

Wait watchers: the application of a waiting list active management program in ambulatory care.

PubMed

de Belvis, Antonio Giulio; Marino, Marta; Avolio, Maria; Pelone, Ferruccio; Basso, Danila; Dei Tos, Gian Antonio; Cinquetti, Sandro; Ricciardi, Walter

2013-04-01

This study describes and evaluates the application of a waiting list management program in ambulatory care. Waiting list active management survey (telephone call and further contact); before and after controlled trial. Local Health Trust in Veneto Region (North-East of Italy) in 2008-09. Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.

Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland

PubMed Central

Lelubre, Mélanie; Kamal, Susan; Genre, Noëllie; Celio, Jennifer; Gorgerat, Séverine; Hugentobler Hampai, Denise; Bourdin, Aline; Berger, Jerôme; Bugnon, Olivier; Schneider, Marie

2015-01-01

The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU), University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV) and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This paper aims to present the organization and program's context, statistical data, published research, and future perspectives. PMID:26839879

Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland.

PubMed

Lelubre, Mélanie; Kamal, Susan; Genre, Noëllie; Celio, Jennifer; Gorgerat, Séverine; Hugentobler Hampai, Denise; Bourdin, Aline; Berger, Jerôme; Bugnon, Olivier; Schneider, Marie

2015-01-01

The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU), University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV) and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This paper aims to present the organization and program's context, statistical data, published research, and future perspectives.

Correction to ``Outstanding Student Paper Awards''

NASA Astrophysics Data System (ADS)

2008-10-01

The name of one of the recipients of an Outstanding Student Paper Award for Atmospheric Sciences at the 2008 Joint Assembly was misspelled in the 23 September issue (Eos, 89(39), 2008). Yuanyuan Fang, Princeton University, Princeton, N. J., received the award for Estimating the episodic contribution of pollutant export from the United States in summer 2004. Eos regrets the error.

Iowa's Forests 2008

Treesearch

Mark D. Nelson; Matt Brewer; Christopher W. Woodall; Charles H. Perry; Grant M. Domke; Ronald J. Piva; Cassandra M. Kurtz; W. Keith Moser; Tonya W. Lister; Brett J. Butler; Dacia M. Meneguzzo; Patrick D. Miles; Charles J. Barnett; Dale Gormanson

2011-01-01

The second full annual inventory of Iowa's forests (2004-2008) reports more than 3 million acres of forest land, almost all of which is timberland (98 percent), with an average volume of more than 1,000 cubic feet of growing stock per acre. American elm and eastern hophornbeam are the most numerous tree species, but silver maple and bur oak predominate in terms of...

Missouri's forests 2008

Treesearch

Gus Raeker; W. Keith Moser; Brett J. Butler; John Fleming; Dale D. Gormanson; Mark H. Hansen; Cassandra M. Kurtz; Patrick D. Miles; Mike Morris; Thomas B. Treiman

2011-01-01

The second full annual inventory of Missouri's forests (2004-2008) reports more than 15 million acres of forest land, almost all of which is timberland (98 percent), with an average volume of more than 1,117 cubic feet of growing stock per acre. White oak and black oak are the most abundant in terms of live tree volume. Eighty-three percent of the State's...

Why Aren't They Paying Attention to Me? Strategies for Preventing Distraction in a 1:1 Learning Environment

ERIC Educational Resources Information Center

Tagsold, Jennifer T.

2013-01-01

K-12 education research has become increasingly concerned with technology's impact on students' attention in the classroom, particularly with regard to laptop computers and other mobile devices (Gay & Hembrooke, 2004; Jackson, 2008; Mann, 2008; Kraushaar & Novak, 2010). While this classroom technology has created many positive implications…

Prevalence of HIV infection in pregnant women in Mumbai, India: Experience from 1993-2004 and 2008

PubMed Central

Shah, Ira; Lala, Mamatha; Damania, Kaizad

2017-01-01

Aim: Prevalence of HIV among pregnant women in India is of great concern, especially to prevent HIV in children. Mother–to-child transmission of HIV is the most common cause of transmission of HIV in children. Prevalence of HIV infection in pregnant women in India has ranged from 0.7% to 1.2%. Thus, estimating prevalence of HIV in pregnant women would aid in developing and prioritizing prevention of parent-to-child transmission of HIV programs. Materials and Methods: All pregnant women referred to the antenatal clinic from 1993 onward were tested for HIV infection by ELISA test after pretest counseling. A woman was diagnosed to be HIV infected if she tested positive on more than two HIV ELISA tests. Prevalence of HIV infection in them was calculated and also whether there was an increasing trend was determined. Results: A total of 123,439 pregnant women were tested for HIV from 1993 to 2004, of which 1797 women were HIV infected. Overall, the prevalence rate was found to be 1.4%. Prevalence rose from 0.76% in 1993 to 2.37% in 1998. However, from 2004, the prevalence has decreased to 0.6%. Conclusion: Prevalence of HIV in pregnant women in Mumbai is decreasing. PMID:29302524

Integrated employee assistance program/managed behavioral health care benefits: relationship with access and client characteristics.

PubMed

Levy Merrick, Elizabeth S; Hodgkin, Dominic; Horgan, Constance M; Hiatt, Deirdre; McCann, Bernard; Azzone, Vanessa; Zolotusky, Galina; Ritter, Grant; Reif, Sharon; McGuire, Thomas G

2009-11-01

This study examined service user characteristics and determinants of access for enrollees in integrated EAP/behavioral health versus standard managed behavioral health care plans. A national managed behavioral health care organization's claims data from 2004 were used. Integrated plan service users were more likely to be employees rather than dependents, and to be diagnosed with adjustment disorder. Logistic regression analyses found greater likelihood in integrated plans of accessing behavioral health services (OR 1.20, CI 1.17-1.24), and substance abuse services specifically (OR 1.23, CI 1.06-1.43). Results are consistent with the concept that EAP benefits may increase access and address problems earlier.

Ecology of West Nile Fever across four European countries: Review of weather profiles, vector population dynamics and vector control response

USDA-ARS?s Scientific Manuscript database

West Nile virus (WNV) represents a serious burden to human and animal health because of its capacity to cause large unforeseen epidemics. Until 2004, only lineage 1 and 3 WNV strains had been found in Europe. Lineage 2 strains were initially isolated in 2004 (Hungary), again in 2008 (Austria), and f...

In Situ Wetland Restoration Demonstration

DTIC Science & Technology

2014-07-28

products, charcoal, zero-valent iron, sulfur-infused AC, and/or zeolite (USEPA, 1994; USEPA, 1997; Renholds, 1998; Reible, 2004; Barth and Reible, 2008...activated carbon, zeolites , or other sequestration agents can be effectively delivered to the hydric soils, then toxicity, mobility, and...Organoclays, zeolites , and activated carbon have been used extensively for the treatment of water and soil contamination (McDonald et al., 2004

Childless Women's Time with Children: A Focus on Educational Differences

ERIC Educational Resources Information Center

Martin, Steven P.; Kendig, Sarah M.

2013-01-01

This study examines time with children among women who remain childless in young to middle adulthood. The authors identify biologically childless women aged 25 to 44 years in the June 2004-2008 Current Population Survey, and use their subsequent time use diaries in the 2004-2009 American Time Use Survey to measure their time with children. The…

Care fragmentation, quality, and costs among chronically ill patients.

PubMed

Frandsen, Brigham R; Joynt, Karen E; Rebitzer, James B; Jha, Ashish K

2015-05-01

To assess the relationship between care fragmentation and both quality and costs of care for commercially insured, chronically ill patients. We used claims data from 2004 to 2008 for 506,376 chronically ill, privately insured enrollees of a large commercial insurance company to construct measures of fragmentation. We included patients in the sample if they had chronic conditions in any of the following categories: cardiovascular disease, diabetes, asthma, arthritis, or migraine. We assigned each patient a fragmentation index based on the patterns of care of their primary care provider (PCP), with care patterns spread across a higher number of providers considered to be more fragmented. We used regression analysis to examine the relationship between fragmentation and both quality and cost outcomes. Patients of PCPs in the highest quartile of fragmentation had a higher chance of having a departure from clinical best practice (32.8%, vs 25.9% among patients of PCPs in the lowest quartile of fragmentation; P < .001). Similarly, patients of PCPs with high fragmentation had higher rates of preventable hospitalizations (9.1% in highest quartile vs 7.1% in lowest quartile; P < .001). High fragmentation was associated with $4542 higher healthcare spending ($10,396 in the highest quartile vs $5854 in the lowest quartile; P < .001). We found similar or larger effects on quality and costs among patients when we examined the most frequently occurring disease groups individually. Chronically ill patients whose primary care providers offer highly fragmented care more often experience lapses in care quality and incur greater healthcare costs.

Addressing the needs of Nicaraguan older adults living on the edge: A university-community partnership in international service-learning.

PubMed

Neal, Margaret B; Cannon, Melissa; DeLaTorre, Alan; Bolkan, Cory R; Wernher, Iris; Nolan, Elisabeth; López Norori, Milton; Largaespada-Fredersdorff, Carmen; Brown Wilson, Keren

2017-01-01

Nicaragua is a very low-income country entering a period of rapid aging with limited geriatric training for health care professionals. To help build capacity and to enhance student learning, a short-term international service-learning program was implemented in 2004 in partnership with the Jessie F. Richardson Foundation and Nicaraguan community stakeholders. Graduate and undergraduate students at Portland State University complete coursework for one term in the United States then travel to Nicaragua for about two weeks to participate in educational, research, and service activities, primarily in group homes for older Nicaraguans. Students learn about global aging, gerontology, community development, service learning, and Nicaraguan history and culture, then apply their gerontology-related knowledge by training direct care staff, older adults and their family members, and students. The authors describe the impetus for and evolution of the program, students' evaluation of the program, faculty observations on program benefits and challenges, lessons learned, and future plans.

ElderSmile: A Comprehensive Approach to Improving Oral Health for Seniors

PubMed Central

Northridge, Mary E.; De La Cruz, Leydis D.; Vaughan, Roger D.; O'Neil-Dunne, Jarlath; Lamster, Ira B.

2009-01-01

Societal changes, including the aging of the US population and the lack of routine dental service coverage under Medicare, have left many seniors unable to afford any dental care whatsoever, let alone the most advanced treatments.1 In 2004, the Columbia University College of Dental Medicine and its partners instituted the ElderSmile program in the largely impoverished communities of Harlem and Washington Heights/Inwood in New York City. The long-term goal of this program is to improve access to and delivery of oral health care for seniors; the short-term goal is to establish and operate a network of prevention centers surrounding a limited number of treatment centers. Preliminary results indicate substantial unmet dental needs in this largely Hispanic and Black elderly population. PMID:19276459

Assimilation of HF Radar-Derived Radials and Total Currents in the Monterey Bay Area

DTIC Science & Technology

2009-01-01

39529-5004, USA b Naval Postgraduate School Monterey. USA ARTICLE INFO Article history: Accepted 16 August 2008 Available online 19 September 2008 ...et al„ 1998; Breivick and Saetra, 2001; Oke et al., 2002; Kurapov et al., 2003; Paduan and Shulman, 2004; Wilkin et al., 2005). Surface-current data...atmospheric model nest covering the central California region that was first put in place during AOSN-II (Doyle et al., 2008 ). In this study, we address

Incidence of congenital syphilis in Brazil and its relationship with the Family Health Strategy.

PubMed

Araújo, Cinthia Lociks de; Shimizu, Helena Eri; Sousa, Artur Iuri Alves de; Hamann, Edgar Merchán

2012-06-01

To estimate the incidence of congenital syphilis and identify its relationship with Family Health Strategy coverage. An observational ecological study was carried out with both descriptive and analytical components, by two different approaches: one that explores a temporal series (2003 to 2008) and one that focuses on the 2008 data. The secondary data (epidemiological, demographic, and socioeconomic) were obtained from the Department of Informatics of the Unified Health System and the Brazilian Institute of Geography and Statistics. Analysis of the possible effects of the implementation of the Family Health Strategy on the prevention of congenital syphilis was performed on selected subgroups of counties according to two approaches: a) the variation of the average annual rate of incidence of congenital syphilis in different strata of Family Health Program coverage between 2003 and 2008 and the calculation of the simple linear regression coefficient; and b) a negative binomial regression analysis of data from 2008 to control for confounding factors. Increasingly trends of congenital syphilis notification in Brazil reflect social inequalities in the distribution of cases. The incidence of congenital syphilis was lower in the counties with high Family Health Strategy coverage; however, after controlling for the co-variables, such an effect might be attributed to the coverage of prenatal care and the demographic characteristics of the counties where the implementation of the Strategy was a priority. Despite the increase in prenatal care coverage, the actions implemented still exhibit low effectiveness in the prevention of congenital syphilis. Prenatal care performed by Family Health Strategy teams did not control syphilis better than the prenatal care performed within the context of other models of assistance.

Risk factors for low birth weight in Botucatu city, SP state, Brazil: a study conducted in the public health system from 2004 to 2008.

PubMed

da Fonseca, Cátia Regina Branco; Strufaldi, Maria Wany Louzada; de Carvalho, Lídia Raquel; Puccini, Rosana Fiorini

2012-01-23

Low birth weight (LBW), defined as birth weight less than 2500 g, has a complex etiology and may be a result of premature interruption of pregnancy or intrauterine growth restriction. The objective of this study was to provide information on determinants of LBW and contribute to the understanding of the problem in Brazil. A case-control study was conducted in Botucatu city, SP state, Brazil. The study population consisted of 2 groups with 860 newborns in each group as follows: low weight newborns (LWNB) and a control group (weight ≥ 2500 g). Secondary data from 2004 to 2008 were collected using the Live Birth Certificate (LBC) and records from medical charts of pregnant women in Basic Health Units (BHU) and in the Public University Hospital (UH). Variables were as follows: maternal socio-demographic characteristics, pregnancy and birth conditions including quality of prenatal care according to 3 criteria. They were based on parameters established by the Ministry of Health (MH), one of them, the modified Kessner Index. The multivariable analysis by logistic regression was used to evaluate the association between variables and LBW. According to the analysis, the factors associated with LBW were as follows: prematurity (OR = 56.98, 95% CI 29.52-109.95), twin pregnancy (OR = 20.00, 95% CI 6.25-100.00), maternal smoking (OR = 2.12, 95% CI 1.33-3.45), maternal malnourishment (OR = 2.30, 95% CI 1.08-5.00), maternal obesity (OR = 2.30, 95% IC 1.18-4.48), weight gain during pregnancy less than 5 kg (OR = 2.63, 95% CI 1.35-5.00) and weight gain during pregnancy more than 15 kg (OR = 2.26, 95% CI 1.16-4.41). Adequacy of prenatal care visits adjusted to gestational age was less frequent in the LBW group than in the control group (68.7% vs. 80.5%, x2 p < 0.001). According to the modified Kessner Index, 64.4% of prenatal visits in the LWNB group were adequate. LWNB are a quite heterogeneous group of infants concerning their determinants and prevention actions against LBW and the follow-up of these infants have also been very complex. Therefore, improvement in the quality of care provided should be given priority through concrete actions for prevention of LBW.

Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004-2012.

PubMed

Cook, Benjamin Lê; Trinh, Nhi-Ha; Li, Zhihui; Hou, Sherry Shu-Yeu; Progovac, Ana M

2017-01-01

This study compared trends in racial-ethnic disparities in mental health care access among whites, blacks, Hispanics, and Asians by using the Institute of Medicine definition of disparities as all differences except those due to clinical appropriateness, clinical need, and patient preferences. Racial-ethnic disparities in mental health care access were examined by using data from a nationally representative sample of 214,597 adults from the 2004-2012 Medical Expenditure Panel Surveys. The main outcome measures included three mental health care access measures (use of any mental health care, any outpatient care, and any psychotropic medication in the past year). Significant disparities were found in 2004-2005 and in 2011-2012 for all three racial-ethnic minority groups compared with whites in all three measures of access. Between 2004 and 2012, black-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.2% to 10.8% and from 7.6% to 10.0%. Similarly, Hispanic-white disparities in any mental health care and any psychotropic medication use increased, respectively, from 8.4% to 10.9% and 7.3% to 10.3%. No reductions in racial-ethnic disparities in access to mental health care were identified between 2004 and 2012. For blacks and Hispanics, disparities were exacerbated over this period. Clinical interventions that improve identification of symptoms of mental illness, expansion of health insurance, and other policy interventions that remove financial barriers to access may help to reduce these disparities.

Increased prevalence of pregnancy and comparative risk of program attrition among individuals starting HIV treatment in East Africa.

PubMed

Holmes, Charles B; Yiannoutsos, Constantin T; Elul, Batya; Bukusi, Elizabeth; Ssali, John; Kambugu, Andrew; Musick, Beverly S; Cohen, Craig; Williams, Carolyn; Diero, Lameck; Padian, Nancy; Wools-Kaloustian, Kara K

2018-01-01

The World Health Organization now recommends initiating all pregnant women on life-long antiretroviral therapy (ART), yet there is limited information about the characteristics and program outcomes of pregnant women already on ART in Africa. Our hypothesis was that pregnant women comprised an increasing proportion of those starting ART, and that sub-groups of these women were at higher risk for program attrition. We used the International Epidemiology Databases to Evaluate AIDS- East Africa (IeDEA-EA) to conduct a retrospective cohort study including HIV care and treatment programs in Kenya, Uganda, and Tanzania. The cohort consecutively included HIV-infected individuals 13 years or older starting ART 2004-2014. We examined trends over time in the proportion pregnant, their characteristics and program attrition rates compared to others initiating and already receiving ART. 156,474 HIV-infected individuals (67.0% women) started ART. The proportion of individuals starting ART who were pregnant women rose from 5.3% in 2004 to 12.2% in 2014. Mean CD4 cell counts at ART initiation, weighted for annual program size, increased from 2004 to 2014, led by non-pregnant women (annual increase 20 cells/mm3) and men (17 cells/mm3 annually), with lower rates of change in pregnant women (10 cells/mm3 per year) (p<0.0001). There was no significant difference in the cumulative incidence of program attrition at 6 months among pregnant women starting ART and non-pregnant women. However, healthy pregnant women starting ART (WHO stage 1/2) had a higher rate of attrition rate (9.6%), compared with healthy non-pregnant women (6.5%); in contrast among women with WHO stage 3/4 disease, pregnant women had lower attrition (8.4%) than non-pregnant women (14.4%). Among women who initiated ART when healthy and remained in care for six months, subsequent six-month attrition was slightly higher among pregnant women at ART start (3.5%) compared to those who were not pregnant (2.4%), (absolute difference 1.1%, 95% CI 0.7%-1.5%). Pregnant women comprise an increasing proportion of those initiating ART in Africa, and pregnant women starting ART while healthy are at higher risk for program attrition than non-pregnant women. As ART programs further expand access to healthier pregnant women, further studies are needed to better understand the drivers of loss among this high risk group of women to optimize retention.

Establishing an ISO 10001-based promise in inpatients care.

PubMed

Khan, Mohammad Ashiqur Rahman; Karapetrovic, Stanislav

2015-01-01

The purpose of this paper is to explore ISO 10001:2007 in planning, designing and developing a customer satisfaction promise (CSP) intended for inpatients care. Through meetings and interviews with research participants, who included a program manager, unit managers and registered nurses, information about potential promises and their implementation was obtained and analyzed. A number of promises were drafted and one was finally selected to be developed as a CSP. Applying the standard required adaptation and novel interpretation. Additionally, ISO 10002:2004 (Clause 7) was used to design the feedback handling activities. A promise initially chosen for development turned out to be difficult to implement, experience that helped in selecting and developing the final promise. Research participants found the ISO 10001-based method useful and comprehensible. This paper presents a specific health care example of how to adapt a standard's guideline in establishing customer promises. The authors show how a promise can be used in alleviating an existing issue (i.e. communication between carers and patients). The learning can be beneficial in various health care settings. To the knowledge, this paper shows the first example of applying ISO 10001:2007 in a health care case. A few activities suggested by the standard are further detailed, and a new activity is introduced. The integrated use of ISO 10001:2007 and 10002:2004 is presented and how one can be "augmented" by the other is demonstrated.

2008 Stability, Security, Transition and Reconstruction Operations Conference

DTIC Science & Technology

2008-09-04

Facilitator Power of Public-Private Partnerships • Health Professional Education • Greater Access to Care China Diabetes Education Program Dominican Republic...Argentina Canada Chile Colombia Ecuador Peru Uruguay Interagency, multinational, inter-institutional partnerships State Department Homeland Security...Disaster Preparedness Disaster Response Regional Response Capacity OFDA-LAC / MDROs Regional Security System (RSS) UNCLASSIFIED ECUADOR / KY PERU / WV

Australian General Practitioner Uptake of a Remunerated Medicare Health Assessment for People with Intellectual Disability

ERIC Educational Resources Information Center

Koritsas, Stella; Iacono, Teresa; Davis, Robert

2012-01-01

In 2007 the Australian Commonwealth Government announced the Medicare Health Assessment for People with an Intellectual Disability as part of the Enhanced Primary Care (EPC) program (Department of Health and Ageing, 2008). The annual health assessment is a structured framework for general practitioners (GPs), which enables an annual comprehensive…

The contribution of organization theory to nursing health services research.

PubMed

Mick, Stephen S; Mark, Barbara A

2005-01-01

We review nursing and health services research on health care organizations over the period 1950 through 2004 to reveal the contribution of nursing to this field. Notwithstanding this rich tradition and the unique perspective of nursing researchers grounded in patient care production processes, the following gaps in nursing research remain: (1) the lack of theoretical frameworks about organizational factors relating to internal work processes; (2) the need for sophisticated methodologies to guide empirical investigations; (3) the difficulty in understanding how organizations adapt models for patient care delivery in response to market forces; (4) the paucity of attention to the impact of new technologies on the organization of patient care work processes. Given nurses' deep understanding of the inner workings of health care facilities, we hope to see an increasing number of research programs that tackle these deficiencies.

A multifaceted program for improving quality of care in intensive care units: IATROREF study.

PubMed

Garrouste-Orgeas, Maite; Soufir, Lilia; Tabah, Alexis; Schwebel, Carole; Vesin, Aurelien; Adrie, Christophe; Thuong, Marie; Timsit, Jean Francois

2012-02-01

To test the effects of three multifaceted safety programs designed to decrease insulin administration errors, anticoagulant prescription and administration errors, and errors leading to accidental removal of endotracheal tubes and central venous catheters, respectively. Medical errors and adverse events are associated with increased mortality in intensive care patients, indicating an urgent need for prevention programs. Multicenter cluster-randomized study. One medical intensive care unit in a university hospital and two medical-surgical intensive care units in community hospitals belonging to the Outcomerea Study Group. Consecutive patients >18 yrs admitted from January 2007 to January 2008 to the intensive care units. We tested three multifaceted safety programs vs. standard care in random order, each over 2.5 months, after a 1.5-month observation period. Incidence rates of medical errors/1000 patient-days in the multifaceted safety program and standard-care groups were compared using adjusted hierarchical models. In 2117 patients with 15,014 patient-days, 8520 medical errors (567.5/1000 patient-days) were reported, including 1438 adverse events (16.9%, 95.8/1000 patient-days). The insulin multifaceted safety program significantly decreased errors during implementation (risk ratio 0.65; 95% confidence interval [CI] 0.52-0.82; p = .0003) and after implementation (risk ratio 0.51; 95% CI 0.35-0.73; p = .0004). A significant Hawthorne effect was found. The accidental tube/catheter removal multifaceted safety program decreased errors significantly during implementation (odds ratio [OR] 0.34; 95% CI 0.15-0.81; p = .01]) and nonsignificantly after implementation (OR 1.65; 95% CI 0.78-3.48). The anticoagulation multifaceted safety program was not significantly effective (OR 0.64; 95% CI 0.26-1.59) but produced a significant Hawthorne effect. A multifaceted program was effective in preventing insulin errors and accidental tube/catheter removal. Significant Hawthorne effects occurred, emphasizing the need for appropriately designed studies before definitively implementing strategies. clinicaltrials.gov Identifier: NCT00461461.

Extracorporeal therapies in pediatric severe sepsis: findings from the pediatric health-care information system.

PubMed

Ruth, Amanda; McCracken, Courtney E; Fortenberry, James D; Hebbar, Kiran B

2015-11-10

Pediatric severe sepsis (PSS) continues to be a major health problem. Extracorporeal therapies (ETs), defined as extracorporeal membrane oxygenation (ECMO) and RRenal replacement therapyenal replacement therapy (RRT), are becoming more available for utilization in a variety of health conditions. We aim to describe (1) rates of utilization of ET in PSS, (2) outcomes for PSS patients receiving ET, and (3) epidemiologic characteristics of patients receiving ET. We conducted a retrospective review of a prospectively collected database. Data from the Pediatric Health Information System (PHIS) database collected by the Children's Hospital Association (CHA) from 2004-2012 from 43 US children's hospitals' pediatric intensive care units (PICUs) were used. Patients with PSS were defined by (1) International Classification of Diseases, 9th Revision (ICD-9) codes reflecting severe sepsis and septic shock and (2) ICD-9 codes of infection and organ dysfunction as defined by updated Angus criteria. Among the patients with PSS, those with a PHIS flag of ECMO or RRT were identified further as our main cohort. From 2004 to 2012, 636,842 patients were identified from 43 hospitals, and PSS prevalence was 7.7 % (49,153 patients). Nine point eight percent (4795 patients) received at least one form of ET, and the associated mortality rate was 39 %. Mortality rates were 47.8 % for those who received ECMO, 32.3 % in RRT, and 58.0 % in RRT + ECMO. Underlying co-morbidities were found in 3745 patients (78.1 %) who received ET (81 % for ECMO, 77.9 % in RRT, and 71.2 % in those who received both). There was a statistically significant increase in ECMO utilization in patients with at least three organ dysfunctions from 2004 to 2012 (6.9 % versus 10.3 %, P < 0.001) while RRT use declined (24.5 % versus 13.2 %, P < 0.001). After 2009, there was a significant increase in ECMO utilization (3.6 % in 2004-2008 versus 4.0 % in 2009-2012, P = 0.004). ECMO and RRT were used simultaneously in only 500 patients with PSS (1 %). ETs were used in a significant portion of PSS patients with multiple organ dysfunction syndrome (MODS) during this time period. Mortality was significant and increased with increasing organ failure. ECMO use in PSS patients with MODS increased from 2004 to 2012. Further evaluation of ET use in PSS is warranted.

National review of maternity services 2008: women influencing change

PubMed Central

2011-01-01

Background In 2009 the Australian government announced a major program of reform with the move to primary maternity care. The reform agenda represents a dramatic change to maternity care provision in a society that has embraced technology across all aspects of life including childbirth. Methods A critical discourse analysis of selected submissions in the consultation process to the national review of maternity services 2008 was undertaken to identify the contributions of individual women, consumer groups and organisations representing the interests of women. Results Findings from this critical discourse analysis revealed extensive similarities between the discourses identified in the submissions with the direction of the 2009 proposed primary maternity care reform agenda. The rise of consumer influence in maternity care policy reflects a changing of the guard as doctors' traditional authority is questioned by strong consumer organisations and informed consumers. Conclusions Unified consumer influence advocating a move away from obstetric -led maternity care for all pregnant women appears to be synergistic with the ethos of corporate governance and a neoliberal approach to maternity service policy. The silent voice of one consumer group (women happy with their obstetric-led care) in the consultation process has inadvertently contributed to a consensus of opinion in support of the reforms in the absence of the counter viewpoint. PMID:21762522

Patterns of care and treatment outcomes of patients with Craniopharyngioma in the national cancer database.

PubMed

Rao, Yuan J; Hassanzadeh, Comron; Fischer-Valuck, Benjamin; Chicoine, Michael R; Kim, Albert H; Perkins, Stephanie M; Huang, Jiayi

2017-03-01

To investigate the patterns of care and outcomes in patients with craniopharyngioma in the National Cancer Data Base (NCDB). This study included 697 patients (166 pediatric and 531 adult cases) treated for craniopharyngioma between 2004 and 2012 in the NCDB. Adjuvant radiotherapy (RT) was defined if within 6 months of surgery. Limited surgery (LS) was defined as biopsy or subtotal resection. Proportional-hazards models were used to evaluate associations between covariates and overall survival (OS). A time-dependent analysis of RT was performed to account for early deaths after surgery. Median follow-up was 46 months. Overall, 21% of patients received adjuvant RT. Of patients with known surgical extent (n = 195), 71% had LS. Utilization of adjuvant RT increased from 18% in 2004-2007 to 24% in 2008-2012. Patterns of care regarding adjuvant RT or LS were not significantly different between adult and pediatric patients. Tumor size, low comorbidity, and LS were associated with increased utilization of adjuvant RT. The 5-year OS among patients treated with LS, LS+RT, and gross total resection were 75, 85, and 82% (p = 0.02). On multivariate analysis of the 195 patients with known surgical extent, LS+RT was associated with improved OS compared to LS (HR 0.22, 95% CI 0.05-0.99, p = 0.04), but was not significant when early deaths (<2 months from surgery) were removed to adjust for immortal-time bias. Medical practice regarding surgical approach and adjuvant RT are similar for pediatric and adult craniopharyngiomas. Immortal-time bias may confound assessment of OS for adjuvant RT. Prospective studies comparing adjuvant RT versus observation after LS are warranted.

An analysis of needs for respiratory therapists in northeast Ohio and development of strategies to meet increased recruitment demands.

PubMed

Orens, Douglas K; Chatburn, Robert L; Volsko, Teresa A; Stoller, James K

2007-12-01

The 2005 American Association for Respiratory Care Human Resources Survey suggested that the national demand for respiratory therapists (RTs) exceeds the supply. At the Cleveland Clinic an expected hospital expansion of 350 beds by 2008 has increased the need for RT staff. This report describes a strategy by which we developed a plan, in concert with local RT colleges, to recruit RTs. Local RT managers were surveyed regarding demand for RTs. We developed a recruitment plan, based on discussions with RT program directors. The survey data and models estimated an annual mean of 33.4 new positions in northeast Ohio. Despite the fact that approximately 84 people graduated from northeast Ohio RT programs yearly in 2004 to 2007, the growth in demand for RTs exceeded the estimated supply. The main factor that caused RT schools to limit the supply of RTs was the paucity of clinical sites. Our analysis shows the schools could achieve a 40% increase in student output, and that if the Cleveland Clinic could essentially double its graduate hires, all RT staff needs in our hospital would be met by 2010. To assure a needed supply of RTs, this work shows the value of modeling supply and demand scenarios, coupled with surveying local RT leaders and fostering dialog between local RT leaders in hospitals and colleges. The product of this activity was a strategy for achieving recruitment goals while assuring that other regional demands for RTs are also met. We recommend this approach to colleagues facing similar challenges.

KSC-2010-4904

NASA Image and Video Library

2010-09-28

CAPE CANAVERAL, Fla. -- To commemorate the history of the Space Shuttle Program's last external fuel tank, its intertank door is emblazoned with an ET-122 insignia. The tank is in the Vehicle Assembly Building at NASA's Kennedy Space Center in Florida after traveling 900 miles by sea from NASA's Michoud Assembly Facility in New Orleans aboard the Pegasus Barge. It eventually will be attached to space shuttle Endeavour for the STS-134 mission to the International Space Station. STS-134, targeted to launch in Feb. 2011, currently is scheduled to be the last mission in the shuttle program. The tank, which is the largest element of the space shuttle stack, was completed in 2002, modified during Return to Flight operations in 2003 and 2004, damaged during Hurricane Katrina in 2005, and then restored to flight configuration by Lockheed Martin Space Systems Company employees in 2008 at NASA's Marshall Space Flight Center in Alabama. Photo credit: NASA/Jack Pfaller

KSC-2010-4906

NASA Image and Video Library

2010-09-28

CAPE CANAVERAL, Fla. -- To commemorate the history of the Space Shuttle Program's last external fuel tank, its intertank door is emblazoned with an ET-122 insignia. The tank is in the Vehicle Assembly Building at NASA's Kennedy Space Center in Florida after traveling 900 miles by sea from NASA's Michoud Assembly Facility in New Orleans aboard the Pegasus Barge. It eventually will be attached to space shuttle Endeavour for the STS-134 mission to the International Space Station. STS-134, targeted to launch in Feb. 2011, currently is scheduled to be the last mission in the shuttle program. The tank, which is the largest element of the space shuttle stack, was completed in 2002, modified during Return to Flight operations in 2003 and 2004, damaged during Hurricane Katrina in 2005, and then restored to flight configuration by Lockheed Martin Space Systems Company employees in 2008 at NASA's Marshall Space Flight Center in Alabama. Photo credit: NASA/Jack Pfaller

Oahu Groundwater Flow Model

DOE Data Explorer

Nicole Lautze

2015-01-01

Groundwater flow model for the island of Oahu. Data is from the following sources: Rotzoll, K., A.I. El-Kadi. 2007. Numerical Ground-Water Flow Simulation for Red Hill Fuel Storage Facilities, NAVFAC Pacific, Oahu, Hawaii - Prepared TEC, Inc. Water Resources Research Center, University of Hawaii, Honolulu.; Whittier, R.B., K. Rotzoll, S. Dhal, A.I. El-Kadi, C. Ray, G. Chen, and D. Chang. 2004. Hawaii Source Water Assessment Program Report – Volume VII – Island of Oahu Source Water Assessment Program Report. Prepared for the Hawaii Department of Health, Safe Drinking Water Branch. University of Hawaii, Water Resources Research Center. Updated 2008.; and Whittier, R. and A.I. El-Kadi. 2009. Human and Environmental Risk Ranking of Onsite Sewage Disposal Systems – Final. Prepared by the University of Hawaii, Dept. of Geology and Geophysics for the State of Hawaii Dept. of Health, Safe Drinking Water Branch. December 2009.

Analysis of the trauma section of the orthopaedic in-training examination.

PubMed

Taylor, Benjamin C; Fowler, T Ty

2011-07-07

The Orthopaedic In-Training Examination is a comprehensive test produced annually by the American Academy of Orthopaedic Surgeons, and was first administered in 1963. At the time of the examination's conception, its objectives were to: (1) measure the knowledge of orthopedic residents and provide objective comparisons; (2) help determine acceptable minimal standards for trainees; and (3) help provide an objective assessment of orthopedic education. We retrospectively reviewed all Orthopaedic In-Training Examinations from 2004 to 2008, with particular focus on the questions listed in the musculoskeletal trauma domain on each year's program director report. The musculoskeletal trauma domain, including topics, recommended answers, and references, was reviewed to provide an educational resource for residents and residency programs when studying or designing educational curricula. The information in this analysis may help in development of a core musculoskeletal trauma knowledge base or facilitate determination of appropriate journal club and didactic lecture content. Copyright 2011, SLACK Incorporated.

Trends in hospitalised sport/leisure injuries in New South Wales, Australia--implications for the targetting of population-focussed preventive sports medicine efforts.

PubMed

Finch, Caroline F; Mitchell, Rebecca; Boufous, Soufiane

2011-01-01

Sport/leisure injuries are a population health issue in Australia. Over 2003-2004 to 2007-2008, the rate of sport/leisure injury NSW hospitalisations was 195.5/100,000 residents. Males and children/young people had consistently highest rates of hospitalisation. There was no significant decline in rates over this period and no change in the profiles of the types of sport/leisure injuries. The extent to which effective preventive programs have been developed and implemented needs to be determined as current programs do not seem to be impacting on hospitalisation rates. Medical/health promotion agencies and sports bodies need to jointly formulate and implement policies to reduce sport/leisure injuries. This is one of the most significant challenges facing sports medicine professionals today. Copyright © 2010 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Delphi Study of Instructional Strategies for English Language Learners with Disabilities: Recommendations from Educators Nationwide. ELLs with Disabilities Report 21

ERIC Educational Resources Information Center

Thurlow, Martha; Shyyan, Vitaliy; Barrera, Manuel; Liu, Kristi

2008-01-01

This study is part of national research over the past seven years at the National Center on Educational Outcomes focused on identifying and validating instructional strategies for ELLs with disabilities (Shyyan, Thurlow, & Liu, 2008; Thurlow, Albus, Shyyan, Liu, & Barrera, 2004). In recent work (Barrera, Shyyan, Liu, & Thurlow, 2008),…

30th Annual Report to Congress on the Implementation of the "Individuals with Disabilities Education Act," 2008

ERIC Educational Resources Information Center

Office of Special Education and Rehabilitative Services, US Department of Education, 2011

2011-01-01

This is the 30th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act, 2008. Section 664(d) of the Individuals with Disabilities Education Act (IDEA), as reauthorized in 2004, requires that the Department of Education report annually on the progress made toward the provision of a free appropriate…

Grounding Research in Reality: Fiscal Equity and K-12 Funding in Illinois. Policy Research: IERC 2008-3

ERIC Educational Resources Information Center

Mullin, Christopher M.; Brown, Kathleen Sullivan

2008-01-01

The purpose of this study was to replicate both The Education Trust's "The Funding Gap" and D. Verstegen and L. Driscoll's "The Illinois Dilemma" studies published in 2008 utilizing the actual allocations to districts resulting from the fiscal policy mechanism (funding formula) in Illinois for the 2004-2005 school year to…

Are Canadian youth still exposed to second-hand smoke in homes and in cars?

PubMed

Barisic, A; Leatherdale, S T; Burkhalter, R; Ahmed, R

2014-07-01

The objective of this manuscript is to examine the prevalence of youth exposed to second-hand smoke (SHS) in homes and cars, changes in SHS exposure over time, and factors associated with beliefs youth hold regarding SHS exposure among a nationally representative sample of Canadian youth. Descriptive analysis of SHS exposure in homes and cars was conducted using data from the Canadian Youth Smoking Survey (2004, 2006 and 2008). Logistic regression was conducted to examine factors associated with beliefs youth had about SHS exposure in 2008. In 2008, 21.5% of youth reported being exposed to SHS in their home on a daily or almost daily basis, while 27.3% reported being exposed to SHS while riding in a car at least once in the previous week. Between 2004 and 2008, the prevalence of daily SHS exposure in the home and cars decreased by 4.7% and 18.0% respectively. Despite reductions in SHS exposure over time, a substantial number of Canadian youth continue to be exposed to SHS in homes and cars. Further effort is required to implement and evaluate policies designed to protect youth from SHS.

Paediatric cardiology programs in countries with limited resources: how to bridge the gap.

PubMed

Sulafa, K M Ali

2010-07-01

Establishing paediatric cardiology service in a country with limited resources like Sudan is a challenging task. A paediatric cardiac team was formed then the services in different disciplines were gradually established. Echocardiography (echo) clinics were founded in tertiary and peripheral hospitals. Cardiac catheterization (cath) was established at the Sudan Heart Centre (SHC) in 2004 and over 400 procedures had been performed including interventional catheterization like pulmonary valve dilatation, patent ductus arteriosus and atrial septal defect device closure. Congenital heart surgery started in 2001, currently 200 cases are done each year including closed procedures as well as open heart procedures for patients weighing more than 8 kg. Cardiology-cardiac surgery as well as adult congenital heart disease meetings were held and contributed positively to the services. The cardiology-cardiac surgery scientific club meeting was founded as a forum for academic discussions. A fellowship program was established in 2004 and included seven candidates trained in paediatric cardiology and intensive care. Two training courses had been established: congenital heart disease echo and paediatric electrocardiogram interpretation. Links with regional and international cardiac centres had important roles in consolidating our program. Significant obstacles face our service due to the small number of trained personnel, high cost of procedures, the lack of regular supplies and lack of cardiac intensive care facilities for young infants. Bridging the huge gap needs extensive official as well as non-governmental efforts, training more staff, supporting families and collaboration with regional and international centres.

Clandestine Message Passing in Virtual Environments

DTIC Science & Technology

2008-09-01

accessed April 4, 2008). Weir, Laila. “Boring Game? Outsorce It.” (August 24, 2004). http://www.wired.com/ entertainment / music /news/2004/08/ 64638...Multiplayer Online MOVES - Modeling Virtual Environments and Simulation MTV – Music Television NPS - Naval Postgraduate School PAN – Personal Area...Network PSP - PlayStation Portable RPG – Role-playing Game SL - Second Life SVN - Subversion VE – Virtual Environments vMTV – Virtual Music

Combustion of Alane and Aluminum with Water for Hydrogen and Thermal Energy Generation

DTIC Science & Technology

2010-01-01

Herr, Green Rocket Propulsion by Reaction of Al and Mg Powders and Water, AIAA 2004-4037, 2004. [9] J.L. Sabourin , G.A. Risha, R.A. Yetter, S.F. Son...Wiley and Sons, Inc., 1992. [32] G.A. Risha, J.L. Sabourin , V. Yang, R.A. Yetter, S.F. Son, B.C. Tappan, Combust. Sci. Technol. 180 (2008) 2127–2142

Characterizing Medical Care by Disease Phase in Metastatic Colorectal Cancer

PubMed Central

Song, Xue; Zhao, Zhongyun; Barber, Beth; Gregory, Christopher; Schutt, David; Gao, Sue

2011-01-01

Purpose: To characterize patterns of medical care by disease phase in patients with newly diagnosed metastatic colorectal cancer (mCRC). Methods: Patients with mCRC newly diagnosed between 2004 and 2008 were selected from a large US national commercially insured claims database and were observed from initial mCRC diagnosis to death, disenrollment, or end of study period (July 31, 2009), whichever occurred first. The observation period was divided into three distinct phases of disease: diagnostic, treatment, and death. Within each phase, patterns of medical care were examined by the mutually exclusive service categories of inpatient, emergency room (ER), outpatient office and facility, outpatient pharmacy, chemotherapy, and biologic therapy, as measured by estimation of aggregate and category costs per patient per month. Results: A total of 6,675 patients with newly diagnosed mCRC were analyzed. Mean age was 64.1 years; 55.5% were males. Mean costs per patient per month for diagnostic, treatment, and death phases were $16,895, $8,891, and $27,554, respectively. Inpatient care was the primary driver of medical care for both the diagnostic (41.7% of costs) and death (71.4% of costs) phases. The largest category of medical care for the treatment phase was outpatient care (45.0% of costs). Chemotherapy and biologic therapy accounted for 15.6% and 17.6% of costs in the treatment phase, respectively. Conclusion: Substantial differences in patterns of medical care were found between mCRC disease phases. Inpatient care was the key driver of medical care in the diagnostic and death phases compared with outpatient care in the treatment phase. PMID:21886516

76 FR 73025 - Medicare Program; Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-28

...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

Experiences and opinions of health-care professionals regarding legal abortion in Mexico City: a qualitative study.

PubMed

Contreras, Xipatl; van Dijk, Marieke G; Sanchez, Tahilin; Smith, Patricio Sanhueza

2011-09-01

This study examines the experiences and opinions of health-care professionals after the legalization of abortion in Mexico City in 2007. Sixty-four semistructured interviews were conducted between 1 December 2007 and 16 July 2008 with staff affiliated with abortion programs in 12 hospitals and 1 health center, including obstetricians/gynecologists, nurses, social workers, key decisionmakers at the Ministry of Health, and others. Findings suggest that program implementation was difficult because of the lack of personnel, space, and resources; a great number of conscientious objectors; and the enormous influx of women seeking services, which resulted in a work overload for participating professionals. The professionals interviewed indicate that the program improved significantly over time. They generally agree that legal abortion should be offered, despite serious concerns about repeat abortions. They recommend improving family planning campaigns and post-procedure contraceptive use, and they encourage the opening of primary health-care facilities dedicated to providing abortion services.

Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

ERIC Educational Resources Information Center

Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

2010-01-01

Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

Physical rehabilitation following polytrauma. The Canadian Forces Physical Rehabilitation Program 2008-2011.

PubMed

Besemann, Markus

2011-12-01

As a consequence of Canada's involvement in the war in Afghanistan, many members of the Canadian Forces have experienced debilitating injuries. Despite the Canadian Forces Health Services (CFHS) having outstanding relationships with many civilian care providers for the rehabilitation of injured soldiers, it became apparent early on that the high-level goals and aspirations of these returning soldiers were sometimes beyond the capability of these centres to facilitate. From this reality grew the need to develop a Physical Rehabilitation Program within the CFHS. This article describes the lessons learned since the creation of the program and outlines the future vision in terms of unique challenges and opportunities. The primary purpose of this article is to describe a hybrid model of civilian-military rehabilitation for injured soldiers and discuss the benefits and challenges of such a model of care.

Prostate cancer, comorbidity, and participation in randomized controlled trials of therapy.

PubMed

Chao, Herta H; Mayer, Tina; Concato, John; Rose, Michal G; Uchio, Edward; Kelly, Wm Kevin

2010-03-01

Randomized controlled trials (RCTs) evaluate the potential benefits of chemotherapy regimens and guide clinical care for patients with cancer. Inclusion criteria for RCTs are usually stringent and may exclude many patients seen in clinical practice. Our objective was to determine the proportion of men with castrate-resistant prostate cancer (CRPC) in a clinical setting that would have been excluded from major phase 3 RCTs. We reviewed eligibility criteria from 24 phase 3 clinical trials evaluating chemotherapy for CRPC active from January, 2004, through April, 2008. We created a common list of criteria used in at least 3 studies and separately considered the criteria from a prominent RCT (TAX 327). We applied these criteria to a population of patients with CRPC treated during 2004 to 2006 at the Veterans Affairs Connecticut Healthcare System. Among 106 patients with CRPC, 99 (93%) had complete medical records, and 45 (45%) of the 99 would have been excluded from RCTs. Common reasons for exclusion were abnormal laboratory values, other malignancies, and other serious medical conditions including cardiac disease. Almost half of the CRPC patients examined in a clinical setting would have been ineligible for phase 3 RCTs, highlighting that such trials may not be applicable to general oncology practice.

2004 SHOPP : State Highway Operation and Protection Program : 2004/05 through 2007/08.

DOT National Transportation Integrated Search

2004-04-01

The 2004 SHOPP is a four-year program of projects for fiscal years 2004/05 through 2007/08, that have a purpose of collision reduction, bridge preservation, roadway preservation, roadside preservation, mobility or facilities related to the state high...

Association between the Availability of Hospital-Based Palliative Care and Treatment Intensity for Critically Ill Patients.

PubMed

Hua, May; Ma, Xiaoyue; Morrison, R Sean; Li, Guohua; Wunsch, Hannah

2018-05-29

In the intensive care unit (ICU), studies involving specialized palliative care services have shown decreases in the use of non-beneficial life-sustaining therapies and ICU length of stay for patients. However, whether widespread availability of hospital-based palliative care is associated with less frequent use of high intensity care is unknown. To determine whether availability of hospital-based palliative care is associated with decreased markers of treatment intensity for ICU patients. Retrospective cohort study of adult ICU patients in New York State hospitals, 2008-2014. Multilevel regression was used to assess the relationship between availability of hospital-based palliative care during the year of admission and hospital length of stay, use of mechanical ventilation, dialysis and artificial nutrition, placement of a tracheostomy or gastrostomy tube, days in ICU and discharge to hospice. Of 1,025,503 ICU patients in 151 hospitals, 814,794 (79.5%) received care in a hospital with a palliative care program. Hospital length of stay was similar for patients in hospitals with and without palliative care programs (6 days, interquartile range (IQR) 3-12 vs. 6 days, IQR 3-11, adjusted rate ratio 1.04 [1.03 to 1.05], p < 0.001), as were other healthcare utilization outcomes. However, patients in hospitals with palliative care programs were 46% more likely to be discharged to hospice than those in hospitals without palliative care programs (1.7% vs. 1.4%, adjusted odds ratio 1.46 [1.30 to 1.64], p<0.001). Availability of hospital-based palliative care was not associated with differences in in-hospital treatment intensity but was associated with significantly increased hospice utilization for ICU patients. At this time, the measurable benefit of palliative care programs for critically ill patients may be the increased use of hospice facilities, as opposed to decreased healthcare utilization during an ICU-associated hospitalization.

Delay to mental healthcare in a cohort of Canadian Armed Forces personnel with deployment-related mental disorders, 2002-2011: a retrospective cohort study.

PubMed

Boulos, David; Zamorski, Mark A

2016-09-08

To assess whether the delay to care among Canadian Armed Forces (CAF) personnel who sought care for a mental disorder changed over time and in association with CAF mental health system augmentations. A stratified, random sample (n=2014) was selected for study from an Afghanistan-deployed cohort (N=30 513) and the 415 (weighted N=4108) individuals diagnosed with an Afghanistan service-related mental disorder were further assessed. Diagnosis-related data were abstracted from medical records (22 June 2010 to 30 May 2011). Other data were extracted from administrative databases. Delay to care was assessed across five mental health system eras: 2002/2004, 2005/2006, 2007, 2008 and 2009/2010. Weighted Cox proportional hazards regression assessed the association between era, handled as a time-dependent covariate, and the outcome while controlling for a broad range of potential confounders (ie, sociodemographic, military and clinical characteristics). Taylor series linearisation methods and sample design weights were applied in generating descriptive and regression analysis statistics. The outcome was the delay to mental healthcare, defined as the latency from most recent Afghanistan deployment return date to diagnosis date, among individuals with an Afghanistan service-related mental disorder diagnosis. Mean delay to care was 551 days (95% CI 501 to 602); the median was 400 days. Delay to care decreased in subsequent eras relative to 2002/2004; however, only the most recent era (2009/2010) was statistically significant (adjusted HR (aHR): 3.01 (95% CI 1.91 to 4.73)). Men, operations support occupations, higher ranks, non-musculoskeletal comorbidities and fewer years of military service were also independently associated with longer delays to care. CAF mental health system changes were associated with reduced delays to mental healthcare. Further evaluation research is needed to identify the key system changes that were most impactful. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Human resource development for a community-based health extension program: a case study from Ethiopia.

PubMed

Teklehaimanot, Hailay D; Teklehaimanot, Awash

2013-08-20

Ethiopia is one of the sub-Saharan countries most affected by high disease burden, aggravated by a shortage and imbalance of human resources, geographical distance, and socioeconomic factors. In 2004, the government introduced the Health Extension Program (HEP), a primary care delivery strategy, to address the challenges and achieve the World Health Organization Millennium Development Goals (MDGs) within a context of limited resources. The health system was reformed to create a platform for integration and institutionalization of the HEP with appropriate human capacity, infrastructure, and management structures. Human resources were developed through training of female health workers recruited from their prospective villages, designed to limit the high staff turnover and address gender, social and cultural factors in order to provide services acceptable to each community. The service delivery modalities include household, community and health facility care. Thus, the most basic health post infrastructure, designed to rapidly and cost-effectively scale up HEP, was built in each village. In line with the country's decentralized management system, the HEP service delivery is under the jurisdiction of the district authorities. The nationwide implementation of HEP progressed in line with its target goals. In all, 40 training institutions were established, and over 30,000 Health Extension Workers have been trained and deployed to approximately 15,000 villages. The potential health service coverage reached 92.1% in 2011, up from 64% in 2004. While most health indicators have improved, performance in skilled delivery and postnatal care has not been satisfactory. While HEP is considered the most important institutional framework for achieving the health MDGs in Ethiopia, quality of service, utilization rate, access and referral linkage to emergency obstetric care, management, and evaluation of the program are the key challenges that need immediate attention. This article describes the strategies, human resource developments, service delivery modalities, progress in service coverage, and the challenges in the implementation of the HEP. The Ethiopian approach of revitalization of primary care through innovative, locally appropriate and acceptable strategies will provide important lessons to other poorly resourced countries. It is hoped that the approaches and strategies described in this paper will aid in that process.

Sustainability and scalability of the hospital elder life program at a community hospital.

PubMed

Rubin, Fred H; Neal, Kelly; Fenlon, Kerry; Hassan, Shuja; Inouye, Sharon K

2011-02-01

The Hospital Elder Life Program (HELP), an effective intervention to prevent delirium in older hospitalized adults, has been successfully replicated in a community teaching hospital as a quality improvement project. This article reports on successfully sustaining the program over 7 years and expanding its scale from one to six inpatient units at the same hospital. The program currently serves more than 7,000 older patients annually and is accepted as the standard of care throughout the hospital. Innovations that enhanced scalability and widespread implementation included ensuring dedicated staffing for the program, local adaptations to streamline protocols, continuous recruitment of volunteers, and more-efficient data collection. Outcomes include a lower rate of incident delirium; shorter length of stay (LOS); greater satisfaction of patients, families, and nursing staff; and significantly lower costs for the hospital. The financial return of the program, estimated at more than $7.3 million per year during 2008, comprises cost savings from delirium prevention and revenue generated from freeing up hospital beds (shorter LOS of HELP patients with and without delirium). Delirium poses a major challenge for hospital quality of care, patient safety, Medicare no-pay conditions, and costs of hospital care for older persons. Faced with rising numbers of elderly patients, hospitals can use HELP to improve the quality and cost-effectiveness of care. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Pediatric asthma hospitalizations among urban minority children and the continuity of primary care.

PubMed

Utidjian, Levon H; Fiks, Alexander G; Localio, A Russell; Song, Lihai; Ramos, Mark J; Keren, Ron; Bell, Louis M; Grundmeier, Robert W

2017-12-01

To examine the effect of ambulatory health care processes on asthma hospitalizations. A retrospective cohort study using electronic health records was completed. Patients aged 2-18 years receiving health care from 1 of 5 urban practices between Jan 1, 2004 and Dec 31, 2008 with asthma documented on their problem list were included. Independent variables were modifiable health care processes in the primary care setting: (1) use of asthma controller medications; (2) regular assessment of asthma symptoms; (3) use of spirometry; (4) provision of individualized asthma care plans; (5) timely influenza vaccination; (6) access to primary healthcare; and (7) use of pay for performance physician incentives. Occurrence of one or more asthma hospitalizations was the primary outcome of interest. We used a log linear model (Poisson regression) to model the association between the factors of interest and number of asthma hospitalizations. 5,712 children with asthma were available for analysis. 96% of the children were African American. The overall hospitalization rate was 64 per 1,000 children per year. None of the commonly used asthma-specific indicators of high quality care were associated with fewer asthma hospitalizations. Children with documented asthma who experienced a lack of primary health care (no more than one outpatient visit at their primary care location in the 2 years preceding hospitalization) were at higher risk of hospitalization compared to those children with a greater number of visits (incidence rate ratio 1.39; 95% CI 1.09-1.78). In children with asthma, more frequent primary care visits are associated with reduced asthma hospitalizations.

Epidemiology and trend of common cancers in Iran (2004-2008).

PubMed

Amori, N; Aghajani, M; Asgarian, F S; Jazayeri, M

2017-09-01

Cancer is one of the most important causes of mortality worldwide. It includes approximately 13% of death cases. This study aimed to investigate the incidence trend of common cancers in Iran during 2004-2008 to improve reporting distribution the disease. This was a retrospective study. The study population was all cases of cancer diagnosed in Iran during 2004-2008. The crude incidence rate of cancers was calculated per 100 000 people by age groups and sex. Age-standardised incidence rates (ASRs) were calculated using direct standardisation and the world standard population. Data were analysed using SPSS (version 17) and Microsoft Office Excel 2007. In this study, a total of 301 055 cases of cancer were diagnosed. ASRs were 60.51 and 84.51 in women and men respectively. Most common cancers in men were skin (ASR = 18.85), stomach (15.02), bladder (ASR = 11.25), prostate (ASR = 8.93) and colorectal (ASR = 8.29). Most common cancers in women were breast (ASR = 18.24), skin (ASR = 12.01), colorectal (ASR = 7.75), stomach (ASR = 7.05) and haematocyte (ASR = 4.01). A significant increase was observed in the incidence of cancers in the country. Therefore, it is necessary to perform screening, early diagnosis and treatment in early stages of cancers. © 2016 John Wiley & Sons Ltd.

The impact of health insurance reform on insurance instability.

PubMed

Freund, Karen M; Isabelle, Alexis P; Hanchate, Amresh D; Kalish, Richard L; Kapoor, Alok; Bak, Sharon; Mishuris, Rebecca G; Shroff, Swati M; Battaglia, Tracy A

2014-02-01

We investigated the impact of the 2006 Massachusetts health care reform on insurance coverage and stability among minority and underserved women. We examined 36 months of insurance claims among 1,946 women who had abnormal cancer screening at six community health centers pre-(2004-2005) and post-(2007-2008) insurance reform. We examined frequency of switches in insurance coverage as measures of longitudinal insurance instability. On the date of their abnormal cancer screening test, 36% of subjects were publicly insured and 31% were uninsured. Post-reform, the percent ever uninsured declined from 39% to 29% (p .001) and those consistently uninsured declined from 23% to 16%. To assess if insurance instability changed between the pre- and post-reform periods, we conducted Poisson regression models, adjusted for patient demographics and length of time in care. These revealed no significant differences from the pre- to post-reform period in annual rates of insurance switches, incident rate ratio 0.98 (95%- CI 0.88-1.09). Our analysis is limited by changes in the populations in the pre- and post-reform period and inability to capture care outside of the health system network. Insurance reform increased stability as measured by decreasing uninsured rates without increasing insurance switches.

The Computer-Assisted Brief Intervention for Tobacco (CABIT) program: a pilot study.

PubMed

Boudreaux, Edwin D; Bedek, Kristyna L; Byrne, Nelson J; Baumann, Brigitte M; Lord, Sherrill A; Grissom, Grant

2012-12-03

Health care providers do not routinely carry out brief counseling for tobacco cessation despite the evidence for its effectiveness. For this intervention to be routinely used, it must be brief, be convenient, require little investment of resources, require little specialized training, and be perceived as efficacious by providers. Technological advances hold much potential for addressing the barriers preventing the integration of brief interventions for tobacco cessation into the health care setting. This paper describes the development and initial evaluation of the Computer-Assisted Brief Intervention for Tobacco (CABIT) program, a web-based, multimedia tobacco intervention for use in opportunistic settings. The CABIT uses a self-administered, computerized assessment to produce personalized health care provider and patient reports, and cue a stage-matched video intervention. Respondents interested in changing their tobacco use are offered a faxed referral to a "best matched" tobacco treatment provider (ie, dynamic referral). During 2008, the CABIT program was evaluated in an emergency department, an employee assistance program, and a tobacco dependence program in New Jersey. Participants and health care providers completed semistructured interviews and satisfaction ratings of the assessment, reports, video intervention, and referrals using a 5-point scale. Mean patient satisfaction scores (n = 67) for all domains ranged from 4.00 (Good) to 5.00 (Excellent; Mean = 4.48). Health care providers completed satisfaction forms for 39 patients. Of these 39 patients, 34 (87%) received tobacco resources and referrals they would not have received under standard care. Of the 45 participants offered a dynamic referral, 28 (62%) accepted. The CABIT program provided a user-friendly, desirable service for tobacco users and their health care providers. Further development and clinical trial testing is warranted to establish its effectiveness in promoting treatment engagement and tobacco cessation.

The Computer-Assisted Brief Intervention for Tobacco (CABIT) Program: A Pilot Study

PubMed Central

Bedek, Kristyna L; Byrne, Nelson J; Baumann, Brigitte M; Lord, Sherrill A; Grissom, Grant

2012-01-01

Background Health care providers do not routinely carry out brief counseling for tobacco cessation despite the evidence for its effectiveness. For this intervention to be routinely used, it must be brief, be convenient, require little investment of resources, require little specialized training, and be perceived as efficacious by providers. Technological advances hold much potential for addressing the barriers preventing the integration of brief interventions for tobacco cessation into the health care setting. Objective This paper describes the development and initial evaluation of the Computer-Assisted Brief Intervention for Tobacco (CABIT) program, a web-based, multimedia tobacco intervention for use in opportunistic settings. Methods The CABIT uses a self-administered, computerized assessment to produce personalized health care provider and patient reports, and cue a stage-matched video intervention. Respondents interested in changing their tobacco use are offered a faxed referral to a “best matched” tobacco treatment provider (ie, dynamic referral). During 2008, the CABIT program was evaluated in an emergency department, an employee assistance program, and a tobacco dependence program in New Jersey. Participants and health care providers completed semistructured interviews and satisfaction ratings of the assessment, reports, video intervention, and referrals using a 5-point scale. Results Mean patient satisfaction scores (n = 67) for all domains ranged from 4.00 (Good) to 5.00 (Excellent; Mean = 4.48). Health care providers completed satisfaction forms for 39 patients. Of these 39 patients, 34 (87%) received tobacco resources and referrals they would not have received under standard care. Of the 45 participants offered a dynamic referral, 28 (62%) accepted. Conclusions The CABIT program provided a user-friendly, desirable service for tobacco users and their health care providers. Further development and clinical trial testing is warranted to establish its effectiveness in promoting treatment engagement and tobacco cessation. PMID:23208070

DOE Hydrogen Program 2004 Annual Merit Review and Peer Evaluation Report

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

Not Available

This document summarizes the project evaluations and comments from the DOE Hydrogen Program 2004 Annual Program Review. Hydrogen production, delivery and storage; fuel cells; technology validation; safety, codes and standards; and education R&D projects funded by DOE in FY2004 are reviewed.

What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs.

PubMed

van Dijk, Christel E; Verheij, Robert A; Swinkels, Ilse C S; Rijken, Mieke; Schellevis, François G; Groenewegen, Peter P; de Bakker, Dinny H

2011-10-01

Disease management programs (DMP) aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs. Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (n=316) and data from electronic medical records (EMR) (n=9023), and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard. On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. Ninety-six percent contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs. Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.

Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong.

PubMed

Taw, Benedict B T; Lam, Alan C S; Ho, Faith L Y; Hung, K N; Lui, W M; Leung, Gilberto K K

2012-07-01

Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We aim to review the outcome of severely head-injured patients after discharge from acute care at a designated trauma center in Hong Kong. This is a retrospective study of prospectively collected data of patients admitted with severe head injuries between 2004 and 2008. Patients' functional status post-discharge was assessed using the Extended Glasgow Outcome Score (GOSE). Of a total of 1565 trauma patients, 116 had severe head injuries and 41 of them survived acute hospital care. Upon the last follow-up, 23 (56.1%) of the acute-care survivors had improvements in their GOSE, six (11.8%) experienced deteriorations, and 12 (23.5%) did not exhibit any change. The greatest improvement was observed in patients with GOSE of 5 and 6 upon discharge, but two of the 16 patients with GOSE 2 or 3 also had a good recovery. On logistic regression analysis, old age and prolonged acute hospital stay were found to be independent predictors of poor functional outcome after a mean follow-up duration of 42 months. Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery. Copyright © 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.

Changes in diagnosed diabetes, obesity, and physical inactivity prevalence in US counties, 2004-2012

PubMed Central

Kirtland, Karen; Lin, Ji; Shrestha, Sundar; Thompson, Ted; Albright, Ann; Gregg, Edward W.

2017-01-01

Recent studies suggest that prevalence of diagnosed diabetes in the United States reached a plateau or slowed around 2008, and that this change coincided with obesity plateaus and increases in physical activity. However, national estimates can obscure important variations in geographic subgroups. We examine whether a slowing or leveling off in diagnosed diabetes, obesity, and leisure time physical inactivity prevalence is also evident across the 3143 counties of the United States. We used publicly available county estimates of the age-adjusted prevalence of diagnosed diabetes, obesity, and leisure-time physical inactivity, which were generated by the Centers for Disease Control and Prevention (CDC). Using a Bayesian multilevel regression that included random effects by county and year and applied cubic splines to smooth these estimates over time, we estimated the average annual percentage point change (APPC) from 2004 to 2008 and from 2008 to 2012 for diabetes, obesity, and physical inactivity prevalence in each county. Compared to 2004–2008, the median APPCs for diabetes, obesity, and physical inactivity were lower in 2008–2012 (diabetes APPC difference = 0.16, 95%CI 0.14, 0.18; obesity APPC difference = 0.65, 95%CI 0.59, 0.70; physical inactivity APPC difference = 0.43, 95%CI 0.37, 0.48). APPCs and APPC differences between time periods varied among counties and U.S. regions. Despite improvements, levels of these risk factors remained high with most counties merely slowing rather than reversing, which suggests that all counties would likely benefit from reductions in these risk factors. The diversity of trajectories in the prevalence of these risk factors across counties underscores the continued need to identify high risk areas and populations for preventive interventions. Awareness of how these factors are changing might assist local policy makers in targeting and tracking the impact of efforts to reduce diabetes, obesity and physical inactivity. PMID:28267760

Changes in diagnosed diabetes, obesity, and physical inactivity prevalence in US counties, 2004-2012.

PubMed

Geiss, Linda S; Kirtland, Karen; Lin, Ji; Shrestha, Sundar; Thompson, Ted; Albright, Ann; Gregg, Edward W

2017-01-01

Recent studies suggest that prevalence of diagnosed diabetes in the United States reached a plateau or slowed around 2008, and that this change coincided with obesity plateaus and increases in physical activity. However, national estimates can obscure important variations in geographic subgroups. We examine whether a slowing or leveling off in diagnosed diabetes, obesity, and leisure time physical inactivity prevalence is also evident across the 3143 counties of the United States. We used publicly available county estimates of the age-adjusted prevalence of diagnosed diabetes, obesity, and leisure-time physical inactivity, which were generated by the Centers for Disease Control and Prevention (CDC). Using a Bayesian multilevel regression that included random effects by county and year and applied cubic splines to smooth these estimates over time, we estimated the average annual percentage point change (APPC) from 2004 to 2008 and from 2008 to 2012 for diabetes, obesity, and physical inactivity prevalence in each county. Compared to 2004-2008, the median APPCs for diabetes, obesity, and physical inactivity were lower in 2008-2012 (diabetes APPC difference = 0.16, 95%CI 0.14, 0.18; obesity APPC difference = 0.65, 95%CI 0.59, 0.70; physical inactivity APPC difference = 0.43, 95%CI 0.37, 0.48). APPCs and APPC differences between time periods varied among counties and U.S. regions. Despite improvements, levels of these risk factors remained high with most counties merely slowing rather than reversing, which suggests that all counties would likely benefit from reductions in these risk factors. The diversity of trajectories in the prevalence of these risk factors across counties underscores the continued need to identify high risk areas and populations for preventive interventions. Awareness of how these factors are changing might assist local policy makers in targeting and tracking the impact of efforts to reduce diabetes, obesity and physical inactivity.

Design and operation of the national home health aide survey: 2007-2008.

PubMed

Bercovitz, Anita; Moss, Abigail J; Sengupta, Manisha; Harris-Kojetin, Lauren D; Squillace, Marie R; Emily, Rosenoff; Branden, Laura

2010-03-01

This report provides an overview of the National Home Health Aide Survey (NHHAS), the first national probability survey of home health aides. NHHAS was designed to provide national estimates of home health aides who provided assistance in activities of daily living (ADLs) and were directly employed by agencies that provide home health and/or hospice care. This report discusses the need for and objectives of the survey, the design process, the survey methods, and data availability. METHODS NHHAS, a multistage probability sample survey, was conducted as a supplement to the 2007 National Home and Hospice Care Survey (NHHCS). Agencies providing home health and/or hospice care were sampled, and then aides employed by these agencies were sampled and interviewed by telephone. Survey topics included recruitment, training, job history, family life, client relations, work-related injuries, and demographics. NHHAS was virtually identical to the 2004 National Nursing Assistant Survey of certified nursing assistants employed in sampled nursing homes with minor changes to account for differences in workplace environment and responsibilities. RESULTS From September 2007 to April 2008, interviews were completed with 3,416 aides. A public-use data file that contains the interview responses, sampling weights, and design variables is available. The NHHAS overall response rate weighted by the inverse of the probability of selection was 41 percent. This rate is the product of the weighted first-stage agency response rate of 57 percent (i.e., weighted response rate of 59 percent for agency participation in NHHCS times the weighted response rate of 97 percent for agencies participating in NHHCS that also participated in NHHAS) and the weighted second-stage aide response rate of 72 percent to NHHAS.

A Study of the Teacher's Professional Development in Identification of First Grade Students' Phases of Word Learning and Its Effect on Instructional Practice

ERIC Educational Resources Information Center

Humbert, Mary Beth C.

2017-01-01

Beginning readers and struggling readers need explicit, systematic instruction in phonemic awareness and phonics (Adams, 2008; Ehri,1992, 1998; Ehri, Nunes, Willows, Schuster, & Yaghoub-Zadeh, 2001; Gaskins et al., 1997; Moats, 2004; Morris, 2015; National Reading Panel, 2000; Reutzel, 2015). Ehri and McCormick's (2008) phases of word learning…

Transparent Armor Cost Benefit Study

DTIC Science & Technology

2008-04-01

2005 2006 UNCLASSIFIED UNCLASSIFIED 4/30/2008 4/17 2006 “Iraqi Pope Glass” 2004-2005 - GPK Recent HistoryEarly OIF Curb Wt: 10,300lbs GVW: 12,100lbs...UNCLASSIFIED UNCLASSIFIED 4/30/2008 5/17 Future Transparent Gun Shields Requirement: Upgrade GPKS with transparent armor for enhanced situational...awareness while maintaining soldier cover within armor envelope. AHI GS & GPK Upgraded Gunner Shield – Transparent Armored Gun Shield (TAGS

Testing Cognitive Behavior With Emphasis on Analytical Propensity of Service Members

DTIC Science & Technology

2012-04-01

TRADOC Pam 525-3-1, researchers such as Allen (2008), Hutchins et al. (2004; 2007), Fingar (2011), Krizan (1999), and Treverton and Gabbard (2008), among...Joint Military Intelligence College: Washington, DC, 2003. Treverton, G. F.; Gabbard , C. B. Assessing the Tradecraft of Intelligence Analysts. The...Treverton, G. F.; Gabbard , C. B. Assessing the Tradecraft of Intelligence Analysts. The RAND Corporation, National Security Research Division

Office of Inspector General; Medicare and state health care programs: fraud and abuse; issuance of advisory opinions by the OIG. Final rule.

PubMed

2008-07-17

OIG is adopting in final form, without change, an interim final rule published on March 26, 2008 (73 FR 15937). We received no comments to the interim final rule. The interim final rule revised the process for advisory opinion requestors to submit payments for advisory opinion costs.

Integrated employee assistance program/managed behavioral health plan utilization by persons with substance use disorders.

PubMed

Merrick, Elizabeth S Levy; Hodgkin, Dominic; Hiatt, Deirdre; Horgan, Constance M; Greenfield, Shelly F; McCann, Bernard

2011-04-01

New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product (N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes. Copyright © 2011 Elsevier Inc. All rights reserved.

Medicare Advantage Penetration and Hospital Costs Before and After the Affordable Care Act.

PubMed

Henke, Rachel Mosher; Karaca, Zeynal; Gibson, Teresa B; Cutler, Eli; White, Chapin; Wong, Herbert S

2018-04-01

Research has suggested that growth in the Medicare Advantage (MA) program indirectly benefits the entire 65+-year-old population by reducing overall expenditures and creating spillover effects of patient care practices. Medicare programs and innovations initiated by the Affordable Care Act (ACA) have encouraged practices to adopt models applying to all patient populations, which may influence the continued benefits of MA program growth. This study investigated the relationship between MA program growth and inpatient hospital costs and utilization before and after the ACA. Primary data sources were 2005-2014 Health Care Cost and Utilization Project hospital data and 2004-2013 Centers for Medicare & Medicaid Services enrollment data. County-year-level regression analysis with fixed effects examined the relationship between Medicare managed care penetration and hospital cost per enrollee. We decomposed results into changes in utilization, severity, and severity-adjusted inpatient resource use. Analyses were stratified by whether the admission was urgent or nonurgent. A 10% increase in MA penetration was associated with a 3-percentage point decrease in inpatient cost per Medicare enrollee before the ACA. This effect was more prominent in nonurgent admissions and diminished after the ACA. Results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. We did not observe a strong relationship between MA enrollment and inpatient days per enrollee. Future research should examine whether spillover effects still are observed in outpatient settings.

Introduction: the Interdisciplinary Nursing Quality Research Initiative.

PubMed

Naylor, Mary D; Lustig, Adam; Kelley, Heather J; Volpe, Ellen M; Melichar, Lori; Pauly, Mark V

2013-04-01

The Robert Wood Johnson Foundation launched the Interdisciplinary Nursing Quality Research Initiative (INQRI) program in 2005 to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality. This special edition of Medical Care provides an overview of the program's strategy, goals, and impact, highlighting cross-cutting issues addressed by the initiative. INQRI's leadership and select grantees discuss the implications of a collection of studies on the following: advances in the science of nursing's contribution to quality, measurement of quality, interdisciplinary collaboration, implementation methodology, dissemination and translation of findings, and the business case for nursing. A comprehensive review of the scholarly literature published in 2004 and 2009 found that the evidence linking nursing to quality of care has grown. The second paper discusses INQRI's work on measurement of quality of care, revealing the need for additional comprehensive measures. The third paper examines INQRI's focus on interdisciplinary collaboration, finding that it can enhance methodological approaches and result in substantive changes in health delivery systems. The fourth paper presents methodological challenges faced in health care implementation, emphasizing the need for standardized terms and research designs. The fifth paper addresses INQRI's commitment to translating research into practice, illustrating dissemination strategies and lessons learned. The final paper discusses how the INQRI program has contributed to the current evidence regarding the business case for nursing. This supplement describes the accomplishments of the INQRI program, discusses current issues in research design and implementation, and places INQRI research within the larger context regarding advances in nursing science.

Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data

PubMed Central

Sabin, Keith; Ho, Thi Quynh Trang; Le, Ai Kim Anh; Hayashi, Chika; Kato, Masaya

2017-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013. Objective The objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam. Methods This community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp). Results A total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P<.001). Overall survival rate for HIV-exposed infants at 12 months was 97.7%. Conclusions A combination of program and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission, such as late diagnosis, remain to be addressed. PMID:29263016

A cohort study of the acute and chronic respiratory effects of toner exposure among handlers: a longitudinal analyses from 2004 to 2013.

PubMed

Ikegami, Kazunori; Hasegawa, Masayuki; Ando, Hajime; Hata, Koichi; Kitamura, Hiroko; Ogami, Akira; Higashi, Toshiaki

2016-10-08

This study examines the acute and chronic respiratory effects of toner exposure based on markers for interstitial pneumonia, oxidative stress and pulmonary function tests. A total of 112 subjects working in a Japanese toner and photocopier manufacturing company participated in this study in 2004. We annually conducted personal exposure measurements, pulmonary function tests, chest X-ray examinations, biomarkers, and questionnaires on respiratory symptoms to the subjects. We report in this paper the results of the analysis of combined annual survey point data from 2004 to 2008 and data from three annual survey points, 2004, 2008, and 2013. During these survey periods, we observed that none of subjects had a new onset of respiratory disease or died of such a disease. In both the analyses, there were no significant differences in each biomarker and pulmonary function tests within the subjects, nor between a toner-handling group and a non-toner-handling group, except for a few results on pulmonary function tests. The findings of this study suggest that there were no acute and chronic respiratory effects of toner exposure in this cohort group, although the number of subjects was small and the level of toner exposure in this worksite was low.

A cohort study of the acute and chronic respiratory effects of toner exposure among handlers: a longitudinal analyses from 2004 to 2013

PubMed Central

IKEGAMI, Kazunori; HASEGAWA, Masayuki; ANDO, Hajime; HATA, Koichi; KITAMURA, Hiroko; OGAMI, Akira; HIGASHI, Toshiaki

2016-01-01

This study examines the acute and chronic respiratory effects of toner exposure based on markers for interstitial pneumonia, oxidative stress and pulmonary function tests. A total of 112 subjects working in a Japanese toner and photocopier manufacturing company participated in this study in 2004. We annually conducted personal exposure measurements, pulmonary function tests, chest X–ray examinations, biomarkers, and questionnaires on respiratory symptoms to the subjects. We report in this paper the results of the analysis of combined annual survey point data from 2004 to 2008 and data from three annual survey points, 2004, 2008, and 2013. During these survey periods, we observed that none of subjects had a new onset of respiratory disease or died of such a disease. In both the analyses, there were no significant differences in each biomarker and pulmonary function tests within the subjects, nor between a toner–handling group and a non–toner–handling group, except for a few results on pulmonary function tests. The findings of this study suggest that there were no acute and chronic respiratory effects of toner exposure in this cohort group, although the number of subjects was small and the level of toner exposure in this worksite was low. PMID:27021062

Circulation of the Elite in the Chinese Communist Party

DTIC Science & Technology

2014-09-02

the 11th Party Congress. Li Disheng (rank 6) made it to the 11th Congress, but as a Politburo member, and not as a PSC member. Only Ye Jianying (rank 5...2003; Holbig 2009; Holbig and Gilley 2010; Hsu 2001; Lee 2010: Li 2013b; Schubert 2007; Zheng 2003. 4Dittmer 2001, 58; Yue 2008, 82-83. 5Bo 2007; Cho...2008; Dittmer 2001; Fewsmith 2003; Kou and Zang 2014; Li 1994; Li 2012; Lin 2004; Nathan 1973; Shih 2008; Shih et al. 2010; Shih et al. 2012; Tsou and

Medicare overpayments to private plans, 1985-2012: shifting seniors to private plans has already cost Medicare US$282.6 billion.

PubMed

Hellander, Ida; Himmelstein, David U; Woolhandler, Steffie

2013-01-01

Previous research has documented Medicare overpayments to the private Medicare Advantage (MA) plans that compete with traditional fee-for-service Medicare. This research has assessed individual categories of overpayment for, at most, a few years. However, no study has calculated the total overpayments to private plans since the program's inception. Prior to 2004, selective enrollment of healthier seniors was the major source of excess payments. We estimate this has added US$41 billion to Medicare's costs since 1985. Medicare adopted a risk-adjustment scheme in 2004, but this has not curbed private plans' ability to game the payment system. This has added US$122.5 billion to Medicare's costs since 2004. Congress mandated increased payment to private plans in the 2003 Medicare Modernization Act, which was mitigated, to a degree, by the subsequent Affordable Care Act. In total, we find that Medicare has overpaid private insurers by US$282.6 billion since 1985. Risk adjustment does not work in for-profit MA plans, which have a financial incentive, the data, and the ingenuity to game whatever system Medicare devises. It is time to end Medicare's costly experiment with privatization. The U.S. needs to adopt a single-payer national health insurance program with effective methods for controlling costs.

Reported care giver strategies for improving drinking water for young children.

PubMed

McLennan, John D; Farrelly, Ashley

2010-11-01

Care givers may engage in a variety of strategies to try and improve drinking water for children. However, the pattern of these efforts is not well known, particularly for young children in high-risk situations. The objective of this study was to determine care giver-reported strategies for young children with (1) undernutrition and (2) living in an unplanned poor peri-urban community in the Dominican Republic. Practices reported by care givers of young children from a community and clinic group were extracted from interviews conducted between 2004 and 2008 (n = 563). These results were compared to two previous similar samples interviewed in 1997 (n = 341). Bottled water is currently the most prevalent reported strategy for improving drinking water for young children. Its use increased from 6% to 69% in the community samples over the last decade and from 13% to 79% in the clinic samples. Boiling water continues to be a common strategy, particularly for the youngest children, though its overall use has decreased over time. Household-level chlorination is infrequently used and has dropped over time. Care givers are increasingly turning to bottled water in an attempt to provide safe drinking water for their children. While this may represent a positive trend for protecting children from water-transmitted diseases, it may represent an inefficient approach to safe drinking water provision that may place a financial burden on low-income families.

Design and baseline characteristics from the KAN-QUIT disease management intervention for rural smokers in primary care.

PubMed

Cox, Lisa Sanderson; Cupertino, Ana-Paula; Mussulman, Laura M; Nazir, Niaman; Greiner, K Allen; Mahnken, Jonathan D; Ahluwalia, Jasjit S; Ellerbeck, Edward F

2008-08-01

To describe the design, implementation, baseline data, and feasibility of establishing a disease management program for smoking cessation in rural primary care. The study is a randomized clinical trial evaluating a disease management program for smoking cessation. The intervention combined pharmacotherapy, telephone counseling, and physician feedback, and repeated intervention over two years. The program began in 2004 and was implemented in 50 primary care clinics across the State of Kansas. Of eligible patients, 73% were interested in study participation. 750 enrolled participants were predominantly Caucasian, female, employed, and averaged 47.2 years of age (SD=13.1). In addition to smoking, 427 (57%) had at least one additional major risk factor for cardiovascular disease (diabetes, hypertension, high cholesterol, heart disease or stroke). Participants smoked on average 23.7 (SD=10.4) cigarettes per day, were contemplating (61%) or preparing to quit (30%), were highly motivated and confident of their ability to quit smoking, and reported seeing their physicians multiple times in the past twelve months (Median=3.50; Mean=5.48; SD=6.58). Initial findings demonstrate the willingness of patients to enroll in a two-year disease management program to address nicotine dependence, even among patients not ready to make a quit attempt. These findings support the feasibility of identifying and enrolling rural smokers within the primary care setting.

Design and Baseline Characteristics from the KAN-QUIT Disease Management Intervention for Rural Smokers in Primary Care

PubMed Central

Cox, Lisa Sanderson; Cupertino, Ana-Paula; Mussulman, Laura M.; Nazir, Niaman; Greiner, K. Allen; Mahnken, Jonathan D.; Ahluwalia, Jasjit S.; Ellerbeck, Edward F.

2008-01-01

Objective To describe the design, implementation, baseline data, and feasibility of establishing a disease management program for smoking cessation in rural primary care. Method The study is a randomized clinical trial evaluating a disease management program for smoking cessation. The intervention combined pharmacotherapy, telephone counseling, and physician feedback, and repeated intervention over two years. The program began in 2004 and was implemented in 50 primary care clinics across the State of Kansas. Results Of eligible patients, 73% were interested in study participation. 750 enrolled participants were predominantly Caucasian, female, employed, and averaged 47.2 years of age (SD=13.1). In addition to smoking, 427 (57%) had at least one additional major risk factor for cardiovascular disease (diabetes, hypertension, high cholesterol, heart disease or stroke). Participants smoked on average 23.7 (SD=10.4) cigarettes per day, were contemplating (61%) or preparing to quit (30%), were highly motivated and confident of their ability to quit smoking, and reported seeing their physicians multiple times in the past twelve months (Median=3.50; Mean=5.48; SD=6.58). Conclusion Initial findings demonstrate the willingness of patients to enroll in a two-year disease management program to address nicotine dependence, even among patients not ready to make a quit attempt. These findings support the feasibility of identifying and enrolling rural smokers within the primary care setting. PMID:18544464

Lipid increases in European eel (Anguilla anguilla) in Scotland 1986-2008: an assessment of physical parameters and the influence of organic pollutants.

PubMed

Oliver, Ian W; Macgregor, Kenneth; Godfrey, Jason D; Harris, Lynsay; Duguid, Alistair

2015-05-01

Recruitment of the European eel (Anguilla anguilla) has fallen steadily in recent decades, with current levels understood to be at around 5% of those in the 1970s, and the species is now widely recognised as being endangered. Changes in ocean currents, climate shifts, habitat loss, overfishing, barriers to migration, increased predation, plastic litter and exposure to chemicals have all been postulated as potential causative factors. Several studies have shown a general decline in eel quality (lower lipid content and body condition) over time that may be linked to reduced reproductive success. In this study, data from an eel sampling campaign in 1987 are compared with recent data (2004-2008) for eels in Scotland to assess any temporal changes in eel quality indicators and also to assess any links between current levels of chemical exposure and eel quality. Mean lipid levels, as a percentage of wet muscle mass, were higher in 2004-2008 (37 ± 1.9% SE) than in 1986 (21 ± 0.9% SE). By contrast, mean body condition index (K) was slightly lower in the latter period. Considering the 2004-2008 samples, significant inter-site variation was observed for condition index K, while intra-site variation was observed for lipid content and physical parameters relative to age (i.e. mass/age, length/age and lipid/age ratios); however, the variations observed could not be linked to differences in chemical body burdens, indicating that no chemical impacts on the parameters assessed are discernible during the continental life stage of eels in Scotland.

Mass Intrusion at Mount St. Helens (WA) From Temporal Gravity Variations

NASA Astrophysics Data System (ADS)

Battaglia, M.; Lisowski, M.; Dzurisin, D.; Poland, M. P.; Schilling, S. P.; Diefenbach, A. K.; Wynn, J.

2015-12-01

Repeated high-precision gravity measurements made at Mount St. Helens (WA) have revealed systematic temporal variations in the gravity field several years after the end of the 2004-2008 dome-building eruption. Changes in gravity with respect to a stable reference station 36 km NW of the volcano were measured at 10 sites on the volcanic edifice and at 4 sites far afield (10 to 36 km) from the summit in August 2010, August 2012 and August 2014. After simulating and removing the gravity signal associated with changes in mass of the crater glacier, the local hydrothermal aquifer, and vertical deformation, the residual gravity field observed at sites near the volcano's summit significantly increased with respect to the stable reference site during 2010-2012 (maximum change 48 ± 15 mgal). No significant change was measured during 2012-2014. The pattern of gravity increase is radially symmetrical, with a half-width of about 2.5 km and a point of maximum change centered at the 2004-2008 lava dome. Forward modeling of residual gravity data using the same source geometry, depth, and location as that inferred from geodetic data (a spheroidal source centered 7.5 km beneath the 2004-2008 dome) indicates a mass increase rate of the order of 1011 kg/year. For a reasonable magma density (~2250 kg/m3), the volume rate of magma intrusion beneath the summit region inferred from gravity (~ 0.1 km3/yr) greatly exceeds the volume inferred from inversion of geodetic data (0.001 km3/yr between 2008-2011), suggesting that either magma compressibility or other processes are important aspects of magma storage at Mount St. Helens, or that the data argue for a different source.

Research Based Science Education: An Exemplary Program for Broader Impacts

NASA Astrophysics Data System (ADS)

Walker, C. E.; Pompea, S. M.

2016-12-01

Broader impacts are most effective when standing on the shoulders of successful programs. The Research Based Science Education (RBSE) program was such a successful program and played a major role in activating effective opportunities beyond the scope of its program. NSF funded the National Optical Astronomy Observatory (NOAO) to oversee the project from 1996-2008. RBSE provided primarily high school teachers with on-site astronomy research experiences and their students with astronomy research projects that their teachers could explain with confidence. The goal of most student research projects is to inspire and motivate students to go into STEM fields. The authors of the original NSF proposal felt that for students to do research in the classroom, a foundational research experience for teachers must first be provided. The key components of the program consisted of 16 teachers/year on average; a 15-week distance learning course covering astronomy content, research, mentoring and leadership skills; a subsequent 10-day summer workshop with half the time on Kitt Peak on research-class telescopes; results presented on the 9th day; research brought back to the classroom; more on-site observing opportunities for students and teachers; data placed on-line to reach a wider audience; opportunities to submit research articles to the project's refereed journal; and travel for teachers (and the 3 teachers they each mentored) to a professional meeting. In 2004, leveraging on the well-established RBSE program, the NOAO/NASA Spitzer Space Telescope Research began. Between 2005 and 2008, metrics included 32 teachers (mostly from RBSE), 10 scientists, 15 Spitzer Director Discretionary proposals, 31 AAS presentations and many Intel ISEF winners. Under new funding in 2009, the NASA/IPAC Teacher Archive Research Program was born with similar goals and thankfully still runs today. Broader impacts, lessons learned and ideas for future projects will be discussed in this presentation.

Original research: New nurses: has the recession increased their commitment to their jobs?

PubMed

Brewer, Carol S; Kovner, Christine T; Yingrengreung, Siritorn; Djukic, Maja

2012-03-01

Current evidence suggests that the economic recession has induced retired RNs to reenter nursing and working nurses to work more hours and delay retirement, thus easing the projected RN shortage. We wondered whether the economic downturn had affected new nurses' work attitudes and behaviors, including those related to turnover. The purpose of this study was to compare perceptions about job opportunities, as well as key attitudinal variables (such as job satisfaction and intent to stay), in two cohorts of newly licensed RNs. Our data came from two sources: a subset of new RNs licensed between August 1, 2004, and July 31, 2005, who were part of a larger 2006 study on turnover, and a later cohort of new RNs licensed between August 1, 2007, and July 31, 2008. We mailed survey questionnaires to one cohort before the recession in 2006 and to a second cohort during the recession in 2009. We found that RNs' commitment to their current employers was higher in the later cohort than in the earlier one, although neither nurses' incomes nor their reported job satisfaction levels had changed. Our findings suggest that, despite some improvements in working conditions, newly licensed RNs may just be waiting for the recession to end before changing jobs. Health care organizations' efforts to improve RNs' working conditions and wages, and to implement or support existing programs aimed at increasing retention, should be continued.

Adult obesity management in primary care, 2008-2013.

PubMed

Fitzpatrick, Stephanie L; Stevens, Victor J

2017-06-01

In the U.S., the occurrence of weight counseling in primary care for patients with obesity decreased by 10% between 1995-1996 and 2007-2008. There have been several national recommendations and policies to improve obesity management since 2008. The purpose of this study was to examine the rates of body mass index (BMI) screening, obesity diagnosis, and weight management counseling in the U.S. from 2008 to 2013. The National Ambulatory Medical Care Survey visit-level data for adults 18 and over with a primary care visit during survey years 2008-2009, 2010-2011, and 2012-2013 was included in the analyses using SAS v9.3. Study outcomes included percent of visits with: BMI screening; obesity diagnosis; and weight counseling. We compared survey years on these outcomes using 2008-2009 as the reference as well as examined patient and practice-level predictors. Analyses were conducted from 2015 to early 2017. Of the total 55,608 adult primary care visits sampled, 14,143 visits (25%) were with patients with obesity. BMI screening significantly increased between 2008-2009 and 2012-2013 from 54% to 73% (OR=1.75, 95% CI 1.28-2.41); however, percent of visits with an obesity diagnosis remained low at <30%. Weight management counseling during visits significantly declined from 33% to 21% between 2008-2009 and 2012-2013 (OR=0.62, 95% CI 0.41-0.92). Despite emerging recommendations and policies, from 2008 to 2013, obesity management in primary care remained suboptimal. Identifying practical strategies to enforce policies and implement evidence-based behavioral treatment in primary care should be a high priority in healthcare reform. Copyright © 2017 Elsevier Inc. All rights reserved.

Health care of youth aging out of foster care.

PubMed

2012-12-01

Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.

Focus and coverage of Bolsa Família Program in the Pelotas 2004 birth cohort

PubMed Central

Schmidt, Kelen H; Labrecque, Jeremy; Santos, Iná S; Matijasevich, Alicia; Barros, Fernando C; Barros, Aluisio J D

2017-01-01

ABSTRACT OBJECTIVE To describe the focalization and coverage of Bolsa Família Program among the families of children who are part of the 2004 Pelotas birth cohort (2004 cohort). METHODS The data used derives from the integration of information from the 2004 cohort and the Cadastro Único para Programas Sociais do Governo Federal (CadÚnico – Register for Social Programs of the Federal Government), in the 2004-2010 period. We estimated the program coverage (percentage of eligible people who receive the benefit) and its focus (proportion of eligible people among the beneficiaries). We used two criteria to define eligibility: the per capita household income reported in the cohort follow-ups and belonging to the 20% poorest families according to the National Economic Indicator (IEN), an asset index. RESULTS Between 2004 and 2010, the proportion of families in the cohort that received the benefit increased from 11% to 34%. We observed an increase in all wealth quintiles. In 2010, by income and wealth quintiles (IEN), 62%-72% of the families were beneficiaries among the 20% poorest people, 2%-5% among the 20% richest people, and about 30% of families of the intermediate quintile. According to household income (minus the benefit) 29% of families were eligible in 2004 and 16% in 2010. By the same criteria, the coverage of the program increased from 43% in 2004 to 71% in 2010. In the same period, by the wealth criterion (IEN), coverage increased from 29% to 63%. The focalization of the program decreased from 78% in 2004 to 32% in 2010 according to income, and remained constant (37%) according to the IEN. CONCLUSIONS Among the families of the 2004 cohort, there was a significant increase in the program coverage, from its inception until 2010, when it was near 70%. The focus of the program was below 40% in 2010, indicating that more than half of the beneficiaries did not belong to the target population. PMID:28380211

Training and service in public health, Nigeria Field Epidemiology and Laboratory Training, 2008 - 2014.

PubMed

Nguku, Patrick; Oyemakinde, Akin; Sabitu, Kabir; Olayinka, Adebola; Ajayi, Ikeoluwapo; Fawole, Olufunmilayo; Babirye, Rebecca; Gitta, Sheba; Mukanga, David; Waziri, Ndadilnasiya; Gidado, Saheed; Biya, Oladayo; Gana, Chinyere; Ajumobi, Olufemi; Abubakar, Aisha; Sani-Gwarzo, Nasir; Ngobua, Samuel; Oleribe, Obinna; Poggensee, Gabriele; Nsubuga, Peter; Nyager, Joseph; Nasidi, Abdulsalami

2014-01-01

The health workforce is one of the key building blocks for strengthening health systems. There is an alarming shortage of curative and preventive health care workers in developing countries many of which are in Africa. Africa resultantly records appalling health indices as a consequence of endemic and emerging health issues that are exacerbated by a lack of a public health workforce. In low-income countries, efforts to build public health surveillance and response systems have stalled, due in part, to the lack of epidemiologists and well-trained laboratorians. To strengthen public health systems in Africa, especially for disease surveillance and response, a number of countries have adopted a competency-based approach of training - Field Epidemiology and Laboratory Training Program (FELTP). The Nigeria FELTP was established in October 2008 as an inservice training program in field epidemiology, veterinary epidemiology and public health laboratory epidemiology and management. The first cohort of NFELTP residents began their training on 20th October 2008 and completed their training in December 2010. The program was scaled up in 2011 and it admitted 39 residents in its third cohort. The program has admitted residents in six annual cohorts since its inception admitting a total of 207 residents as of 2014 covering all the States. In addition the program has trained 595 health care workers in short courses. Since its inception, the program has responded to 133 suspected outbreaks ranging from environmental related outbreaks, vaccine preventable diseases, water and food borne, zoonoses, (including suspected viral hemorrhagic fevers) as well as neglected tropical diseases. With its emphasis on one health approach of solving public health issues the program has recruited physicians, veterinarians and laboratorians to work jointly on human, animal and environmental health issues. Residents have worked to identify risk factors of disease at the human animal interface for influenza, brucellosis, tick-borne relapsing fever, rabies, leptospirosis and zoonotic helminthic infections. The program has been involved in polio eradication efforts through its National Stop Transmission of Polio (NSTOP). The commencement of NFELTP was a novel approach to building sustainable epidemiological capacity to strengthen public health systems especially surveillance and response systems in Nigeria. Training and capacity building efforts should be tied to specific system strengthening and not viewed as an end to them. The approach of linking training and service provision may be an innovative approach towards addressing the numerous health challenges.

The comparison of the performance of two screening strategies identifying newly-diagnosed HIV during pregnancy.

PubMed

Boer, Kees; Smit, Colette; van der Flier, Michiel; de Wolf, Frank

2011-10-01

In the Netherlands, a non-selective opt-out instead of a selective opt-in antenatal HIV screening strategy was implemented in 2004. In case of infection, screening was followed by prevention of mother-to-child-transmission (PMTCT). We compared the performance of the two strategies in terms of detection of new cases of HIV and vertical transmission. HIV-infected pregnant women were identified retrospectively from the Dutch HIV cohort ATHENA January 2000 to January 2008. Apart from demographic, virological and immunological data, the date of HIV infection in relation to the index pregnancy was established. Separately, all infants diagnosed with HIV born following implementation of the screening program were identified by a questionnaire via the paediatric HIV centres. 162/481 (33.7%) HIV-positive pregnant women were diagnosed with HIV before 2004 and 172/214 (80.3%) after January 2004. Multivariate analysis showed an 8-fold (95% confidence interval 5.47-11.87) increase in the odds of HIV detection during pregnancy after the national introduction of the opt-out strategy. Still, three children born during a 5-year period after July 2004 were infected due to de novo infection in pregnancy. Implementation of a nation-wide screening strategy based upon non-selective opt-out screening followed by effective PMTCT appeared to detect more HIV-infected women for the first time in pregnancy and to reduce vertical transmission of HIV substantially. Nonetheless, still few children are infected because of maternal infection after the first trimester. We propose the introduction of partner screening on HIV as part of the antenatal screening strategy.

Changes in Resident Well-Being at One Institution Across a Decade of Progressive Work Hours Limitations.

PubMed

Krug, Michael F; Golob, Anna L; Wander, Pandora L; Wipf, Joyce E

2017-10-01

To measure changes in markers of resident well-being over time as progressive work hours limitations (WHLs) were enforced, and to investigate resident perceptions of the 2011 WHLs. A survey study of internal medicine residents was conducted at the University of Washington's multihospital residency program in 2012. The survey included validated well-being questions: the Maslach Burnout Inventory, the two-question PRIME-MD depression screen, and career satisfaction questions. Chi-square tests were used to compare 2012 well-being questionnaire responses against nearly identical surveys conducted in 2001 and 2004 at the same institution. In addition, residents were asked to rate the impact of WHLs on resident well-being and education as well as patient care, and to state preferences for future WHLs. Significantly different proportions of residents met burnout criteria across time, with fewer meeting criteria in 2012 than in 2001 (2001: 76% [87/115]; 2004: 64% [75/118]; 2012: 61% [68/112]; P = .039). Depression screening results also differed across time, with fewer screening positive in 2012 than in 2004 (2001: 45% [52/115]; 2004: 55% [65/118]; 2012 [35/112]: 31%; P = .001). Residents, especially seniors, reported perceived negative impacts of WHLs on their well-being, education, and patient care. Most senior residents favored reverting to the pre-July 2011 system of WHLs. Interns were more divided. Validated measures of resident well-being changed across the three time points measured. Residents had the lowest rates of burnout and depression in 2012. Resident perceptions of the 2011 WHLs, however, were generally negative.

The flyby of Rosetta at asteroid Šteins - mission and science operations

NASA Astrophysics Data System (ADS)

Accomazzo, Andrea; Wirth, Kristin R.; Lodiot, Sylvain; Küppers, Michael; Schwehm, Gerhard

2010-07-01

The international Rosetta mission, a cornerstone mission of the european space agency scientific Programme, was launched on 2nd March 2004 on its 10 years journey towards a rendezvous with comet Churyumov-Gerasimenko ( Gardini et al., 1999). During its interplanetary flight towards its target Rosetta crosses the asteroid belt twice with the opportunity to observe at close quarters two asteroids: (2867)-Šteins in 2008 and (21)-Lutetia in 2010. The spacecraft design was such that these opportunities could be fully exploited to deliver valuable data to the scientific community. The mission trajectory was controlled such that Rosetta would fly next to asteroid Šteins on the 5th of September 2008 with a relative speed of 8.6 km/s at a minimum distance of 800 km. Mission operations have been carefully planned to achieve the best possible flyby scenario and scientific outcome. The flyby scenario, the optical navigation campaign, and the planning of the scientific observations had to be adapted by the Mission and the Science Operations Centres to the demanding requirements expressed by the scientific community. The flyby was conducted as planned with a large number of successful observations.

Use of a primary care database to determine trends in genital chlamydia testing, diagnostic episodes and management in UK general practice, 1990–2004

PubMed Central

Hughes, Gwenda; Williams, Tim; Simms, Ian; Mercer, Catherine; Fenton, Kevin; Cassell, Jackie

2007-01-01

Objective To determine the extent of testing, diagnostic episodes and management of genital Chlamydia trachomatis (CT) infection in UK primary care using a large primary care database. Methods The incidence of CT tests, diagnostic episodes, treatments and referrals was measured for all adult patients in the General Practice Research Database between 1990 and 2004. Results Rates of CT testing in those aged 12–64 years in 2004 increased to 1439/100 000 patient years (py) in women but only 74/100 000 py in men. Testing rates were highest among 20–24‐year‐old women (5.5% tested in 2004), followed by 25–34‐year‐old women (3.7% tested in 2004). 0.5% of registered 16–24‐year‐old women were diagnosed as having CT infection in 2004. Three‐quarters of patients with a recorded diagnosis of CT had had an appropriate prescription issued in 2004, a proportion that increased from 1990 along with a decrease in referrals to genitourinary medicine. In 2004, general practitioners treated 25.0% of all recorded diagnoses of CT in women and 5.1% of those in men. Conclusions Testing for and diagnostic episodes of CT in primary care have increased since 1990. Testing continues disproportionately to target women aged >24 years. Extremely low rates of testing in men, together with high positivity, demonstrate a missed opportunity for diagnosis of CT and contact tracing in general practice. PMID:17360731

Trends in characteristics of children served by the Children's Mental Health Initiative: 1994-2007.

PubMed

Walrath, Christine; Garraza, Lucas Godoy; Stephens, Robert; Azur, Melissa; Miech, Richard; Leaf, Philip

2009-11-01

Data from 14 years of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program were used to understand the trends of the emotional and behavioral problems and demographic characteristics of children entering services. The data for this study were derived from information collected at intake into service in 90 sites who received their initial federal funding between 1993 and 2004. The findings from this study suggest children entering services later in a site's funding cycle had lower levels of behavioral problems and children served in sites funded later in the 14 year period had higher levels of behavioral problems. Females have consistently entered services with more severe problems and children referred from non-mental health sources, younger children, and those from non-white racial/ethnic backgrounds have entered system of care services with less severe problems. The policy and programming implications, as well as implications for local system of care program development and implementation are discussed.

Health Services Utilization in Older Adults with Dementia Receiving Care Coordination: The MIND at Home Trial.

PubMed

Amjad, Halima; Wong, Stephanie K; Roth, David L; Huang, Jin; Willink, Amber; Black, Betty S; Johnston, Deirdre; Rabins, Peter V; Gitlin, Laura N; Lyketsos, Constantine G; Samus, Quincy M

2018-02-01

To investigate effects of a novel dementia care coordination program on health services utilization. A total of 303 community-dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008-2011). Single-blind RCT evaluating efficacy of an 18-month care coordination intervention delivered through community-based nonclinical care coordinators, supported by an interdisciplinary clinical team. Study partners reported acute care/inpatient, outpatient, and home- and community-based service utilization at baseline, 9, and 18 months. From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community-based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005). While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia-related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use. © Health Research and Educational Trust.

Integrated monitoring for environmental health impact assessment related to the genotoxic effects of vehicular pollution in Uberlândia, Brazil.

PubMed

Pereira, Boscolli Barbosa; da Cunha, Paolla Brandão; Silva, Guilherme Gomes; de Campos Júnior, Edimar Olegário; Morelli, Sandra; Filho, Cláudio Alves Vieira; de Lima, Euclides Antônio Pereira; Barrozo, Marcos Antônio Souza

2017-01-01

The development of parameters to explore the link between air-related diseases and their significant driving forces is an important aim in terms of national economics and public health. In this study, we did an integrated analysis involving multiple environmental health indicators from Uberlândia, Brazil, registered before and during a period when the Brazilian government reduced taxes on new cars in a bid to bolster local manufacturing. In addition, the present study utilized Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) frameworks to evaluate correlations in environmental health indicators over 10 years (2004-2013), in which the Brazilian government reduced vehicle production taxes beginning in 2008. Significant correlations in all indicators selected were found from 2008 to 2013, corresponding to the tax reduction on new vehicles. The frequency of micronuclei (MN) was significantly higher in the city center compared to the reference site, with the highest MN levels observed during the period of reduced taxes. Results reinforced the need to adopt air quality monitoring programs in major cities.

Association of a Proactive Swallowing Rehabilitation Program With Feeding Tube Placement in Patients Treated for Pharyngeal Cancer.

PubMed

Ajmani, Gaurav S; Nocon, Cheryl C; Brockstein, Bruce E; Campbell, Nicholas P; Kelly, Amy B; Allison, Jamie; Bhayani, Mihir K

2018-04-19

A proactive speech and language pathology (SLP) program is an important component of the multidisciplinary care of patients with head and neck squamous cell carcinoma (HNSCC). Swallowing rehabilitation can reduce the rate of feeding tube placement, thereby significantly improving quality of life. To evaluate the initiation of a proactive SLP rehabilitation program at a single institution and its association with rates of feeding tube placement and dietary intake in patients with HNSCC. Cohort study at a tertiary care and referral center for patients with HNSCC serving the northern Chicago region. Patients were treated for squamous cell carcinomas of the hypopharynx, oropharynx, and nasopharynx from 2004 to 2015 with radiation or chemoradiation therapy in the definitive or adjuvant setting. Patients who received less than 5000 cGy radiation or underwent reirradiation were excluded. A proactive SLP program for patients with HNSCC was initiated in 2011. Study cohorts were divided into 2 groups: 2004 through 2010 and 2011 through 2015. Primary outcome variables were SLP referral placement and timing of the referral. Secondary outcomes were feeding tube placement and ability to tolerate any oral intake. A total of 254 patients met inclusion criteria (135 before and 119 after implementation of SLP program; median age, 60 years [range, 14-94 years]; 77% male). With the initiation of a proactive SLP program, pretreatment evaluations increased from 29 (21.5%) to 70 (58.8%; risk ratio [RR], 2.74; 95% CI, 1.92-3.91), and rate of referral overall at any time increased from 60.0% to 79.8% (RR, 1.33; 95% CI, 1.13-1.57). Feeding tube placement rates decreased from 45.9% (n = 62) to 29.4% (n = 35; RR, 0.64; 95% CI, 0.46-0.89). Among patients receiving a swallow evaluation, feeding tube requirements were less frequent for those receiving a pretreatment evaluation (31 of 99 [31%]) than for those referred during (11 of 18 [61%]) or after (38 of 59 [64%]) treatment. The rate of tolerating any oral intake at the end of treatment improved from 71.1% (n = 96) in the preimplementation period to 82.4% (n = 98; RR, 1.16; 95% CI, 1.01-1.33). A proactive SLP program can be successfully established as part of the multidisciplinary care of patients with HNSCC and improve patient quality of life.

Continuing education for primary health care nurse practitioners in Ontario, Canada.

PubMed

Baxter, Pamela; DiCenso, Alba; Donald, Faith; Martin-Misener, Ruth; Opsteen, Joanne; Chambers, Tracey

2013-04-01

The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated. Copyright © 2012 Elsevier Ltd. All rights reserved.

The WHO collaborating centre for public health palliative care programs: an innovative approach of palliative care development.

PubMed

Ela, Sara; Espinosa, Jose; Martínez-Muñoz, Marisa; Lasmarías, Cristina; Beas, Elba; Mateo-Ortega, Dolors; Novellas, Anna; Gómez-Batiste, Xavier

2014-04-01

The designation of the Catalan Institute of Oncology (Barcelona, Spain) as World Health Organization (WHO) Collaborating Centre for Public Health Palliative Care Programmes (WHOCC-ICO) in February 2008 turns the institution into the first ever center of international reference in regards to palliative care implementation from a public health perspective. The center aims to provide support to countries willing to develop palliative care programs, to identify models of success, to support WHO's policies, and to generate and spread evidence on palliative care. This article describes the WHOCC-ICO's contribution in the implementation of public health palliative care programs and services. The center's main features and future actions are emphasized. At the end of the initial four-year designation period, the organization evaluates the task done to reach its objectives. Such global assessment would take forward the quality of the institution, and generate a revision of its terms of reference for the next designation period. Based on new evidence, the center has recently decided to expand its scope by adopting a community-wide chronic care approach which moves beyond cancer and focuses on the early identification of patients with any chronic disease in need of palliative care. Moreover, the center advocates the development of comprehensive models of care that address patients' psychosocial needs. This center's new work plan includes additional significant innovations, such as the startup of the first chair of palliative care in Spain. Such a whole new approach responds to the main challenges of current palliative care.

Petrogenetic grids for sapphirine-bearing granulites

NASA Astrophysics Data System (ADS)

Podlesskii, Konstantin K.

2010-05-01

Phase relations involving sapphirine, garnet, spinel, orthopyroxene, olivine, cordierite, alumina silicates, corundum, and quartz have been calculated in the system FeO-MgO-Al2O3-SiO2 based on internally consitent thermodynamic properties of both the end-member minerals and the solid solutions (Gerya et al., 2004; Podlesskii et al., 2008). The derived P-T diagrams imply stable invariant points and stability fields of key assemblages that differ from those proposed by other authors (Kelsey et al., 2004; Harley 2008). The sapphirine + quartz assemblage, which is widely recognized as indicative of ultrahigh-temperature metamorphism, can be stable down to 835° C and ~6 kbar. The sapphirine + kyanite assemblage has been found stable at temperatures below 860° C and 11.3 kbar, whereas the sapphirine + forsterite assemblage may be stable below 800° C only under specific conditions of a very low activity of water. The existing constraints on the thermodynamic properties of sapphirine are considered insufficient to make decisive conclusions about metamorphic conditions. Granulites containing the sapphirine + quartz assemblage have been investigated with the microprobe to apply both the conventional thermobarometry and thermometry based on Ti contents of quartz (TitaniQ, Wark & Watson, 2006). The results demonstrate that, in some cases, this assemblage might have formed at relatively low temperatures during retrograde stages of metamorphism. The research has been supported by the RFBR grant 09-05-00193. References Gerya,T.V., Perchuk,L.L., & Podlesskii,K.K. In: Zharikov,V.A. & Fed'kin,V.V. (eds.) Experimental Mineralogy: Some Results on the Century's Frontier. Moscow: Nauka, Vol. 2, 188-206 (2004). Harley,S.L. Refining the P-T records of UHT crustal metamorphism. Journal of Metamorphic Geology, 26, 125-154 (2008). Kelsey,D.E., White,R.W., Holland,T.J.B., & Powell,R. Journal of Metamorphic Geology, 22, 559-578 (2004). Podlesskii,K.K., Aranovich,L.Y., Gerya,T.V., & Kosyakova,N.A. Sapphirine-bearing assemblages in the system MgO-Al2O3-SiO2: A continuing ambiguity. European Journal of Mineralogy, 20, 721-734 (2008). Wark,D.A. & Watson,E.B. TitaniQ: a titanium-in-quartz geothermometer. Contributions to Mineralogy and Petrology, 152, 743-754 (2006).

Molecular evolution of H5N1 in Thailand between 2004 and 2008.

PubMed

Suwannakarn, Kamol; Amonsin, Alongkorn; Sasipreeyajan, Jiroj; Kitikoon, Pravina; Tantilertcharoen, Rachod; Parchariyanon, Sujira; Chaisingh, Arunee; Nuansrichay, Bandit; Songserm, Thaweesak; Theamboonlers, Apiradee; Poovorawan, Yong

2009-09-01

Highly pathogenic avian influenza (HPAI) H5N1 viruses have seriously affected the Asian poultry industry since their occurrence in 2004. Thailand has been one of those countries exposed to HPAI H5N1 outbreaks. This project was designed to compare the molecular evolution of HPAI H5N1 in Thailand between 2004 and 2008. Viruses with clade 1 hemagglutinin (HA) were first observed in early 2004 and persisted until 2008. Viruses with clade 2.3.4 HA were first observed in the northeastern region of Thailand between 2006 and 2007. Phylogenetic analysis among Thai isolates indicated that clade 1 viruses in Thailand consist of three distinct lineages: CUK2-like, PC168-like, and PC170-like viruses. The CUK2-like virus represents the predominant lineage and has been circulating throughout the course of the 4-year outbreaks. Analysis of recently isolated viruses has shown that the genetic distance was slightly different from viruses of the early outbreak and that CUK2-like viruses comprise the native strain. Between 2005 and 2007, PC168-like and PC170-like viruses were first observed in several areas around central and lower northern Thailand. In 2008, viruses reassorted from these two lineages, PC168-like and PC170-like viruses, were initially isolated in the lower northern provinces of Thailand and subsequently spread to the upper central part of Thailand. On the other hand, CUK2-like viruses were still detected around the lower northern and the upper central part of Thailand. Furthermore, upon emergence of the reassorted viruses, the PC168-like and PC170-like lineages could not be detected, suggesting that the only predominant strains still circulating in Thailand were CUK2-like and reassorted viruses. The substitution rate among clade 1 viruses in Thailand was lower. The virus being limited to the same area might explain the lower nucleotide substitution rate. This study has demonstrated that nationwide attempts to monitor the virus may help curb access and propagation of new HPAI viral genes.

Managing respiratory care services.

PubMed

Thalman, Janice J

2004-06-01

Managing in a health care environment is not for the frail of heart or weak of spirit. Health care is a system in crisis that is exacerbated because it got there by doing what once made it successful. From 1900 to 2004, focus of health care has shifted from controlling infectious diseases to episodic care and to present-day chronic and perspective care. The system has moved from issues of mortality, to morbidity, to mobility, to quality of life, to feeling good and, finally, to looking good. Managing the delivery of health care, if you choose to accept it, is not an impossible mission, but it will be a challenging job. Obviously, the focus of managers is how the system can be designed to innovate and improve care. Organizations and professions must change not only structures and processes, but national priorities for improvement with better methods of disseminating and applying knowledge. Managers of respiratory care departments must foster the use of information technology in clinical care, must create payment policies that encourage innovation and tested performance, and must enhance education programs to strengthen and retain the health care work forces.

Utilization of telemedicine in the U.S. military in a deployed setting.

PubMed

Hwang, Jane S; Lappan, Charles M; Sperling, Leonard C; Meyerle, Jon H

2014-11-01

A retrospective evaluation of the Department of Defense teledermatology consultation program from 2004 to 2012 was performed, focusing on clinical application and outcome measures such as consult volume, response time, and medical evacuation status. A retrospective review of the teledermatology program between 2004 and 2012 was evaluated based on defined outcome measures. In addition, 658 teledermatology cases were reviewed to assess how the program was utilized by health care providers from 2011 to 2012. As high as 98% of the teledermatology consults were answered within 24 hours, and 23% of consults within 1 hour. The most common final diagnoses included eczematous dermatitis, contact dermatitis, and evaluation for nonmelanoma skin cancer. The most common medications recommended included topical corticosteroids, oral antibiotics, antihistamines, and emollients. Biopsy was most commonly recommended for further evaluation. Following teleconsultation, 46 dermatologic evacuations were "avoided" as the patient was not evacuated based on the consultants' recommendation. Consultants' recommendations to the referring provider "facilitated" 41 evacuations. Telemedicine in the U.S. military has provided valuable dermatology support to providers in remote locations by delivering appropriate and timely consultation for military service members and coalition partners. In addition to avoiding unnecessary medical evacuations, the program facilitated appropriate evacuations that may otherwise have been delayed. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Does hospital competition harm equity? Evidence from the English National Health Service.

PubMed

Cookson, Richard; Laudicella, Mauro; Li Donni, Paolo

2013-03-01

Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the English National Health Service progressively introduced from 2004 to 2006. We use a panel of 32,482 English small areas followed from 2003 to 2008 and a difference in differences approach. The effect of competition on equity is identified by the interaction between market structure, small area income deprivation and year. We find a negative association between market competition and elective admissions in deprived areas. The effect of pro-competition reform was to reduce this negative association slightly, suggesting that competition did not undermine equity. Copyright © 2012 Elsevier B.V. All rights reserved.

Relating Agulhas Leakage to the Agulhas Current Retroflection Location

DTIC Science & Technology

2009-11-03

branch return flow of the Atlantic meridional overturning circulation (Gordon, 1986; Weijer et al., 1999; Peeters et al., 2004; Biastoch et al., 2008a...demonstrated that the mesoscale dynamics reflected in the decadal variability of the Atlantic meridional overturning circulation (Biastoch et al...Lutjeharms, J. R. E.: Agulhas leakage dynamics affects decadal variability in Atlantic overturn - ing circulation , Nature, 456, 489–492, 2008a. Biastoch, A

Emergency Department Visits for Drug-Related Suicide Attempts Involving Antidepressants by Adolescents and Young Adults: 2004 to 2008. The DAWN Report

ERIC Educational Resources Information Center

Substance Abuse and Mental Health Services Administration, 2011

2011-01-01

In 2008, adolescents made 23,124 visits to the emergency department (ED) for drug-related suicide attempts, and young adults made 38,036 such visits; of these visits, 23.0 percent (5,312 visits) among adolescents and 17.6 percent (6,700 visits) among young adults involved antidepressants. Among ED visits for suicide attempts involving…

Are We Approaching the Real Defeat of the FARC in Colombia

DTIC Science & Technology

2009-03-01

Democracia Asediada, Balance y perspectivas del conflicto armado en Colombia. (Bogota, Grupo Editorial Norma 2004). 64 46 Fundacion Seguridad y Democracia ...the armed forces in false accusations, and defending the rebels captured. 35 Eduardo Pizarro Leon gomez, “Una Democracia Asediada”: balance y...Colombia, la seguridad y la defense de las fronteras. (Bogota, November 2008),19. 47 Alfredo Rangel, Un vecindario inseguro , (Semana, November 13, 2008

Deeply discounted medications: Implications of generic prescription drug wars.

PubMed

Czechowski, Jessica L; Tjia, Jennifer; Triller, Darren M

2010-01-01

To describe the history of generic prescription pricing programs at major pharmacy chains and their potential implications on prescribing, quality of care, and patient safety. Publicly available generic prescription discount program drug lists as of May 1, 2009. Fierce competition among major pharmacy chains such as Walgreens, CVS, and Walmart has led to a generic prescription pricing war with unclear public health implications. Introduced in 2006, currently 7 of the 10 largest pharmacy chains advertise a version of a deeply discounted medication (DDM) program, accounting for more than 25,000 locations nationally. By early 2008, almost 70 million Americans had used these programs. Although DDM programs lower drug costs for many patients, DDM formularies include potentially ineffective or harmful medications, have the potential to influence physician prescribing behavior, and may impair pharmacists' ability to review complete drug-dispensing records. DDMs are widespread but have the potential for unintended consequences on patients, providers, and the health care system. A systematic review of DDMs needs to evaluate the clinical, economic, and system-level implications of such programs.

MHS Stakeholder’s Report

DTIC Science & Technology

2011-01-01

sedentary lifestyle, alcohol abuse and family violence reduce well-being and readiness. The MHS strives to engage with all beneficiaries and enable them... Obstetric Surgical 2006 2007 2008 2009 2006 2007 2008 2009 2006 2007 2008 2009 Satisfaction with Inpatient Care (Overall Hospital Rating) Direct...Patients receiving obstetrical care at TRICARE network hospitals report higher satisfaction with health care. Patients enrolled to TRICARE network

An integrated comprehensive occupational surveillance system for health care workers.

PubMed

Dement, John M; Pompeii, Lisa A; Østbye, Truls; Epling, Carol; Lipscomb, Hester J; James, Tamara; Jacobs, Michael J; Jackson, George; Thomann, Wayne

2004-06-01

Workers in the health care industry may be exposed to a variety of work-related stressors including infectious, chemical, and physical agents; ergonomic hazards; psychological hazards; and workplace violence. Many of these hazards lack surveillance systems to evaluate exposures and health outcomes. The development and implementation of a comprehensive surveillance system within the Duke University Health System (DUHS) that tracks occupational exposures and stressors as well as injuries and illnesses among a defined population of health care workers (HCWs) is presented. Human resources job and work location data were used to define the DUHS population at risk. Outcomes and exposure data from existing occupational health and safety programs, health promotion programs, and employee health insurance claims, were linked with human resources data and de-identified to create the Duke Health and Safety Surveillance System (DHSSS). The surveillance system is described and four examples are presented demonstrating how the system has successfully been used to study consequences of work-related stress, hearing conservation program evaluation, risk factors for back pain and inflammation, and exposures to blood and body fluids (BBF). Utilization of existing data, often collected for other purposes, can be successfully integrated and used for occupational health surveillance monitoring of HCWs. Use of the DHSSS for etiologic studies, benchmarking, and intervention program evaluation are discussed. Copyright 2004 Wiley-Liss, Inc.

Community pediatric hospitalists providing care in the emergency department: an analysis of physician productivity and financial performance.

PubMed

Dudas, Robert A; Monroe, David; McColligan Borger, Melissa

2011-11-01

Community hospital pediatric inpatient programs are being threatened by current financial and demographic trends. We describe a model of care and report on the financial implications associated with combining emergency department (ED) and inpatient care of pediatric patients. We determine whether this type of model could generate sufficient revenue to support physician salaries for continuous in-house coverage in community hospitals. Financial productivity and selected performance indicators were obtained from a retrospective review of registration and billing records. Data were obtained from 2 community-based pediatric hospitalist programs, which are part of a single health system and included care delivered in the ED and inpatient settings during a 1-year period from July 1, 2008, to July 1, 2009. Together, the combined programs were able to generate 6079 total relative value units and collections of $244,828 annually per full-time equivalent (FTE). Salary, benefits, and practice expenses totaled $235,674 per FTE. Thus, combined daily revenues exceeded expenses and provided 104% of physician salary, benefits, and practice expenses. However, 1 program generated a net profit of $329,715 ($40,706 per FTE), whereas the other recorded a loss of $207,969 ($39,994 per FTE). Emergency department throughput times and left-without-being-seen rates at both programs were comparable to national benchmarks. Incorporating ED care into a pediatric hospitalist program can be an effective strategy to maintain the financial viability of pediatric services at community hospitals with low inpatient volumes that seek to provide 24-hour pediatric staffing.