Science.gov

Sample records for societal health quality

  1. Societal health and urban sustainability indicators

    SciTech Connect

    Petrich, C.H.; Tonn, B.E.

    1996-08-27

    Without the social will, no city can successfully Undertake the planning and programs necessary for meaningful progress toward sustainability. Social will derives from wellsprings of vital societal health. This paper presents an approach to helping cities in APEC member economies initiate a program for developing indicators of sustainability. Representative indicators of social capital and other aspects of civic engagement, as proxies for societal health, are presented.

  2. Evaluating landscape health: Integrating societal goals and biophysical process

    USGS Publications Warehouse

    Rapport, D.J.; Gaudet, C.; Karr, J.R.; Baron, J. S.; Bohlen, C.; Jackson, W.; Jones, B.; Naiman, R.J.; Norton, B.; Pollock, M. M.

    1998-01-01

    Evaluating landscape change requires the integration of the social and natural sciences. The social sciences contribute to articulating societal values that govern landscape change, while the natural sciences contribute to understanding the biophysical processes that are influenced by human activity and result in ecological change. Building upon Aldo Leopold's criteria for landscape health, the roles of societal values and biophysical processes in shaping the landscape are explored. A framework is developed for indicators of landscape health and integrity. Indicators of integrity are useful in measuring biological condition relative to the condition in landscapes largely unaffected by human activity, while indicators of health are useful in evaluating changes in highly modified landscapes. Integrating societal goals and biophysical processes requires identification of ecological services to be sustained within a given landscape. It also requires the proper choice of temporal and spatial scales. Societal values are based upon inter-generational concerns at regional scales (e.g. soil and ground water quality). Assessing the health and integrity of the environment at the landscape scale over a period of decades best integrates societal values with underlying biophysical processes. These principles are illustrated in two contrasting case studies: (1) the South Platte River study demonstrates the role of complex biophysical processes acting at a distance; and (2) the Kissimmee River study illustrates the critical importance of social, cultural and economic concerns in the design of remedial action plans. In both studies, however, interactions between the social and the biophysical governed the landscape outcomes. The legacy of evolution and the legacy of culture requires integration for the purpose of effectively coping with environmental change.

  3. Societal output and use of research performed by health research groups

    PubMed Central

    2010-01-01

    The last decade has seen the evaluation of health research pay more and more attention to societal use and benefits of research in addition to scientific quality, both in qualitative and quantitative ways. This paper elaborates primarily on a quantitative approach to assess societal output and use of research performed by health research groups (societal quality of research). For this reason, one of the Dutch university medical centres (i.e. the Leiden University Medical Center (LUMC)) was chosen as the subject of a pilot study, because of its mission to integrate top patient care with medical, biomedical and healthcare research and education. All research departments were used as units of evaluation within this university medical centre. The method consisted of a four-step process to reach a societal quality score per department, based on its (research) outreach to relevant societal stakeholders (the general public, healthcare professionals and the private sector). For each of these three types of stakeholders, indicators within four modes of communication were defined (knowledge production, knowledge exchange, knowledge use and earning capacity). These indicators were measured by a bottom-up approach in a qualitative way (i.e. all departments of the LUMC were asked to list all activities they would consider to be of societal relevance), after which they were converted into quantitative scores. These quantitative scores could then be compared to standardised scientific quality scores that are based on scientific publications and citations of peer-reviewed articles. Based on the LUMC pilot study, only a weak correlation was found between societal and scientific quality. This suggests that societal quality needs additional activities to be performed by health research groups and is not simply the consequence of high scientific quality. Therefore we conclude that scientific and societal evaluation should be considered to be synergistic in terms of learning for the

  4. Societal Influences on Health and Life-styles

    PubMed Central

    Ulmer, David D.

    1984-01-01

    Strong sociocultural forces affect individual attitudes toward health and choice of life-style. Economic deprivation fosters negative health behaviors. Positive health habits are reinforced by discrete societal groups. The news media, particularly television, disseminate much useful health information, though the overall educational value is diminished by the content of commercial messages and programming. The automobile is a major societal influence, but neither individual drivers nor the car manufacturers give enough priority to highway safety, leaving that role to governmental regulation. American industry is becoming a positive influence in the encouragement of good health habits, and fashion is lately an important ally in personal health maintenance. PMID:6523860

  5. Differences Between Individual and Societal Health State Valuations

    PubMed Central

    Chapman, Benjamin P.; Franks, Peter; Duberstein, Paul R.; Jerant, Anthony

    2009-01-01

    Objective The concept of “adaptation” has been proposed to account for differences between individual and societal valuations of specific health states in patients with chronic diseases. Little is known about psychological indices of adaptational capacity, which may predict differences in individual and societal valuations of health states. We investigated whether such differences were partially explained by personality traits in chronic disease patients. Research Design Analysis of baseline data of randomized controlled trial. Subjects Three hundred seventy patients with chronic disease. Measures The NEO-five factor inventory measure of personality, EuroQoL-5D (EQ-5D) societal-based, and the EQ visual analogue scale individually-based measures of health valuation. Results Regression analyses modeled Dev, a measure of difference between the EQ-Visual Analogue Scale and EQ-5D, as a function of personality traits, sociodemographic factors, and chronic diseases. Individual valuations were significantly and clinically higher than societal valuations among patients in the second and third quartile of conscientiousness (Dev = 0.08, P = 0.01); among covariates, only depression (Dev = -0.04, P = 0.046) was also associated with Dev. Conclusion Compared with societal valuations of a given health state, persons at higher quartiles of conscientiousness report less disutility associated with poor health. The effect is roughly twice that of some estimates of minimally important clinical differences on the EQ-5D and of depression. Although useful at the aggregate level, societal preference measures may systematically undervalue the health states of more conscientious individuals. Future work should examine the impact this has on individual patient outcome evaluation in clinical studies. PMID:19543121

  6. Air quality management using modern remote sensing and spatial technologies and associated societal costs.

    PubMed

    Uddin, Waheed

    2006-09-01

    This paper presents a study of societal costs related to public health due to the degradation of air quality and the lack of physical activity, both affected by our built environment. The paper further shows road safety as another public health concern. Traffic fatalities are the number one cause of death in the world. Traffic accidents result in huge financial loss to the people involved and the related public health cost is a significant part of the total societal cost. Motor vehicle exhausts and industrial emissions, gasoline vapors, and chemical solvents as well as natural sources emit nitrogen oxides and volatile organic compounds, which are precursors to the formation of ground-level Ozone. High concentration values of ground-level Ozone in hot summer days produce smog and lead to respiratory problems and loss in worker's productivity. These factors and associated economic costs to society are important in establishing public policy and decision-making for sustainable transportation and development of communities in both industrialized and developing countries. This paper presents new science models for predicting ground-level Ozone and related air quality degradation. The models include predictor variables of daily climatological data, traffic volume and mix, speed, aviation data, and emission inventory of point sources. These models have been implemented in the user friendly AQMAN computer program and used for a case study in Northern Mississippi. Lifecycle benefits from reduced societal costs can be used to implement sustainable transportation policies, enhance investment decision-making, and protect public health and the environment.

  7. Air Quality Management Using Modern Remote Sensing and Spatial Technologies and Associated Societal Costs

    PubMed Central

    Uddin, Waheed

    2006-01-01

    This paper presents a study of societal costs related to public health due to the degradation of air quality and the lack of physical activity, both affected by our built environment. The paper further shows road safety as another public health concern. Traffic fatalities are the number one cause of death in the world. Traffic accidents result in huge financial loss to the people involved and the related public health cost is a significant part of the total societal cost. Motor vehicle exhausts and industrial emissions, gasoline vapors, and chemical solvents as well as natural sources emit nitrogen oxides and volatile organic compounds, which are precursors to the formation of ground-level Ozone. High concentration values of ground-level Ozone in hot summer days produce smog and lead to respiratory problems and loss in worker’s productivity. These factors and associated economic costs to society are important in establishing public policy and decision-making for sustainable transportation and development of communities in both industrialized and developing countries. This paper presents new science models for predicting ground-level Ozone and related air quality degradation. The models include predictor variables of daily climatological data, traffic volume and mix, speed, aviation data, and emission inventory of point sources. These models have been implemented in the user friendly AQMAN computer program and used for a case study in Northern Mississippi. Life-cycle benefits from reduced societal costs can be used to implement sustainable transportation policies, enhance investment decision-making, and protect public health and the environment. PMID:16968969

  8. Research and Evaluations of the Health Aspects of Disasters, Part IV: Framework for Societal Structures: the Societal Systems.

    PubMed

    Birnbaum, Marvin L; Daily, Elaine K; O'Rourke, Ann P

    2015-12-01

    For the purposes of research and/or evaluation, a community/society is organized into 13 Societal Systems under the umbrella of an overall Coordination and Control System. This organization facilitates descriptions of a community/society or a component of a community for assessment at any designated time across the Temporal Phases of a disaster. Such assessments provide a picture of the functional status of one or more Systems that comprise a community. Since no system operates in isolation from the other systems, information of the concomitant status of several Societal Systems is crucial to gaining a complete understanding of compromised functions, as well as the effects and side effects of any intervention directed at restoring the functional state of the affected community or risk-reduction interventions of a community-at-risk. The 13 Societal Systems include: (1) Public Health; (2) Medical Care; (3) Water and Sanitation; (4) Shelter and Clothing; (5) Food and Nutrition; (6) Energy Supply; (7) Public Works and Engineering; (8) Social Structures; (9) Logistics and Transportation; (10) Security; (11) Communications; (12) Economy; and (13) Education. Many functions and sub-functions of the Systems overlap, or share some common sub-functions with other systems. For the purposes of research/evaluation, it is necessary to assign functions and sub-functions to only one of the Societal Systems.

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

    PubMed

    Raphael, Dennis

    2003-12-01

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

  10. The role of government in health care: a societal issue.

    PubMed

    DeBakey, Michael E

    2006-02-01

    The history of the role of government in health care is briefly reviewed and more fully discussed in the United States since the establishment of Medicare 40 years ago. Data and other evidence of the unintended consequences of this historic event are presented, identifying thorny and onerous issues that government has created, showing failed attempts at band-aid solutions, and suggesting that our present health care system is in disarray and cannot be rectified by the "incrementalism" approach. The establishment of a high-level commission jointly endorsed by the President of the United States and Congress is recommended to consider and analyze scrupulously all the components of our health care complex and provide a "roadmap" toward achieving a universal health care system that is culturally acceptable, affordable, and of optimal quality while avoiding its administration and total control by an ultimately rigid and unwieldy governmental or insurance-industry bureaucracy.

  11. Passenger aircraft cabin air quality: trends, effects, societal costs, proposals.

    PubMed

    Hocking, M B

    2000-08-01

    As aircraft operators have sought to substantially reduce propulsion fuel cost by flying at higher altitudes, the energy cost of providing adequate outside air for ventilation has increased. This has lead to a significant decrease in the amount of outside air provided to the passenger cabin, partly compensated for by recirculation of filtered cabin air. The purpose of this review paper is to assemble the available measured air quality data and some calculated estimates of the air quality for aircraft passenger cabins to highlight the trend of the last 25 years. The influence of filter efficiencies on air quality, and a few medically documented and anecdotal cases of illness transmission aboard aircraft are discussed. Cost information has been collected from the perspective of both the airlines and passengers. Suggestions for air quality improvement are given which should help to result in a net, multistakeholder savings and improved passenger comfort.

  12. Good governance and good health: The role of societal structures in the human immunodeficiency virus pandemic.

    PubMed

    Menon-Johansson, Anatole S

    2005-04-25

    BACKGROUND: Only governments sensitive to the demands of their citizens appropriately respond to needs of their nation. Based on Professor Amartya Sen's analysis of the link between famine and democracy, the following null hypothesis was tested: "Human Immunodeficiency Virus (HIV) prevalence is not associated with governance". METHODS: Governance has been divided by a recent World Bank paper into six dimensions. These include Voice and Accountability, Political Stability and Absence of Violence, Government Effectiveness, Regulatory Quality, Rule of Law and the Control of Corruption. The 2002 adult HIV prevalence estimates were obtained from UNAIDS. Additional health and economic variables were collected from multiple sources to illustrate the development needs of countries. RESULTS: The null hypothesis was rejected for each dimension of governance for all 149 countries with UNAIDS HIV prevalence estimates. When these nations were divided into three groups, the median (range) HIV prevalence estimates remained constant at 0.7% (0.05 - 33.7%) and 0.75% (0.05% - 33.4%) for the lower and middle mean governance groups respectively despite improvements in other health and economic indices. The median HIV prevalence estimates in the higher mean governance group was 0.2% (0.05 - 38.8%). CONCLUSION: HIV prevalence is significantly associated with poor governance. International public health programs need to address societal structures in order to create strong foundations upon which effective healthcare interventions can be implemented.

  13. Health and societal effects from exposure to fragranced consumer products.

    PubMed

    Steinemann, Anne

    2017-03-01

    Fragranced consumer products-such as air fresheners, cleaning supplies, and personal care products- pervade society. This study investigated the occurrence and types of adverse effects associated with exposure to fragranced products in Australia, and opportunities for prevention. Data were collected in June 2016 using an on-line survey with a representative national sample (n = 1098). Overall, 33% of Australians report health problems, such as migraine headaches and asthma attacks, when exposed to fragranced products. Of these health effects, more than half (17.1%) could be considered disabling under the Australian Disability Discrimination Act. Additionally, 7.7% of Australians have lost workdays or a job due to illness from fragranced product exposure in the workplace, 16.4% reported health problems when exposed to air fresheners or deodorizers, 15.3% from being in a room after it was cleaned with scented products, and 16.7% would enter but then leave a business as quickly as possible due to fragranced products. About twice as many respondents would prefer that workplaces, health care facilities and professionals, hotels, and airplanes were fragrance-free rather than fragranced. While 73.7% were not aware that fragranced products, even ones called green and organic, emitted hazardous air pollutants, 56.3% would not continue to use a product if they knew it did. This is the first study in Australia to assess the extent of adverse effects associated with exposure to common fragranced products. It provides compelling evidence for the importance and value of reducing fragranced product exposure in order to reduce and prevent adverse health effects and costs.

  14. SOCIETAL PERSPECTIVE ON COST DRIVERS FOR HEALTH TECHNOLOGY ASSESSMENT IN SINDH, PAKISTAN.

    PubMed

    Khowaja, Asif Raza; Mitton, Craig; Qureshi, Rahat; Bryan, Stirling; Magee, Laura A; von Dadelszen, Peter; Bhutta, Zulfiqar A

    2017-01-01

    Understanding cost-drivers and estimating societal costs are important challenges for economic evaluation of health technologies in low- and middle-income countries (LMICs). This study assessed community experiences of health resource usage and perceived cost-drivers from a societal perspective to inform the design of an economic model for the Community Level Interventions for Pre-eclampsia (CLIP) trials. Qualitative research was undertaken alongside the CLIP trial in two districts of Sindh province, Pakistan. Nine focus groups were conducted with a wide range of stakeholders, including pregnant women, mothers-in-law, husbands, fathers-in-law, healthcare providers at community and health facility-levels, and health decision/policy makers at district-level. The societal perspective included out-of-pocket (OOP), health system, and program implementation costs related to CLIP. Thematic analysis was performed using NVivo software. Most pregnant women and male decision makers reported a large burden of OOP costs for in- and out-patient care, informal care from traditional healers, self-medication, childbirth, newborn care, transport to health facility, and missed wages by caretakers. Many healthcare providers identified health system costs associated with human resources for hypertension risk assessment, transport, and communication about patient referrals. Health decision/policy makers recognized program implementation costs (such as the mobile health infrastructure, staff training, and monitoring/supervision) as major investments for the health system. Our investigation of care-seeking practices revealed financial implications for families of pregnant women, and program implementation costs for the health system. The societal perspective provided comprehensive knowledge of cost drivers to guide an economic appraisal of the CLIP trial in Sindh, Pakistan.

  15. Reduced quality of life in living kidney donors: association with fatigue, societal participation and pre-donation variables.

    PubMed

    de Groot, Ingrid B; Stiggelbout, Anne M; van der Boog, Paul J M; Baranski, Andrzej G; Marang-van de Mheen, Perla J

    2012-09-01

    Health related quality of life (HRQoL) of living kidney donors on average is good, but some donors experience a low HRQoL after donation. This study assessed the prevalence of reduced HRQoL and explored associations with pre- and post-donation variables. 316 donors (response rate 74%) who donated a kidney between 1997 and 2009 filled in a questionnaire. HRQoL was measured using the Short-Form 36; fatigue using the Multidimensional Fatigue Inventory; societal participation using the Utrecht Scale for Evaluation of Rehabilitation-Participation. Donors on average had better HRQoL than the general population. However, 12% had a reduced physical (PCS) and 18% a reduced mental (MCS) HRQoL. Donors with reduced HRQoL reported greater fatigue (P < 0.01), lower societal participation (P < 0.01) and showed a trend towards statistical significance in experiencing more donor-recipient relationship changes (P = 0.07). Prior to donation, donors with reduced PCS had a higher BMI (P < 0.05) and more often smoked (P < 0.05). Donors with reduced MCS had higher expectations (P < 0.05). Reduced HRQoL is associated with higher BMI, smoking and higher expectations prior to donation. These results may be used to develop a screening instrument to select donors at high risk for reduced HRQoL. © 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.

  16. Societal preferences for distributive justice in the allocation of health care resources: a latent class discrete choice experiment.

    PubMed

    Skedgel, Chris; Wailoo, Allan; Akehurst, Ron

    2015-01-01

    Economic theory suggests that resources should be allocated in a way that produces the greatest outputs, on the grounds that maximizing output allows for a redistribution that could benefit everyone. In health care, this is known as QALY (quality-adjusted life-year) maximization. This justification for QALY maximization may not hold, though, as it is difficult to reallocate health. Therefore, the allocation of health care should be seen as a matter of distributive justice as well as efficiency. A discrete choice experiment was undertaken to test consistency with the principles of QALY maximization and to quantify the willingness to trade life-year gains for distributive justice. An empirical ethics process was used to identify attributes that appeared relevant and ethically justified: patient age, severity (decomposed into initial quality and life expectancy), final health state, duration of benefit, and distributional concerns. Only 3% of respondents maximized QALYs with every choice, but scenarios with larger aggregate QALY gains were chosen more often and a majority of respondents maximized QALYs in a majority of their choices. However, respondents also appeared willing to prioritize smaller gains to preferred groups over larger gains to less preferred groups. Marginal analyses found a statistically significant preference for younger patients and a wider distribution of gains, as well as an aversion to patients with the shortest life expectancy or a poor final health state. These results support the existence of an equity-efficiency tradeoff and suggest that well-being could be enhanced by giving priority to programs that best satisfy societal preferences. Societal preferences could be incorporated through the use of explicit equity weights, although more research is required before such weights can be used in priority setting. © The Author(s) 2014.

  17. Influence of societal and practice contexts on health professionals’ clinical reasoning: a scoping study protocol

    PubMed Central

    Carrier, Annie; Levasseur, Mélanie; Freeman, Andrew; Mullins, Gary; Quénec'hdu, Suzanne; Lalonde, Louise; Gagnon, Michaël; Lacasse, Francis

    2013-01-01

    Introduction In a context of constrained resources, the efficacy of interventions is a pivotal aim of healthcare systems worldwide. Efficacy of healthcare interventions is highly compromised if clinical reasoning (CR), the process that practitioners use to plan, direct, perform and reflect on client care, is not optimal. The CR process of health professionals is influenced by the institutional dimension (ie, legal, regulatory, administrative and organisational aspects) of their societal and practice contexts. Although several studies have been conducted with respect to the institutional dimension influencing health professionals’ CR, no clear integration of their results is yet available. The aim of this study is to synthesise and disseminate current knowledge on the influence of the institutional dimension of contexts on health professionals’ CR. Methods and analysis A scoping study of the scientific literature from January 1980 to March 2013 will be undertaken to summarise and disseminate research findings about the influence of the institutional dimension on CR. Numerous databases (n=18) from three relevant fields (healthcare, health law and politics and management) will be searched. Extended search strategies will include the manual search of bibliographies, health-related websites, public registries and journals of interest. Data will be collected and analysed using a thematic chart and content analysis. A systematic multidisciplinary team approach will allow optimal identification of relevant studies, as well as effective and valid content analysis and dissemination of the results. Discussion This scoping study will provide a rigorous, accurate and up-to-date synthesis of existing knowledge regarding: (1) those aspects of the institutional dimension of health professionals’ societal and practice contexts that impact their CR and (2) how these aspects influence health professionals’ CR. Through the synergy of a multidisciplinary research team from a

  18. Workers are people too: societal aspects of occupational health disparities--an ecosocial perspective.

    PubMed

    Krieger, Nancy

    2010-02-01

    Workers are people too. What else is new? This seemingly self-evident proposition, however, takes on new meaning when considering the challenging and deeply important issue of occupational health disparities--the topic that is the focus of 12 articles in this special issue of the American Journal of Industrial Medicine. In this commentary, I highlight some of the myriad ways that societal determinants of health intertwine with each and every aspect of occupation-related health inequities, as analyzed from an ecosocial perspective. The engagement extends from basic surveillance to etiologic research, from conceptualization and measurement of variables to analysis and interpretation of data, from causal inference to preventive action, and from the political economy of work to the political economy of health. A basic point is that who is employed (or not) in what kinds of jobs, with what kinds of exposures, what kinds of treatment, and what kinds of job stability, benefits, and pay-as well as what evidence exists about these conditions and what action is taken to address them-depends on societal context. At issue are diverse aspects of people's social location within their societies, in relation to their jointly experienced-and embodied-realities of socioeconomic position, race/ethnicity, nationality, nativity, immigration and citizen status, age, gender, and sexuality, among others. Reviewing the papers' findings, I discuss the scientific and real-world action challenges they pose. Recommendations include better conceptualization and measurement of socioeconomic position and race/ethnicity and also use of the health and human rights framework to further the public health mission of ensuring the conditions that enable people-including workers-to live healthy and dignified lives.

  19. A note on the depreciation of the societal perspective in economic evaluation of health care.

    PubMed

    Johannesson, M

    1995-07-01

    It is common in cost-effectiveness analyses of health care to only include health care costs, with the argument that some fictive 'health care budget' should be used to maximize the health effects. This paper provides a criticism of the 'health care budget' approach to cost-effectiveness analysis of health care. It is argued that the approach is ad hoc and lacks theoretical foundation. The approach is also inconsistent with using a fixed budget as the decision rule for cost-effectiveness analysis. That is the case unless only costs that fall into a single annual actual budget are included in the analysis, which would mean that any cost paid by the patients should be excluded as well as any future cost changes and all costs that fall on other budgets. Furthermore the prices facing the budget holder should be used, rather than opportunity costs. It is concluded that the 'health care budget' perspective should be abandoned and the societal perspective reinstated in economic evaluation of health care.

  20. Societal costs of air pollution-related health hazards: A review of methods and results

    PubMed Central

    Pervin, Tanjima; Gerdtham, Ulf-G; Lyttkens, Carl Hampus

    2008-01-01

    This paper aims to provide a critical and systematic review of the societal costs of air pollution-related ill health (CAP), to explore methodological issues that may be important when assessing or comparing CAP across countries and to suggest ways in which future CAP studies can be made more useful for policy analysis. The methodology includes a systematic search based on the major electronic databases and the websites of a number of major international organizations. Studies are categorized by origin – OECD countries or non-OECD countries – and by publication status. Seventeen studies are included, eight from OECD countries and nine from non-OECD countries. A number of studies based on the ExternE methodology and the USA studies conducted by the Institute of Transportation are also summarized and discussed separately. The present review shows that considerable societal costs are attributable to air pollution-related health hazards. Nevertheless, given the variations in the methodologies used to calculate the estimated costs (e.g. cost estimation methods and cost components included), and inter-country differences in demographic composition and health care systems, it is difficult to compare CAP estimates across studies and countries. To increase awareness concerning the air pollution-related burden of disease, and to build links to health policy analyses, future research efforts should be directed towards theoretically sound and comprehensive CAP estimates with use of rich data. In particular, a more explicit approach should be followed to deal with uncertainties in the estimations. Along with monetary estimates, future research should also report all physical impacts and source-specific cost estimates, and should attempt to estimate 'avoidable cost' using alternative counterfactual scenarios. PMID:18786247

  1. Morality and the limits of societal values in health care allocation.

    PubMed

    Walker, Rebecca L; Siegel, Andrew W

    2002-04-01

    In this paper, we consider whether there is a clear moral justification for the proposal that societal value preferences (SVPs) should be included in Cost Effectiveness Analyses (CEA) of health care resource allocations. We argue, first, that proponents of the use of SVPs need to be clear about the relationship between these values and moral principles. In particular, once moral principles are accepted as ruling out some SVPs (such as those that are irrational or revealing prejudice), an account is required of why we need to appeal to SVPs rather than moral principles to determine a just division of health care resources. Secondly, we consider whether an independent moral justification might underwrite the use of SVPs. In various places in the literature the notions of representation, presumed consent and democratic decision making appear to be invoked as candidates for fulfilling this justificatory role. We discuss some problems with each of these justifications in the hope of eliciting a more comprehensive proposal from the proponents of SVPs. We conclude that, although a number of interesting proposals have been made, no compelling justification for including SVPs in CEA has yet been systematically articulated.

  2. An Exploratory Analysis of Societal Preferences for Research-Driven Quality of Life Improvements in Canada

    ERIC Educational Resources Information Center

    Rudd, Murray A.

    2011-01-01

    Research in the humanities, arts, and social sciences (HASS) tends to have impacts that enhance quality of life (QOL) but that are not amenable to pricing in established markets. If the economic value of "non-market" research impacts is ignored when making the business case for HASS research, society will under-invest in it. My goal in…

  3. The economic cost of measles: Healthcare, public health and societal costs of the 2012-13 outbreak in Merseyside, UK.

    PubMed

    Ghebrehewet, Sam; Thorrington, Dominic; Farmer, Siobhan; Kearney, James; Blissett, Deidre; McLeod, Hugh; Keenan, Alex

    2016-04-04

    Measles is a highly contagious vaccine-preventable infection that caused large outbreaks in England in 2012 and 2013 in areas which failed to achieve herd protection levels (95%) consistently. We sought to quantify the economic costs associated with the 2012-13 Merseyside measles outbreak, relative to the cost of extending preventative vaccination to secure herd protection. A costing model based on a critical literature review was developed. A workshop and interviews were held with key stakeholders in the Merseyside outbreak to understand the pathway of a measles case and then quantify healthcare activity and costs for the main NHS providers and public health team incurred during the initial four month period to May 2012. These data were used to model the total costs of the full outbreak to August 2013, comprising those to healthcare providers for patient treatment, public health and societal productivity losses. The modelled total cost of the full outbreak was compared to the cost of extending the preventative vaccination programme to achieve herd protection. The Merseyside outbreak included 2458 reported cases. The estimated cost of the outbreak was £ 4.4m (sensitivity analysis £ 3.9 m to £ 5.2m) comprising 15% (£ 0.7 m) NHS patient treatment costs, 40% (£ 1.8m) public health costs and 44% (£ 2.0m) for societal productivity losses. In comparison, over the previous five years in Cheshire and Merseyside a further 11,793 MMR vaccinations would have been needed to achieve herd protection at an estimated cost of £ 182,909 (4% of the total cost of the measles outbreak). Failure to consistently reach MMR uptake levels of 95% across all localities and sectors (achieve herd protection) risks comparatively higher economic costs associated with the containment (including healthcare costs) and implementation of effective public health management of outbreaks. Commissioned by the Cheshire and Merseyside Public Health England Centre. Crown Copyright © 2016. Published

  4. Women's health in a rural setting in societal transition in Ethiopia.

    PubMed

    Berhane, Y; Gossaye, Y; Emmelin, M; Hogberg, U

    2001-12-01

    There are reports indicating a worsening of women's health in transitional rural societies in sub-Saharan Africa in relation to autonomy, workload, illiteracy, nutrition and disease prevalence. Although these problems are rampant, proper documentation is lacking. The objective of this study was to reflect the health situation of women in rural Ethiopia. Furthermore, the study attempts to address the socio-demographic and cultural factors that have potential influence on the health of women in the context of a low-income setting. A combination of qualitative and quantitative research methods was utilised. In-depth interviews and a cross-sectional survey of randomly selected women were the main methods employed. The Butajira Rural Health Program demographic surveillance database provided the sampling frame. Heavy workload, lack of access to health services, poverty, traditional practices, poor social status and decision-making power, and lack of access to education were among the highly prevalent socio-cultural factors that potentially affect the health of women in Butajira. Though the majority of the women use traditional healers younger women show more tendency to use health services. No improvement of women's status was perceived by the younger generation compared to the older generation. Female genital mutilation is universal with a strong motivation to its maintenance. Nail polish has replaced the rite of nail-extraction before marriage in the younger generation. As the factors influencing the health of women are multiple and complex a holistic approach should be adopted with emphasis on improving access to health care and education, enhancing social status, and mechanisms to alleviate poverty.

  5. Medical Education and Societal Expectations: Conflicts at the Clinical Interface.

    ERIC Educational Resources Information Center

    Janeway, Richard

    1986-01-01

    Three factors that will have major effects on the medical cost quality debate are: industrial and governmental policy in regard to health-related expenditures, an aging population, and societal attitudes towards competition in the health care system. Approaches to conflict resolution are offered. (MLW)

  6. The importance of purpose: moving beyond consent in the societal use of personal health information.

    PubMed

    Grande, David; Mitra, Nandita; Shah, Anand; Wan, Fei; Asch, David A

    2014-12-16

    Adoption of electronic health record systems has increased the availability of patient-level electronic health information. To examine public support for secondary uses of electronic health information under different consent arrangements. National experimental survey to examine perceptions of uses of electronic health information according to patient consent (obtained vs. not obtained), use (research vs. marketing), and framing of the findings (abstract description without results vs. specific results). Nationally representative survey. 3064 African American, Hispanic, and non-Hispanic white persons (response rate, 65%). Appropriateness of health information use described in vignettes on a scale of 1 (not at all appropriate) to 10 (very appropriate). Mean ratings ranged from a low of 3.81 for a marketing use when consent was not obtained and specific results were presented to a high of 7.06 for a research use when consent was obtained and specific results were presented. Participants rated scenarios in which consent was obtained as more appropriate than when consent was not obtained (difference, 1.01 [95% CI, 0.69 to 1.34]; P<0.001). Participants rated scenarios in which the use was marketing as less appropriate than when the use was research (difference, -2.03 [CI, -2.27 to -1.78]; P<0.001). Unconsented research uses were rated as more appropriate than consented marketing uses (5.65 vs. 4.52; difference, 1.13 [CI, 0.87 to 1.39]). Participants rated hypothetical scenarios. Results could be vulnerable to nonresponse bias despite the high response rate. Although approaches to health information sharing emphasize consent, public opinion also emphasizes purpose, which suggests a need to focus more attention on the social value of information use. National Human Genome Research Institute.

  7. The Importance of Purpose: Moving beyond Consent in the Societal Use of Personal Health Information

    PubMed Central

    Grande, David; Mitra, Nandita; Shah, Anand; Wan, Fei; Asch, David A.

    2015-01-01

    Background Adoption of electronic health record systems has increased the availability of patient-level electronic health information. Objective Examine public support for secondary uses of electronic health information under different consent arrangements. Design National experimental survey to examine perceptions of uses of electronic health information when varying along three dimensions: patient consent (obtained vs. not obtained), use (research vs. marketing), and framing of the findings (abstract description without results vs. specific results). Setting Nationally representative survey. Participants 3,064 African American, Hispanic, and non-Hispanic White individuals representing a response rate of 65%. Measurements Appropriateness of health information use described in vignettes on a 1-10 scale (1=not at all appropriate; 10=very appropriate). Results Mean ratings ranged from a low of 3.81 for a marketing use when consent was not obtained and specific results were presented to a high of 7.06 for a research use when consent was obtained and specific results were presented. Participants rated scenarios where consent was obtained as more appropriate compared to when consent was not obtained (+1.01; 95% CI 0.69, 1.34, P<0.001). Participants rated scenarios where the use was marketing as less appropriate compared to when the use was research (−2.03; 95% CI −2.27, −1.78, P<0.001). Unconsented research uses were seen as more appropriate than consented marketing uses (5.65 vs. 4.52; difference = 1.13; 95% CI 0.87, 1.39).. Limitations Participants rated hypothetical scenarios and results could be vulnerable to non-response bias despite the high response rate. Conclusions Although approaches to health information sharing emphasize consent, public opinion also emphasizes purpose suggesting a need to focus more attention on the social value of information use. Primary Funding Source National Human Genome Research Institute PMID:25506854

  8. Trends that will affect your future … a portrait of American societal health.

    PubMed

    Schwartz, Stephan A

    2011-01-01

    The SchwartzReport tracks emerging trends that will affect the world, particularly the United States. For EXPLORE, it focuses on matters of health in the broadest sense of that term, including medical issues, changes in the biosphere, technology, and policy considerations, all of which will shape our culture and our lives.

  9. Societal values in the allocation of healthcare resources: is it all about the health gain?

    PubMed

    Stafinski, Tania; Menon, Devidas; Marshall, Deborah; Caulfield, Timothy

    2011-01-01

    Over the past decade, public distrust in unavoidable value-laden decisions on the allocation of resources to new health technologies has grown. In response, healthcare organizations have made considerable efforts to improve their acceptability by increasing transparency in decision-making processes. However, the social value judgments (distributive preferences of the public) embedded in them have yet to be defined. While the need to explicate such judgments has become widely recognized, the most appropriate approach to accomplishing this remains unclear. The aims of this review were to identify factors around which distributive preferences of the public have been sought, create a list of social values proposed or used in current resource allocation decision-making processes for new health technologies, and review approaches to eliciting such values from the general public. Social values proposed or used in making resource allocation decisions for new health technologies were identified through three approaches: (i) a comprehensive review of published, peer-reviewed, empirical studies of public preferences for the distribution of healthcare; (ii) an analysis of non-technical factors or social value statements considered by technology funding decision-making processes in Canada and abroad; and (iii) a review of appeals to funding decisions on grounds in part related to social value judgments. A total of 34 empirical studies, 10 technology funding decision-making processes, and 12 appeals to decisions were identified and reviewed. The key factors/patient characteristics addressed through policy statements and around which distributive preferences of the public have been sought included severity of illness, immediate need, age (and its relationship to lifetime health), health gain (amount and final outcome/health state), personal responsibility for illness, caregiving responsibilities, and number of patients who could benefit (rarity). Empirical studies typically

  10. Is Smokeless Tobacco Use an Appropriate Public Health Strategy for Reducing Societal Harm from Cigarette Smoking?

    PubMed Central

    Tomar, Scott L.; Fox, Brion J.; Severson, Herbert H.

    2009-01-01

    Four arguments have been used to support smokeless tobacco (ST) for harm reduction: (1) Switching from cigarettes to ST would reduce health risks; (2) ST is effective for smoking cessation; (3) ST is an effective nicotine maintenance product; and (4) ST is not a “gateway” for cigarette smoking. There is little evidence to support the first three arguments and most evidence suggests that ST is a gateway for cigarette smoking. There are ethical challenges to promoting ST use. Based on the precautionary principle, the burden of proof is on proponents to provide evidence to support their position; such evidence is lacking. PMID:19440266

  11. STAPOL: A Simulation of the Impact of Policy, Values, and Technological and Societal Developments upon the Quality of Life.

    ERIC Educational Resources Information Center

    Little, Dennis; Feller, Richard

    The Institute for the Future has been conducting research in technological and societal forecasting, social indicators, value change, and simulation gaming. This paper describes an effort to bring together parts of that research into a simulation game ("State Policy," or STAPOL) for analysis of the impact of government policy, social values, and…

  12. Management patterns and health care use after intracerebral hemorrhage. a cost-of-illness study from a societal perspective in Germany.

    PubMed

    Weimar, Christian; Weber, Carsten; Wagner, Markus; Busse, Otto; Haberl, Roman Ludwig; Lauterbach, Karl W; Diener, Hans Christoph

    2003-01-01

    The German cost-of-illness study of stroke is a multicenter study in 6 departments of internal medicine, 9 departments of general neurology and 15 departments of neurology with an acute stroke unit. The aims of this study are to describe the management patterns, cost of treatment and overall resource utilization after intracerebral hemorrhage (ICH) as well as the major differences to ischemic stroke (IS). During a 12-month period, 30 participating centers with a special interest in stroke prospectively included 586 patients with ICH which were collected in a joint data bank. About 75% of all patients could be centrally followed up via structured telephone interviews after 3 and 12 months to assess further acute hospital and rehabilitation stays, outpatient resource utilization, functional outcome and quality of life. Mortality after 3 months (33.5%) was markedly higher than in patients with IS from the same hospitals. Accordingly, only 30.9% of patients had regained independent functional status after 3 months. Cumulative cost of treatment amounted to 5301 EUR for inpatient stay in the documenting hospital and 8920 EUR for the overall hospital stay including rehabilitation. Mean direct cost after discharge during the first year amounted to 4598 EUR and the loss of work force was equivalent to 5537 EUR in all surviving patients. This study provides a comprehensive overview of patient characteristics, treatment strategies and health care cost of ICH from a societal perspective in Germany. Copyright 2003 S. Karger AG, Basel

  13. Ethical, Political and Societal Implications of the Open Access Journal Movement in the Era of Economic Crisis, with Emphasis on Public Health Pharmacogenomics.

    PubMed

    Bragazzi, Nicola Luigi

    2013-12-01

    Publication of the research outputs is a vital step of the research processes and a gateway between the laboratory and the global society. Open Access is revolutionizing the dissemination of scientific ideas, particularly in the field of public health pharmacogenomics that examines the ways in which pharmacogenomics impacts health systems and services at a societal level, rather than a narrow bench to bedside model of translation science. This manuscript argues that despite some limitations and drawbacks, open access has profound ethical, political and societal implications especially on underdeveloped and developing countries, and that it provides opportunities for science to grow in these resource-limited countries, particularly in the era of a severe economic and financial crisis that is imposing cuts and restrictions to research.

  14. Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis.

    PubMed

    Bobak, Martin; Murphy, Mike; Rose, Richard; Marmot, Michael

    2007-11-01

    To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. Multilevel analysis of cross-sectional data. 13 Countries from Central and Eastern Europe and the former Soviet Union. Population samples aged 18+ years (a total of 15 331 respondents). Poor self-rated health. There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20-fold difference). Ecologically, the age- and sex-standardised prevalence of poor self-rated health correlated strongly with life expectancy at age 15 (r = -0.73). In multilevel analyses, societal (country-level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1.15 (95% confidence interval 1.03 to 1.29) per 1 unit (on a 10-point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. Societal measures of prosperity and corruption, but not income inequalities, were associated with health independently of individual

  15. Comparison of EQ-5D, HUI, and SF-36-Derived Societal Health State Values among Spine Patient Outcomes Research Trial (SPORT) Participants

    PubMed Central

    McDonough, Christine M.; Grove, Margaret R.; Tosteson, Tor D.; Lurie, Jon D.; Hilibrand, Alan S.; Tosteson, Anna N. A.

    2009-01-01

    Purpose To compare societal values across health-state classification systems and to describe the performance of these systems at baseline in a large population of persons with confirmed diagnosis of intervertebral disc herniation (IDH), spinal stenosis (SpS), or degenerative spondylolisthesis (DS). Methods We compared values for EQ-5D (York weights), HUI (Mark 2 and 3), SF-6D, and the SF-36-derived estimate of the Quality of Well Being (eQWB) score using signed rank tests. We tested each instrument’s ability to discriminate between health categories and level of symptom satisfaction. Correlations were assessed with Spearman rank correlations. We evaluated ceiling and floor effects by comparing the proportion at the highest and the lowest possible score for each tool. In addition, we compared proportions at the lowest and highest levels by dimension. The number of unique health states assigned was compared across instruments. We calculated the difference between those who were very dissatisfied and all others. Results Mean values ranged from 0.39 to 0.63 among 2,097 participants ages 18–93 (mean age 53, 47% female) with significant differences in pair-wise comparisons noted for all systems. Correlations ranged from 0.30 to 0.78. Although all systems showed statistically significant differences in health state values when baseline comparisons were made between those who were very dissatisfied with their symptoms and those who were not, the magnitude of this difference ranged widely across systems. Mean differences (95% CI) between those very dissatisfied and all others were 0.30 (0.269, 0.329) for EQ-5D, 0.22 (0.190, 0.241) for HUI(3), 0.18 (0.161, 0.201) for HUI(2), 0.11 (0.095, 0.117) for SF-6D, 0.04 (0.039, 0.049) for eQWB, and 0.07 (0.056, 0.077) for VAS (with transformation applied to group means). Conclusion Differences in preference-weighted health state classification systems are evident at baseline in a population with confirmed IDH, SpS, and DS

  16. Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis.

    PubMed

    Padula, William V; Heru, Shiona; Campbell, Jonathan D

    2016-04-01

    Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3% (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). U.S. transgender population starting before transitional therapy. No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suicidality, drug abuse, mortality) dependent on insurance coverage or no health benefit at a willingness-to-pay threshold of $100,000/QALY. Budget impact interpreted as the U.S. per-member-per-month cost. Compared to no health benefits for transgender patients ($23,619; 6.49 QALYs), insurance coverage for medically necessary services came at a greater cost and effectiveness ($31,816; 7.37 QALYs), with an incremental cost-effectiveness ratio (ICER) of $9314/QALY. The budget impact of this coverage is approximately $0.016 per member per month. Although the cost for transitions is $10,000-22,000 and the cost of provider coverage is $2175/year, these additional expenses hold good value for reducing the risk of negative endpoints--HIV, depression, suicidality, and drug abuse. Results were robust to uncertainty. The probabilistic sensitivity analysis showed that provider coverage was cost-effective in 85% of simulations. Health insurance coverage for the U.S. transgender population is affordable

  17. Service quality in health care.

    PubMed

    Kenagy, J W; Berwick, D M; Shore, M F

    1999-02-17

    Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them.

  18. Societal determination of usefulness and utilization wishes of community health services: a population-based survey in Wuhan city, China

    PubMed Central

    Zhang, Peipei; Zhao, Lianyi; Liang, Jing; Qiao, Yan; He, Quanyan; Zhang, Liuyi; Wang, Fang; Liang, Yuan

    2015-01-01

    Background As a developing country with the world’s largest population in a state of economic transition, reforms to China’s health system, including community health services (CHS), are very complex and difficult. The aim of this study is to provide evidence and policy recommendations for the sustainable development of CHS for China, which could also be applicable to other developing countries. Methods A cross-sectional survey was conducted door-to-door and face-to-face in Wuhan city, central China with a sample of 1134 individuals aged 15 and older. The independent variables were duration of residence, previous treatment experience, familiarity with health staff, self-reported family economic status and health insurance. The dependent variables were views on the usefulness of CHS and willingness to use them. Sociodemographic variables and health status were used as control variables. Multiple logistic regression analysis was used to analyse the influence of the independent variables on the dependent variables. Findings This study shows that 26.10% of participants reported that the CHSs are not useful and 37.74% reported they did not want to use their CHS. The results found ‘familiarity with health staff’ and ‘previous experience of using services’ had a negative influence on their views on usefulness of and willingness to use CHS. Conclusion The aim of CHS to see ‘minor illnesses treated in the community and serious illness treated in hospital’ is not being fully realized. The key to increasing the use of CHS may be to enhance the quality of services and health staff. A policy pathway of targeting older residents and those with higher education levels as the priority population, and using these groups to encourage the rest of the community to seek minor services at CHS, may be an effective and sustainable development mechanism. PMID:25492032

  19. How the Spectre of Societal Homogeneity Undermines Equitable Healthcare for Refugees Comment on "Defining and Acting on Global Health: The Case of Japan and the Refugee Crisis".

    PubMed

    Razum, Oliver; Wenner, Judith; Bozorgmehr, Kayvan

    2016-10-17

    Recourse to a purported ideal of societal homogeneity has become common in the context of the refugee reception crisis - not only in Japan, as Leppold et al report, but also throughout Europe. Calls for societal homogeneity in Europe originate from populist movements as well as from some governments. Often, they go along with reduced social support for refugees and asylum seekers, for example in healthcare provision. The fundamental right to health is then reduced to a citizens' right, granted fully only to nationals. Germany, in spite of welcoming many refugees in 2015, is a case in point: entitlement and access to healthcare for asylum seekers are restricted during the first 15 months of their stay. We show that arguments brought forward to defend such restrictions do not hold, particularly not those which relate to maintaining societal homogeneity. European societies are not homogeneous, irrespective of migration. But as migration will continue, societies need to invest in what we call "globalization within." Removing entitlement restrictions and access barriers to healthcare for refugees and asylum seekers is one important element thereof. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  20. The Evaluation Scale: Exploring Decisions About Societal Impact in Peer Review Panels.

    PubMed

    Derrick, Gemma E; Samuel, Gabrielle N

    Realising the societal gains from publicly funded health and medical research requires a model for a reflexive evaluation precedent for the societal impact of research. This research explores UK Research Excellence Framework evaluators' values and opinions and assessing societal impact, prior to the assessment taking place. Specifically, we discuss the characteristics of two different impact assessment extremes - the "quality-focused" evaluation and "societal impact-focused" evaluation. We show the wide range of evaluator views about impact, and that these views could be conceptually reflected in a range of different positions along a conceptual evaluation scale. We describe the characteristics of these extremes in detail, and discuss the different beliefs evaluators had which could influence where they positioned themselves along the scale. These decisions, we argue, when considered together, form a dominant definition of societal impact that influences the direction of its evaluation by the panel.

  1. When "health" is not enough: societal, individual and biomedical assessments of well-being among the Matsigenka of the Peruvian Amazon.

    PubMed

    Izquierdo, Carolina

    2005-08-01

    Although biomedical indicators of health status show that physical health for the Matsigenka of the Peruvian Amazon has significantly improved over the past 20-30 years, the Matsigenka perceive their health and well-being to have severely declined during this period. This discrepancy between empirical measures and local perceptions of health and well-being points to the central tension inherent in measuring and defining "health." While biomedical parameters of health are generally linked to notions of the body free of illness, measurable by physiological means, the Matsigenka define physical health as only one component of what it means to be healthy and to experience well-being. For the Matsigenka, notions of health and well-being are linked fundamentally to ideals about happiness, productivity and goodness, in addition to biomedical health. The Matsigenka attribute the decrease in their well-being to newly instigated sorcery and stressors resulting from outside influences and morality institutionalized by cultural "outsiders", such as missionaries, school teachers, health personnel, oil company employees and government officials. This article explores the relationships between biomedical, societal and personal assessments of health and well-being among the Matsigenka as they seek to preserve their sense of wellness in spite of their rapidly changing social and economic environment. By using longitudinal qualitative and quantitative ethnographic and health data, this paper shows that, for the Matsigenka, increases in acculturation and permanent settlement result in an alarming decrease in their health and well-being.

  2. Societal characteristics and health in the former communist countries of Central and Eastern Europe and the former Soviet Union: a multilevel analysis

    PubMed Central

    Bobak, Martin; Murphy, Mike; Rose, Richard; Marmot, Michael

    2007-01-01

    Objectives To examine whether, in former communist countries that have undergone profound social and economic transformation, health status is associated with income inequality and other societal characteristics, and whether this represents something more than the association of health status with individual socioeconomic circumstances. Design Multilevel analysis of cross‐sectional data. Setting 13 Countries from Central and Eastern Europe and the former Soviet Union. Participants Population samples aged 18+ years (a total of 15 331 respondents). Mean outcome measures Poor self‐rated health. Results There were marked differences among participating countries in rates of poor health (a greater than twofold difference between the countries with the highest and lowest rates of poor health), gross domestic product per capita adjusted for purchasing power parity (a greater than threefold difference), the Gini coefficient of income inequality (twofold difference), corruption index (twofold difference) and homicide rates (20‐fold difference). Ecologically, the age‐ and sex‐standardised prevalence of poor self‐rated health correlated strongly with life expectancy at age 15 (r = −0.73). In multilevel analyses, societal (country‐level) measures of income inequality were not associated with poor health. Corruption and gross domestic product per capita were associated with poor health after controlling for individuals' socioeconomic circumstances (education, household income, marital status and ownership of household items); the odds ratios were 1.15 (95% confidence interval 1.03 to 1.29) per 1 unit (on a 10‐point scale) increase in the corruption index and 0.79 (95% confidence interval 0.68 to 0.93) per $5000 increase in gross domestic product per capita. The effects of gross domestic product and corruption were virtually identical in people whose household income was below and above the median. Conclusion Societal measures of prosperity and corruption

  3. Catalog and comparison of societal preferences (utilities) for lung cancer health states: results from the Cancer Care Outcomes Research and Surveillance (CanCORS) study.

    PubMed

    Tramontano, Angela C; Schrag, Deborah L; Malin, Jennifer K; Miller, Melecia C; Weeks, Jane C; Swan, J Shannon; McMahon, Pamela M

    2015-04-01

    The EQ-5D and SF-6D are 2 health-related quality-of-life indexes that provide preference-weighted measures for use in cost-effectiveness analyses. The National Cancer Institute's Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium included the EQ-5D and SF-12v2 in their survey of newly diagnosed lung cancer patients. Utilities were calculated from patient-provided scores for each domain of the EQ-5D or the SF-6D. Utilities were calculated for categories of cancer type, stage, and treatment. There were 5015 enrolled lung cancer patients with a baseline survey in CanCORS; 2396 (47.8%) completed the EQ-5D, and 2344 (46.7%) also completed the SF-12v2. The mean (standard deviation) utility from the EQ-5D was 0.78 (0.18), and from the SF-6D (derived from SF-12v2) was 0.68 (0.14). The EQ-5D demonstrated a ceiling effect, with 20% of patients reporting perfect scores, translating to a utility of 1.0. No substantial SF-6D floor effects were noted. Utilities increased with age and decreased with stage and comorbidities. Patient-reported (EQ-5D) visual analog scale scores for health status had a moderate (r = 0.48, p < 0.0001) positive correlation with utilities. A subset (n = 1474) completed follow-up EQ-5D questionnaires 11-13 months after diagnosis. Among these patients, there was a nonsignificant decrease in mean utility for stage IV and an increase in mean utility for stages I, II, and III. This study generated a catalog of community-weighted utilities applicable to societal-perspective cost-effectiveness analyses of lung cancer interventions and compared utilities based on the EQ-5D and SF-6D. Potential users of these scores should be aware of the limitations and think carefully about their use in specific studies. © The Author(s) 2015.

  4. Achieving Quality in Occupational Health

    NASA Technical Reports Server (NTRS)

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

    1997-01-01

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

  5. Farmworker Housing Quality and Health.

    PubMed

    Arcury, Thomas A; Jacobs, Ilene J; Ruiz, Virginia

    2015-11-01

    On 11 November 2014, Farmworker Housing Quality and Health: A Transdisciplinary Conference was convened to draw together experts from the variety of disciplines who contribute to research and practice focused on farmworker housing and health in order to delineate current knowledge and propose next steps. The conference addressed three specific aims: (1) to consolidate current knowledge on characteristics and quality of housing provided for farmworkers; (2) to delineate pertinent directions and areas for farmworker housing health and safety research and policy; and (3) to facilitate the development of working groups to support the implementation of research, education, and engineering projects to improve farmworker housing. This article provides an overview of the conference.

  6. Helping You Choose Quality Behavioral Health Care

    MedlinePlus

    Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special thought and attention. The Joint Commission on ...

  7. Does evaluative scientometrics lose its main focus on scientific quality by the new orientation towards societal impact?

    PubMed

    Bornmann, Lutz; Haunschild, Robin

    2017-01-01

    When the meaning of key terms is incompatible in competing taxonomies, a revolution might occur in the field by which the established taxonomy is replaced with another. Since the key term "impact" in scientometrics seems to undergo a taxonomic change, a revolution might be taking place at present: Impact is no longer defined as impact on science alone (measured by citations), but on all sectors of society (e.g. economics, culture, or politics). In this Short Communication, we outline that the current revolution in scientometrics does not only imply a broadening of the impact perspective, but also the devaluation of quality considerations in evaluative contexts. Impact might no longer be seen as a proxy for quality, but in its original sense: the simple resonance in some sectors of society.

  8. The exodus of health professionals from sub-Saharan Africa: balancing human rights and societal needs in the twenty-first century.

    PubMed

    Ogilvie, Linda; Mill, Judy E; Astle, Barbara; Fanning, Anne; Opare, Mary

    2007-06-01

    Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly those in sub-Saharan Africa. The migration of nurses, physicians and other health professionals from countries in sub-Saharan Africa poses a major threat to the achievement of health equity in this region. As nurses form the backbone of healthcare systems in many of the affected countries, it is the accelerating migration of nurses that will be most critical over the next few years. In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to non-discrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.

  9. Societal assessment overview

    NASA Technical Reports Server (NTRS)

    Bloomquist, C. E.

    1980-01-01

    The decision to proceed with SPS depends on a political determination that commitment of the economic, institutional, and social energies required for its implementation is a worthwhile investment. This determination is national (and international) in scope and is based on knowledge of the environmental and societal impacts of the SPS, its projected economics and technological risks, expressed through the influence of contending segments of society. To assist the decision makers, an assessment of societal issues associated with the SPS was undertaken as part of the Concept Development and Evaluation Program. Results of the assessment are reported. The primary societal assessment objectives are to determine if the societal ramifications of an SPS might significantly impede its development, and to establish an information base regarding these issues. Estimates regarding SPS impacts commensurate with its stage of development and the needs of the decision makers are provided.

  10. Quality of life assessment in musculo-skeletal health.

    PubMed

    Beaudart, Charlotte; Biver, Emmanuel; Bruyère, Olivier; Cooper, Cyrus; Al-Daghri, Nasser; Reginster, Jean-Yves; Rizzoli, René

    2017-06-29

    Musculoskeletal disorders affect morbidity, quality of life and mortality, and represent an increasing economic and societal burden in the context of population aging and increased life expectancy. Improvement of quality of life should be one of the priorities of any interventions to prevent and treat musculoskeletal disorders in the ageing population. Two main approaches, namely generic and disease-specific instruments, can be applied to measure health-related quality of life. Among the generic tools available in scientific literature, the short form 36 questionnaire (SF-36) and the Euroqol five item questionnaire (EQ-5D) are two of the most popular questionnaires used to quantify the health related quality of life in people with musculoskeletal disorders. However, because generic tools may not always be able to detect subtle effects of a specific condition on quality of life, a specific tool is highly valuable. Specific tools improve the ability to clinically characterize quality of life in subjects with a specific musculoskeletal disorder, as well as the capacity to assess changes over time in the QoL of these subjects. The recent development of specific tools should help to validate preventive and therapeutic interventions in this field.

  11. The public health implications of United Kingdom offender healthcare policy: a holistic approach to achieve individual and societal gains.

    PubMed

    Senior, Jane; Shaw, Jenny

    2011-01-01

    In 2009, two seminal documents were published by the United Kingdom (UK) government concerning healthcare services for offenders. The Bradley review into diversion for people with mental health problems and learning disabilities emphasised a need to improve offender health, not least because of the high economic costs to society as a whole resulting from unresolved mental illness, physical ill-health and substance abuse problems commonly experienced by offenders. The Bradley review made wide-reaching recommendations for change, requiring strong partnership between health and justice agencies at both central government and local levels. A framework for the delivery of Bradley's recommendations has been set out in Improving health, supporting justice, the Department of Health's offender health strategy which sets out the direction of travel for the next 10 years. This paper discusses the reality of working toward improving health services for this marginalised group in the context of the influence of the current straitened financial climate on the allocation of resources to publically funded healthcare in the UK; it examines the historically based, and widely held, belief in the principle of "less eligibility" within our society, whereby there is much public and media resistance to allocating resources to improving care for offenders when other, more "deserving", groups are perceived to be in continuing need.

  12. Indoor air quality and health

    NASA Astrophysics Data System (ADS)

    Jones, A. P.

    During the last two decades there has been increasing concern within the scientific community over the effects of indoor air quality on health. Changes in building design devised to improve energy efficiency have meant that modern homes and offices are frequently more airtight than older structures. Furthermore, advances in construction technology have caused a much greater use of synthetic building materials. Whilst these improvements have led to more comfortable buildings with lower running costs, they also provide indoor environments in which contaminants are readily produced and may build up to much higher concentrations than are found outside. This article reviews our current understanding of the relationship between indoor air pollution and health. Indoor pollutants can emanate from a range of sources. The health impacts from indoor exposure to combustion products from heating, cooking, and the smoking of tobacco are examined. Also discussed are the symptoms associated with pollutants emitted from building materials. Of particular importance might be substances known as volatile organic compounds (VOCs), which arise from sources including paints, varnishes, solvents, and preservatives. Furthermore, if the structure of a building begins to deteriorate, exposure to asbestos may be an important risk factor for the chronic respiratory disease mesothelioma. The health effects of inhaled biological particles can be significant, as a large variety of biological materials are present in indoor environments. Their role in inducing illness through immune mechanisms, infectious processes, and direct toxicity is considered. Outdoor sources can be the main contributors to indoor concentrations of some contaminants. Of particular significance is Radon, the radioactive gas that arises from outside, yet only presents a serious health risk when found inside buildings. Radon and its decay products are now recognised as important indoor pollutants, and their effects are

  13. Societal Duty and Resource Allocation for Persons with Severe Traumatic Brain Injury.

    ERIC Educational Resources Information Center

    DeJong, Gerben; Batavia, Andrew I.

    1989-01-01

    The article considers eight values and factors that enter into decisions regarding resource allocation for persons with brain injury including the quality of life, moral culpability of the brain-injured person, the social contribution of the person, allocation of family and societal responsibilities, justice, the nature of health care, and…

  14. Societal Duty and Resource Allocation for Persons with Severe Traumatic Brain Injury.

    ERIC Educational Resources Information Center

    DeJong, Gerben; Batavia, Andrew I.

    1989-01-01

    The article considers eight values and factors that enter into decisions regarding resource allocation for persons with brain injury including the quality of life, moral culpability of the brain-injured person, the social contribution of the person, allocation of family and societal responsibilities, justice, the nature of health care, and…

  15. The impact of non-adherence to medication in patients with schizophrenia on health, social care and societal costs. Analysis of the QUATRO study.

    PubMed

    King, D; Knapp, M; Patel, A; Amaddeo, F; Tansella, M; Schene, A; Koeter, M; Angermeyer, M; Becker, T

    2014-03-01

    Aims. For people with schizophrenia, non-adherence to antipsychotic medications may result in high use of health and other services. The objective of our research was to examine the economic consequences of non-adherence in patients with schizophrenia taking antipsychotic medication. Methods. Data were taken from QUATRO, a randomized controlled trial that drew a sample of adults with schizophrenia receiving psychiatric services in four European cities: Amsterdam, Leipzig, London and Verona. Trial inclusion criteria were a clinical diagnosis of schizophrenia, requiring on-going antipsychotic medication for at least 1-year following baseline assessment, and exhibiting evidence of clinical instability in the year prior to baseline. The patient-completed Medication Adherence Questionnaire (MAQ) was used to calculate the 5-point Morisky index of adherence. Generalized linear models (GLM) were developed to determine the effect of adherence on (i) health and social care and (ii) societal costs before and after treatment, taking into account other potential cost-influencing factors. Results. The effect of non-adherence on costs was mixed. For different groups of services, and according to treatment group assignment, non-adherence was both negatively and positively associated with costs. Conclusions. The impact of non-adherence on costs varies across the types of services used by individuals with schizophrenia.

  16. The Translational Science Benefits Model: A New Framework for Assessing the Health and Societal Benefits of Clinical and Translational Sciences.

    PubMed

    Luke, Douglas A; Sarli, Cathy C; Suiter, Amy M; Carothers, Bobbi J; Combs, Todd B; Allen, Jae L; Beers, Courtney E; Evanoff, Bradley A

    2017-09-08

    We report the development of the Translational Science Benefits Model (TSBM), a framework designed to support institutional assessment of clinical and translational research outcomes to measure clinical and community health impacts beyond bibliometric measures. The TSBM includes 30 specific and potentially measurable indicators that reflect benefits that accrue from clinical and translational science research such as products, system characteristics, or activities. Development of the TSBM was based on literature review, a modified Delphi method, and in-house expert panel feedback. Three case studies illustrate the feasibility and face validity of the TSBM for identification of clinical and community health impacts that result from translational science activities. Future plans for the TSBM include further pilot testing and a resource library that will be freely available for evaluators, translational scientists, and academic institutions who wish to implement the TSBM framework in their own evaluation efforts. © 2017 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

  17. Service quality in health care setting.

    PubMed

    Rashid, Wan Edura Wan; Jusoff, Hj Kamaruzaman

    2009-01-01

    This paper attempts to explore the concept of service quality in a health care setting. This paper probes the definition of service quality from technical and functional aspects for a better understanding on how consumers evaluate the quality of health care. It adopts the conceptual model of service quality frequently used by the most researchers in the health care sector. The paper also discusses several service quality dimensions and service quality problems in order to provide a more holistic conception of hospital service quality. The paper finds that service quality in health care is very complex as compared to other services because this sector highly involves risk. The paper adds a new perspective towards understanding how the concept of service quality is adopted in a health care setting.

  18. The Societal Importance of Embracing Counterintuitive Thought in Science: Assisted Exercise in Preterm Infants for Long-term Health Outcomes.

    PubMed

    Olshansky, Ellen; Vaughan, Jessica; Sando, Kelsi; Rich, Julia; Lakes, Kimberley; Cooper, Daniel

    For research to lead to progressive change, scientists and society must embrace what may seem counterintuitive. While there is often resistance to changing views of what we presume to already understand, we must be open to evolving knowledge and evidence. Our research is examining the effect of a novel intervention designed to increase physical activity of premature babies in their first year of life on: (1) body composition, (2) associated biochemical and cellular mechanisms of growth and inflammation, and (3) quality of maternal care. This study is novel because it is counterintuitive to prevailing knowledge of the care and treatment of infants born prematurely. Traditionally, we swaddle infants and restrict their movement in order to minimize energy expenditure. We are proposing the opposite: to increase energy expenditure in a systematic, controlled way in order to increase muscle mass and bone density, with the ultimate goal of preventing diseases associated with lack of muscle mass or bone density. Our research actively engages the mothers in the study by learning about their perceptions and their experiences of doing the exercise with their infants because the mothers, too, are aware of the prevailing views that are counter to what they are being asked to do. The mothers have taught us, however, that they are willing to participate in this exercise study, while paradoxically also viewing their infants as "fragile" and are fearful of hurting their infants. Our thesis in this research-based paper is that science and society must work in tandem to be effective.

  19. Cambodian boys' transitions into young adulthood: exploring the influence of societal and masculinity norms on young men's health.

    PubMed

    Scandurra, Leah; Khorn, Daro; Charles, Thana-Ashley; Sommer, Marni

    2017-07-01

    A growing body of evidence focuses on the experiences of young men in low-income countries, including their health vulnerabilities. Much of this research has been conducted in sub-Saharan Africa, Asia and Latin America. Limited evidence exists on the norms influencing boys' transitions into young adulthood in Southeast Asia, and in Cambodia in particular. To help fill this gap, we conducted a comparative case study using participatory methods with 16-19-year-old young men in rural and urban Cambodia, and with the adults who intersect in their lives. Findings suggest that in line with their counterparts growing up elsewhere, Cambodian boys welcome becoming young men as a time of newly acquired adult roles and responsibilities, while some may experience growing up as a time of bodily change, burgeoning sexual feelings and limited sources of support and guidance. As a result, some may strive more intensely to conform to the alcohol use and violence modelled by the older men in their environments. Additional research is needed to better understand the vulnerabilities of boys' transition into young adulthood in Cambodia today, and how to prevent or reduce engagement with these more negative practices.

  20. Strategic service quality management for health care.

    PubMed

    Anderson, E A; Zwelling, L A

    1996-01-01

    Quality management has become one of the most important and most debated topics within the service sector. This is especially true for health care, as the controversy rages on how the existing American system should be restructured. Health care reform aimed at reducing costs and ensuring access to all Americans cannot be allowed to jeopardize the quality of care. As such, total quality management (TQM) has become a vital ingredient to strategic planning within the health care domain. At the heart of any such quality improvement effort is the issue of measurement. TQM cannot be effectively utilized as a competitive weapon unless quality can be accurately defined, measured, evaluated, and monitored over time. Through such analysis a hospital can elect how to expend its limited resources toward those quality improvement projects which will impact customer perceptions of service quality the most. Thus, the purpose of this report is to establish a framework by which to approach the issue of quality measurement, delineate the various components of quality that exist in health care, and explore how these elements affect one another. We propose that the issue of quality measurement in health care be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to health care. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the health care domain and encourage other researchers to address the interactions of the various quality attributes.

  1. Health Professions Education: A Bridge to Quality

    ERIC Educational Resources Information Center

    Greiner, Ann C., Ed.; Knebel, Elisa, Ed.

    2003-01-01

    The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across…

  2. Quality of life utilities for pelvic inflammatory disease health states.

    PubMed

    Smith, Kenneth J; Tsevat, Joel; Ness, Roberta B; Wiesenfeld, Harold C; Roberts, Mark S

    2008-03-01

    Quality of life utilities for health states associated with pelvic inflammatory disease (PID) have been estimated but not directly measured. Utilities for PID could have important implications on the cost-effectiveness of interventions to prevent and manage this disease. We obtained, in women with versus without a history of PID, visual analogue scale (VAS) and time-tradeoff (TTO) valuations for 5 PID-associated health states: ambulatory PID treatment, hospital PID treatment, ectopic pregnancy, chronic pelvic pain, and infertility. Subjects read brief scenarios describing the medical, functional, and social activity effects typically associated with each state, then gave valuations in the order above. Health state valuations were obtained from 56 women with and 150 women without a PID history. Subjects with a PID history had significantly lower mean valuations (P <0.05) on the VAS for ectopic pregnancy (0.55 vs. 0.63), pelvic pain (0.45 vs. 0.53), and infertility (0.53 vs. 0.66) but not on the TTO; VAS differences remained significant when controlling for demographic and childbearing characteristics. VAS and TTO valuations were similar in women with versus without a history of PID for the ambulatory and hospital PID treatment health states. PID has substantial impact on utility. In addition, some PID-related health states are valued less by women who have experienced PID, which could affect cost-effectiveness analyses of PID treatments when examined from the societal versus patient perspective.

  3. Examining national and district-level trends in neonatal health in Peru through an equity lens: a success story driven by political will and societal advocacy.

    PubMed

    Huicho, Luis; Huayanay-Espinoza, Carlos A; Herrera-Perez, Eder; Niño de Guzman, Jessica; Rivera-Ch, Maria; Restrepo-Méndez, Maria Clara; Barros, Aluisio J D

    2016-09-12

    reduction, by a combination of strong societal advocacy and political will, which translated into pro-poor implementation of evidence-based interventions with a rights-based approach. Although progress in Peru for reducing NMR has been remarkable, future challenges include closing remaining gaps for urban and rural populations and improving newborn health with qualified staff and intermediate- and intensive-level health facilities.

  4. Quality assurance in the health care industry.

    PubMed

    Guth, Kim Ann; Kleiner, Brian

    2005-01-01

    The purpose of this article is to explore the quality assurance methods commonly used in the health care industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the health care industry is described. Quality improvement efforts that are utilized by health care institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care.

  5. Quality and Electronic Health Records in Community Health Centers

    ERIC Educational Resources Information Center

    Lesh, Kathryn A.

    2014-01-01

    Adoption and use of health information technology, the electronic health record (EHR) in particular, has the potential to help improve the quality of care, increase patient safety, and reduce health care costs. Unfortunately, adoption and use of health information technology has been slow, especially when compared to the adoption and use of…

  6. Quality and Electronic Health Records in Community Health Centers

    ERIC Educational Resources Information Center

    Lesh, Kathryn A.

    2014-01-01

    Adoption and use of health information technology, the electronic health record (EHR) in particular, has the potential to help improve the quality of care, increase patient safety, and reduce health care costs. Unfortunately, adoption and use of health information technology has been slow, especially when compared to the adoption and use of…

  7. Organisational Learning for School Quality and Health

    ERIC Educational Resources Information Center

    Lagrosen, Yvonne; Lagrosen, Stefan

    2012-01-01

    Purpose: The purpose of this paper is to shed light upon the connections between quality management, employee health and organisational learning in a school setting. Design/methodology/approach: The study is based on a quantitative survey. Items measuring health status and values of quality management were included in a questionnaire addressed to…

  8. Total quality management in behavioral health care.

    PubMed

    Sluyter, G V

    1998-01-01

    The literature on total quality management or continuous quality improvement in the behavioral health care field is just beginning to emerge. Although most of the evidence on its effectiveness remains anecdotal, it seems clear that it can work in behavioral health care organizations with strong leadership support and a long-term commitment.

  9. Health Professions Education: A Bridge to Quality.

    ERIC Educational Resources Information Center

    Greiner, Ann C., Ed.; Knebel, Elisa, Ed.

    The 2001 Institute of Medicine (IOM) report "Crossing the Quality Chasm: A New Health System for the 21st Century" recommended that an interdisciplinary summit be held to develop next steps for reform of health professions education in order to enhance patient care quality and safety. In June 2002, the IOM convened this summit, which included 150…

  10. Organisational Learning for School Quality and Health

    ERIC Educational Resources Information Center

    Lagrosen, Yvonne; Lagrosen, Stefan

    2012-01-01

    Purpose: The purpose of this paper is to shed light upon the connections between quality management, employee health and organisational learning in a school setting. Design/methodology/approach: The study is based on a quantitative survey. Items measuring health status and values of quality management were included in a questionnaire addressed to…

  11. Systemic vasculitis: how little we know about their societal and economic burden.

    PubMed

    Trieste, Leopoldo; Palla, Ilaria; Baldini, Chiara; Talarico, Rosaria; D'Angiolella, Lucia; Mosca, Marta; Turchetti, Giuseppe

    2012-01-01

    This article attempts to perform an evaluation of the state of the art of the economic and societal burden of systemic vasculitis (VAs). Due to the rarity of these diseases and their variable clinical picture, few data are available in the literature on their health economic issues, and only some papers have been published that marginally examine the problem. Since VAs are severe conditions with a high medical and societal impact and determine high healthcare resource consumption, studies able to define societal, quality of life and economic burden of these pathologies are needed. Policy makers, private and public organisations involved in the care of VAs need data to programme future investment or make cost-effectiveness analysis for introducing new drugs or protocols.

  12. Quality improvement in public health institutions.

    PubMed

    Sanadia, Bharti N

    2005-02-01

    Quality issues are integral to providing primary health care. The delivery of health care is a complex process that involves a number of factors such as interpersonal skill, culture, technology and available resources. In general, quality is defined as customer satisfaction at competitive cost. As per John Guaspari, "Quality should not be positioned as the absence of problems as defined by us. It should be positioned as the presence of Value and satisfaction as defined by the customers/clients."

  13. Biodiversity, air quality and human health

    Treesearch

    David J. Nowak; Sarah Jovan; Christina Branquinho; Sofia Augusto; Manuel C. Ribeiro; Conor E. Kretsch

    2015-01-01

    Air pollution is a significant problem in cities across the world. It affects human health and well-being, ecosystem health, crops, climate, visibility and human-made materials. Health effects related to air pollution include its impact on the pulmonary, cardiac, vascular and neurological systems (Section 2). Trees affect air quality through a number of means (Section...

  14. Patient and Societal Value Functions for the Testing Morbidities Index

    PubMed Central

    Swan, John Shannon; Kong, Chung Yin; Lee, Janie M.; Akinyemi, Omosalewa; Halpern, Elkan F.; Lee, Pablo; Vavinskiy, Sergey; Williams, Olubunmi; Zoltick, Emilie S.; Donelan, Karen

    2013-01-01

    Background We developed preference-based and summated scale scoring for the Testing Morbidities Index (TMI) classification, which addresses short-term effects on quality of life from diagnostic testing before, during and after a testing procedure. Methods The two TMI value functions utilize multiattribute value techniques; one is patient-based and the other has a societal perspective. 206 breast biopsy patients and 466 (societal) subjects informed the models. Due to a lack of standard short-term methods for this application, we utilized the visual analog scale (VAS). Waiting trade-off (WTO) tolls provided an additional option for linear transformation of the TMI. We randomized participants to one of three surveys: the first derived weights for generic testing morbidity attributes and levels of severity with the VAS; a second developed VAS values and WTO tolls for linear transformation of the TMI to a death-healthy scale; the third addressed initial validation in a specific test (breast biopsy). 188 patients and 425 community subjects participated in initial validation, comparing direct VAS and WTO values to the TMI. Alternative TMI scoring as a non-preference summated scale was included, given evidence of construct and content validity. Results The patient model can use an additive function, while the societal model is multiplicative. Direct VAS and the VAS-scaled TMI were correlated across modeling groups (r=0.45 to 0.62) and agreement was comparable to the value function validation of the Health Utilities Index 2. Mean Absolute Difference (MAD) calculations showed a range of 0.07–0.10 in patients and 0.11–0.17 in subjects. MAD for direct WTO tolls compared to the WTO-scaled TMI varied closely around one quality-adjusted life day. Conclusions The TMI shows initial promise in measuring short-term testing-related health states. PMID:23689044

  15. Poor housing quality: Prevalence and health effects.

    PubMed

    Baker, Emma; Lester, Laurence H; Bentley, Rebecca; Beer, Andrew

    2016-01-01

    Housing is a central component of productive, healthy, and meaningful lives, and a principle social determinant of health and well-being. Surprisingly, though, evidence on the ways that housing influences health in Australia is poorly developed. This stems largely from the fact that the majority of the population are accommodated in good quality housing. The dominance of a "good housing paradigm" means that households living in poor quality and unhealthy housing are doubly disadvantaged-by the quality of their housing and because policy makers in Australia do not acknowledge the health effects of housing. In this article, we examine the relationship between health outcomes and quality of housing. We base our analysis on data from the Household Income and Labour Dynamics in Australia (HILDA) survey, a panel dataset that is representative across Australia. We find a sizeable, policy-important, and to date under-acknowledged cohort of Australians whose health is influenced by poor-condition dwellings.

  16. Health care quality and safety issues.

    PubMed

    Cornett, Becky Sutherland

    2006-05-01

    Our health-care system is burdened with high costs, health-care disparities, overtreatment, undertreatment, high error rates, and fraud and abuse. At the same time, the United States has achieved spectacular medical advances using the latest technology. As a result, health-care quality measurement, publicly reported patient safety and quality indicators, and evaluation of patients' experience of care are watchwords of a new era of accountability for health-care professionals and organizations. The health-care industry is subject to increasing regulation, private sector challenges, and public demand to make significant improvements in all three components of the quality triad: structure, process, and outcome. This article examines regulatory initiatives and industry trends pertaining to patient safety and quality measurement and concludes with specific suggestions for the professions of speech-language pathology and audiology.

  17. Health literacy and communication quality in health care organizations.

    PubMed

    Wynia, Matthew K; Osborn, Chandra Y

    2010-01-01

    The relationship between limited health literacy and poor health may be due, in part, to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and health care organization type, patients with limited health literacy were 28% to 79% less likely than those with adequate health literacy to report their health care organization "always" provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in health care organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers.

  18. Health Literacy and Communication Quality in Health Care Organizations

    PubMed Central

    Wynia, Matthew K.; Osborn, Chandra Y.

    2011-01-01

    The relationship between limited health literacy and poor health may be due to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and health care organization type, patients with limited health literacy were 28–79% less likely than those with adequate health literacy to report their health care organization “always” provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in health care organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers. PMID:20845197

  19. Targeting Environmental Quality to Improve Population Health ...

    EPA Pesticide Factsheets

    Key goals of health care reform are to stimulate innovative approaches to improve healthcare quality and clinical outcomes while holding down costs. To achieve these goals value-based payment places the needs of the patient first and encourages multi-stakeholder cooperation. Yet, the stakeholders are typically all within the healthcare system, e.g. the Accountable Care Organization or Patient-Centered Medical Home, leaving important contributors to the health of the population such as the public health and environmental health systems absent. And rarely is the quality of the environment regarded as a modifiable factor capable of imparting a health benefit. Underscoring this point, a PubMed search of the search terms “environmental quality” with “value-based payment”, “value-based healthcare” or “value-based reimbursement” returned no relevant articles, providing further evidence that the healthcare industry largely disregards the quality of the environment as a significant determinant of wellbeing and an actionable risk factor for clinical disease management and population health intervention. Yet, the quality of the environment is unequivocally related to indicators of population health including all-cause mortality. The EPA’s Environmental Quality Index (EQI) composed of five different domains (air, land use, water, built environment and social) has provided new estimates of the associations between environmental quality and health stat

  20. Delay Discounting as an Index of Sustainable Behavior: Devaluation of Future Air Quality and Implications for Public Health

    PubMed Central

    Berry, Meredith S.; Nickerson, Norma P.; Odum, Amy L.

    2017-01-01

    Poor air quality and resulting annual deaths represent significant public health concerns. Recently, rapid delay discounting (the devaluation of future outcomes) of air quality has been considered a potential barrier for engaging in long term, sustainable behaviors that might help to reduce emissions (e.g., reducing private car use, societal support for clean air initiatives). Delay discounting has been shown to be predictive of real world behavior outside of laboratory settings, and therefore may offer an important framework beyond traditional variables thought to measure sustainable behavior such as importance of an environmental issue, or environmental attitudes/values, although more research is needed in this area. We examined relations between discounting of air quality, respiratory health, and monetary gains and losses. We also examined, relations between discounting and self-reported importance of air quality and respiratory health, and nature relatedness. Results showed rapid delay discounting of all outcomes across the time frames assessed, and significant positive correlations between delay discounting of air quality, respiratory health, and monetary outcomes. Steeper discounting of monetary outcomes relative to air quality and respiratory health outcomes was observed in the context of gains; however, no differences in discounting were observed across losses of monetary, air quality, and respiratory health. Replicating the sign effect, monetary outcomes were discounted more steeply than monetary losses. Importance of air quality, respiratory health and nature relatedness were significantly and positively correlated with one another, but not with degree of delay discounting of any outcome, demonstrating the need for more comprehensive measures that predict pro-environmental behaviors that might benefit individuals and public health over time. These results add to our understanding of decision-making, and demonstrate alarming rates of delay discounting of

  1. Delay Discounting as an Index of Sustainable Behavior: Devaluation of Future Air Quality and Implications for Public Health.

    PubMed

    Berry, Meredith S; Nickerson, Norma P; Odum, Amy L

    2017-09-01

    Poor air quality and resulting annual deaths represent significant public health concerns. Recently, rapid delay discounting (the devaluation of future outcomes) of air quality has been considered a potential barrier for engaging in long term, sustainable behaviors that might help to reduce emissions (e.g., reducing private car use, societal support for clean air initiatives). Delay discounting has been shown to be predictive of real world behavior outside of laboratory settings, and therefore may offer an important framework beyond traditional variables thought to measure sustainable behavior such as importance of an environmental issue, or environmental attitudes/values, although more research is needed in this area. We examined relations between discounting of air quality, respiratory health, and monetary gains and losses. We also examined, relations between discounting and self-reported importance of air quality and respiratory health, and nature relatedness. Results showed rapid delay discounting of all outcomes across the time frames assessed, and significant positive correlations between delay discounting of air quality, respiratory health, and monetary outcomes. Steeper discounting of monetary outcomes relative to air quality and respiratory health outcomes was observed in the context of gains; however, no differences in discounting were observed across losses of monetary, air quality, and respiratory health. Replicating the sign effect, monetary outcomes were discounted more steeply than monetary losses. Importance of air quality, respiratory health and nature relatedness were significantly and positively correlated with one another, but not with degree of delay discounting of any outcome, demonstrating the need for more comprehensive measures that predict pro-environmental behaviors that might benefit individuals and public health over time. These results add to our understanding of decision-making, and demonstrate alarming rates of delay discounting of

  2. Quality improvement implementation and disparities: the case of the health disparities collaboratives.

    PubMed

    Chin, Marshall H

    2010-08-01

    The Health Disparities Collaboratives (HDCs), a quality improvement (QI) collaborative incorporating rapid QI, a chronic care model, and learning sessions, have been implemented in over 900 community health centers across the country. To determine the HDC's effect on clinical processes and outcomes, their financial impact, and factors important for successful implementation. Systematic review of the literature. The HDCs improve clinical processes of care over short-term period of 1 to 2 years, and clinical processes and outcomes over longer period of 2 to 4 years. Most participants perceive that the HDCs are successful and worth the effort. Analysis of the Diabetes Collaborative reveals that it is societally cost-effective, with an incremental cost-effectiveness ratio of $33,386 per quality-adjusted life year, but that consistent revenue streams for the initiative do not exist. Common barriers to improvement include lack of resources, time, and staff burnout. Highest ranked priorities for more funding are money for direct patient services, data entry, and staff time for QI. Other common requests for more assistance are help with patient self-management, information systems, and getting providers to follow guidelines. Relatively low-cost ways to increase staff morale and prevent burnout include personal recognition, skills development opportunities, and fair distribution of work. The HDCs have successfully improved quality of care, and the Diabetes Collaborative is societally cost-effective, but policy reforms are necessary to create a sustainable business case for these health centers that serve many uninsured and underinsured populations.

  3. Quality improvement implementation and disparities: the case of the health disparities collaboratives.

    PubMed

    Chin, Marshall H

    2011-12-01

    The Health Disparities Collaboratives (HDCs), a quality improvement (QI) collaborative incorporating rapid QI, a chronic care model, and learning sessions, have been implemented in over 900 community health centers across the country. To determine the HDC's effect on clinical processes and outcomes, their financial impact, and factors important for successful implementation. Systematic review of the literature. The HDCs improve clinical processes of care over short-term period of 1 to 2 years, and clinical processes and outcomes over longer period of 2 to 4 years. Most participants perceive that the HDCs are successful and worth the effort. Analysis of the Diabetes Collaborative reveals that it is societally cost-effective, with an incremental cost-effectiveness ratio of $33,386 per quality-adjusted life year, but that consistent revenue streams for the initiative do not exist. Common barriers to improvement include lack of resources, time, and staff burnout. Highest ranked priorities for more funding are money for direct patient services, data entry, and staff time for QI. Other common requests for more assistance are help with patient self-management, information systems, and getting providers to follow guidelines. Relatively low-cost ways to increase staff morale and prevent burnout include personal recognition, skills development opportunities, and fair distribution of work. The HDCs have successfully improved quality of care, and the Diabetes Collaborative is societally cost-effective, but policy reforms are necessary to create a sustainable business case for these health centers that serve many uninsured and underinsured populations.

  4. Total quality management in health care.

    PubMed

    McDonald, S C

    1994-01-01

    Total quality management (TQM), continuous quality improvement (CQI) and quality control are terms that are becoming very familiar to workers in the health care environment. The purpose of this article is to discuss these terms and the concepts they describe. The origins of TQM and the keen interest in its application to the health care environment today are addressed. In other environments, TQM has shown significant increases in productivity while increasing effectiveness. Its application to the health care environment is the provision of the best possible care through continuously improving service to meet or exceed the needs and expectations of the customer. The customer in the health care environment could be the patient, staff, physician and community serviced by the hospital. Characteristics of the new organizational structure are reviewed. Established techniques and processes are commonly used to identify process-improvement opportunities to assist the manager in continuously evaluating quality trends.

  5. [Health care quality assurance in the Netherlands].

    PubMed

    Reerink, E

    1990-01-01

    In this paper the main structural features of the dutch health system are described, together with a historical survey of its development in recent years. The basic elements of quality assurance in the country are also discussed.

  6. Quality management in Irish health care.

    PubMed

    Ennis, K; Harrington, D

    1999-01-01

    This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

  7. Quality of Big Data in health care.

    PubMed

    Sukumar, Sreenivas R; Natarajan, Ramachandran; Ferrell, Regina K

    2015-01-01

    The current trend in Big Data analytics and in particular health information technology is toward building sophisticated models, methods and tools for business, operational and clinical intelligence. However, the critical issue of data quality required for these models is not getting the attention it deserves. The purpose of this paper is to highlight the issues of data quality in the context of Big Data health care analytics. The insights presented in this paper are the results of analytics work that was done in different organizations on a variety of health data sets. The data sets include Medicare and Medicaid claims, provider enrollment data sets from both public and private sources, electronic health records from regional health centers accessed through partnerships with health care claims processing entities under health privacy protected guidelines. Assessment of data quality in health care has to consider: first, the entire lifecycle of health data; second, problems arising from errors and inaccuracies in the data itself; third, the source(s) and the pedigree of the data; and fourth, how the underlying purpose of data collection impact the analytic processing and knowledge expected to be derived. Automation in the form of data handling, storage, entry and processing technologies is to be viewed as a double-edged sword. At one level, automation can be a good solution, while at another level it can create a different set of data quality issues. Implementation of health care analytics with Big Data is enabled by a road map that addresses the organizational and technological aspects of data quality assurance. The value derived from the use of analytics should be the primary determinant of data quality. Based on this premise, health care enterprises embracing Big Data should have a road map for a systematic approach to data quality. Health care data quality problems can be so very specific that organizations might have to build their own custom software or data

  8. Measuring Physical Neighborhood Quality Related to Health

    PubMed Central

    Rollings, Kimberly A.; Wells, Nancy M.; Evans, Gary W.

    2015-01-01

    Although sociodemographic factors are one aspect of understanding the effects of neighborhood environments on health, equating neighborhood quality with socioeconomic status ignores the important role of physical neighborhood attributes. Prior work on neighborhood environments and health has relied primarily on level of socioeconomic disadvantage as the indicator of neighborhood quality without attention to physical neighborhood quality. A small but increasing number of studies have assessed neighborhood physical characteristics. Findings generally indicate that there is an association between living in deprived neighborhoods and poor health outcomes, but rigorous evidence linking specific physical neighborhood attributes to particular health outcomes is lacking. This paper discusses the methodological challenges and limitations of measuring physical neighborhood environments relevant to health and concludes with proposed directions for future work. PMID:25938692

  9. Continuous Quality Improvement in Rural Health Clinics

    PubMed Central

    Salman, Ghassan F

    2005-01-01

    Aim Continuous quality improvement has been shown to work in urban and suburban clinics. The objective of this project is to test whether continuous quality improvement would improve the quality of care for patients with diabetes mellitus and/or hypertension in a rural health clinic. Setting Rural health clinic with 3 providers and two and half full-time registered nurses. Patients were mostly older adults with Medicare health insurance. Program description Health care providers and nursing staff agreed on the quality improvement project. The intervention included providing quarterly feedback to health care providers, empowering the nurses to remind patients of diabetes care, and flagging the charts to remind providers. Program evaluation The proportions of diabetic patients who had ophthalmologic exam, pneumococcal vaccine and lipid screening significantly improved over 12-month period. The proportions of patients with hypertension who had blood pressure less than 140/90 and patients who were taking aspirin also significantly improved over 12-month period. Conclusion The quality of care for patients with diabetes and patients with hypertension could be improved in rural health clinics using repetitive cycles of measurements, implementation of interventions and evaluation of outcomes. This process could be used as the backbone for translation of evidence into practice and improving quality of care. PMID:16117758

  10. The societal impact value of risk

    SciTech Connect

    Simpson, D.E.

    1995-04-01

    A key ill-defined issue in the management and regulation of potentially hazardous conditions is that of the value to be associated with a reduction (or existence) of human health risks, such as radiation exposure or hazardous substance ingestion. Empirical observations of societal behavior patterns lead to a relationship for the quantitative value of societal risk impact which is consistent with general societal risk acceptance, is not inconsistent with ``de facto`` risk regulation, and is suitable and appropriate as a specification or guide for risk management and risk regulation. This societal risk impact expression is: Impact ($/year) = (8 {times} 10{sup 7}) NR{sub i}{sup 4/3} where Ri = individual annual mortality risk; N = number of persons in the population sharing the risk and benefits. The change in Impact which can be derived from a regulation or risk management activity is the value of annual benefit which society would expect to forego (or annual equivalent cost to incur) in consideration of the activity.

  11. Internet health resources: from quality to trust.

    PubMed

    Lampe, K; Doupi, P; van den Hoven, M Jeroen

    2003-01-01

    Quality of online health resources remains a much debated topic, despite considerable international efforts. The lack of a systematic and comprehensive conceptual analysis is hindering further progress. Therefore we aim at clarifying the origins, nature and interrelations of pertinent concepts. Further, we claim that quality is neither a necessary nor a sufficient condition for Internet health resources to produce an effect offline. As users' trust is also required, we examine the relation of quality aspects to trust building online. We reviewed and analyzed the key documentation and deliverables of quality initiatives, as well as relevant scientific publications. Using the insights of philosophy, we identified the elementary dimensions which underlie the key concepts and theories presented so far in the context of online health information quality. We examined the interrelations of various perspectives and explored how trust as a phenomenon relates to these dimensions of quality. Various aspects associated with the quality of online health resources originate from four conceptual dimensions: epistemic, ethical, economic and technological. We propose a conceptual framework that incorporates all these perspectives. We argue that total quality exists only if all four dimensions have been addressed adequately and that high total quality is conducive to warranted trust. Quality and trust are intertwined, but distinct concepts, and their relation is not always straightforward. Ideally, trust should track quality. Apprehending the composition of these concepts will help to understand and guide the behavior of both users and providers of online information, as well as to foster warranted trust in online resources. The framework we propose provides a conceptual starting point for further deliberations and empirical work.

  12. Quality of health care for the disadvantaged.

    PubMed

    Brook, R H; Williams, K N

    1975-01-01

    Literature review points out that: (a) differentials in health status between the disadvantaged and the nondisadvantaged persist, often to a large degree; (b) differentials in the overall amount of care received are less striking now than heretofore, but standardization by level of need demonstrates measurable discrepancies in health services provided to the disadvantaged compared with the nondisadvantaged; (c) the quality of health care for the disadvantaged is not strikingly poorer than care for the nondisadvantaged, but, in view of demonstrable shortcomings in the quality of health care in general, this is not viewed as a positive statement; and (d) attempts to improve quality of care for the disadvantaged have not had the hoped-for impact. Four new avenues are suggested for possible further research; increased patient responsibility, increased consumer knowledge, financial accountability, and quality assurance activities. Because of the likelihood of only marginal changes in health status, rigorous evaluation of any experimental program is emphasized. During the last decade, many attempts have been made by private and governmental bodies to improve the health of the American people. In general, these efforts have focused on improving the health of members of disadvantaged groups and have included such diverse activities as building OEO health centers, developing maternal and infant care programs, and financing care for the elderly. During the last few years, a different movement, concerned with assuring high quality care for all people, has produced efforts such as quality assurance activities in health maintenance organizations, the Professional Standards Review Organization program, and the medical care evaluation program of the Joint Commission on the Accreditation of Hospitals. Consideration of these two issues, i.e., improving the health of disadvantaged groups and improving the quality of care for all people, has led to two policy-relevant questions: "Can

  13. Quality Improvement Efforts in Pediatric Oral Health.

    PubMed

    Ng, Man Wai

    2016-04-01

    Quality improvement (QI) and measurement are increasingly used in health care to improve patient care and outcomes. Despite current barriers in oral health measurement, there are nascent QI and measurement efforts emerging. This paper describes the role that QI and measurement can play in improving oral health care delivery in clinical practice by presenting a QI initiative that aimed to test and implement a chronic disease management approach to address early childhood caries.

  14. Quality assurance guides health reform in Jordan.

    PubMed

    Abubaker, W; Abdulrahman, M

    1996-01-01

    In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies

  15. 'Are you still on that stupid diet?': women's experiences of societal pressure and support regarding weight loss, and attitudes towards health policy intervention.

    PubMed

    Whale, Katie; Gillison, Fiona B; Smith, Paula C

    2014-12-01

    This study investigated how people's attitudes and motivations towards losing weight are influenced by societal pressures surrounding weight loss, their interaction with the obesogenic environment and individuals' attitudes and motivations towards weight. Semi-structured qualitative interviews were conducted with 10 women currently attending commercial weight-loss programmes. Participants experienced conflicting messages regarding weight norms, with the media portraying powerful social norms relating to thinness and beauty, and changes to the food environment and interactions with family and friends commonly undermining weight-loss activities and promoting increased consumption. Providing social and environmental support for the behaviours needed to produce weight loss may need to be a primary focus for obesity policy.

  16. Improving Indoor Environmental Quality for Public Health: Impediments and Policy Recommendations

    PubMed Central

    Wu, Felicia; Jacobs, David; Mitchell, Clifford; Miller, David; Karol, Meryl H.

    2007-01-01

    Background People in modern societies spend more than 90% of their time indoors. Hence, indoor environmental quality (IEQ) has a significant impact on public health. In this article we describe health risks associated with indoor environments, illuminate barriers to overcoming these risks, and provide policy recommendations to achieve healthier indoor environments. Objectives The weight of evidence suggests that indoor environmental contaminants pose significant public health risks, particularly among children and the poor, and the societal costs of illnesses related to indoor environments are considerable. Despite the evidence of harm to human health, poor indoor environments are generally difficult to regulate and not of sufficient concern to the general public. We discuss several reasons for this lack of concern about IEQ, focusing specifically on home environments. Discussion Economics plays a large role both in political inaction and individual-level indifference. Because little effort has been made to quantify the value of the societal and individual costs of poor housing quality, as well as the benefits achievable by simple interventions, policymakers lack motivation to act on IEQ. Similarly, individual homeowners lack the incentive to remediate homes, as other problems may be more pressing than home environmental quality. Conclusions Although the problem of IEQ involves multiple stakeholders and multiple levels of governance, it is possible to establish economic incentives that would set the wheels in motion for action at all levels to achieve healthy home environments. Also important are education and information dissemination on the public health risks associated with indoor environments. These recommendations are intended for all decision makers who have an influence in developing policy to improve indoor environmental quality. PMID:17589606

  17. Insomnia risks and costs: health, safety, and quality of life.

    PubMed

    Rosekind, Mark R; Gregory, Kevin B

    2010-08-01

    The effect of insomnia on next-day functioning, health, safety, and quality of life results in a substantial societal burden and economic cost. The annual direct cost of insomnia has been estimated in the billions of US dollars and is attributed to the association of insomnia with the increased risk of certain psychiatric and medical comorbidities that result in increased healthcare service utilization. It is well known that psychiatric conditions, anxiety and depression in particular, are comorbid with insomnia. However, emerging data have shown links with several common and costly medical conditions such as heart disease and diabetes. Furthermore, studies show that patients who have insomnia have more emergency department and physician visits, laboratory tests, and prescription drug use than those who do not have insomnia, increasing direct and indirect consumption of healthcare resources. Insomnia also has been shown to negatively affect daytime functioning, including workplace productivity, as well as workplace and public safety. These daytime effects of insomnia are translated into indirect costs that are reportedly higher than the direct costs of this disorder. These observations have significant implications for managed care organizations and healthcare providers. Improvements in diagnosing and treating insomnia can significantly reduce the healthcare cost of insomnia and its comorbid disorders, while providing additional economic benefits from improved daytime functioning and from increased productivity.

  18. Does Competition Improve Health Care Quality?

    PubMed Central

    Scanlon, Dennis P; Swaminathan, Shailender; Lee, Woolton; Chernew, Michael

    2008-01-01

    Objective To identify the effect of competition on health maintenance organizations' (HMOs) quality measures. Study Design Longitudinal analysis of a 5-year panel of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Health Plans Survey® (CAHPS) data (calendar years 1998–2002). All plans submitting data to the National Committee for Quality Assurance (NCQA) were included regardless of their decision to allow NCQA to disclose their results publicly. Data Sources NCQA, Interstudy, the Area Resource File, and the Bureau of Labor Statistics. Methods Fixed-effects models were estimated that relate HMO competition to HMO quality controlling for an unmeasured, time-invariant plan, and market traits. Results are compared with estimates from models reliant on cross-sectional variation. Principal Findings Estimates suggest that plan quality does not improve with increased levels of HMO competition (as measured by either the Herfindahl index or the number of HMOs). Similarly, increased HMO penetration is generally not associated with improved quality. Cross-sectional models tend to suggest an inverse relationship between competition and quality. Conclusions The strategies that promote competition among HMOs in the current market setting may not lead to improved HMO quality. It is possible that price competition dominates, with purchasers and consumers preferring lower premiums at the expense of improved quality, as measured by HEDIS and CAHPS. It is also possible that the fragmentation associated with competition hinders quality improvement. PMID:18793214

  19. Does competition improve health care quality?

    PubMed

    Scanlon, Dennis P; Swaminathan, Shailender; Lee, Woolton; Chernew, Michael

    2008-12-01

    To identify the effect of competition on health maintenance organizations' (HMOs) quality measures. Longitudinal analysis of a 5-year panel of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Health Plans Survey(R) (CAHPS) data (calendar years 1998-2002). All plans submitting data to the National Committee for Quality Assurance (NCQA) were included regardless of their decision to allow NCQA to disclose their results publicly. NCQA, Interstudy, the Area Resource File, and the Bureau of Labor Statistics. Fixed-effects models were estimated that relate HMO competition to HMO quality controlling for an unmeasured, time-invariant plan, and market traits. Results are compared with estimates from models reliant on cross-sectional variation. Estimates suggest that plan quality does not improve with increased levels of HMO competition (as measured by either the Herfindahl index or the number of HMOs). Similarly, increased HMO penetration is generally not associated with improved quality. Cross-sectional models tend to suggest an inverse relationship between competition and quality. The strategies that promote competition among HMOs in the current market setting may not lead to improved HMO quality. It is possible that price competition dominates, with purchasers and consumers preferring lower premiums at the expense of improved quality, as measured by HEDIS and CAHPS. It is also possible that the fragmentation associated with competition hinders quality improvement.

  20. Quality measurement indicators for Iranian Health Centers

    PubMed Central

    Moslehi, Shandiz; Atefi Manesh, Pezhman; Sarabi Asiabar, Ali

    2015-01-01

    Background: Recently, quality is a serious concern in development of organizations. There are various indicators to assess quality and the purpose of this study was to identify the main indicators for quality measurement of Iranian health centers. Methods: This qualitative study was conducted in three stages: first, review of the literature was performed to identify different indicators for quality measurement in health centers; second, a tworound Delphi process was used with participation of 18 experts in both rounds; third, Analytical Hierarchy Process (AHP) method was applied to give weights to each indicator. Results: Twenty-seven indicators were identified from the literature review stage. The Delphi method reduced the list to 4 indicators. Developing a quality plan in the health center had the highest weight (38%) and percentage of followed complaints the lowest (12%). The consistency rate was 7.2% indicating appropriateness of the data. Conclusion: This list of indicators can be used as a template for measuring quality of health centers in Iran and possibly in other developing countries. PMID:26034730

  1. The Evaluation Scale: Exploring Decisions about Societal Impact in Peer Review Panels

    ERIC Educational Resources Information Center

    Derrick, Gemma E.; Samuel, Gabrielle N.

    2016-01-01

    Realising the societal gains from publicly funded health and medical research requires a model for a reflexive evaluation precedent for the societal impact of research. This research explores UK Research Excellence Framework evaluators' values and opinions and assessing societal impact, prior to the assessment taking place. Specifically, we…

  2. The Evaluation Scale: Exploring Decisions about Societal Impact in Peer Review Panels

    ERIC Educational Resources Information Center

    Derrick, Gemma E.; Samuel, Gabrielle N.

    2016-01-01

    Realising the societal gains from publicly funded health and medical research requires a model for a reflexive evaluation precedent for the societal impact of research. This research explores UK Research Excellence Framework evaluators' values and opinions and assessing societal impact, prior to the assessment taking place. Specifically, we…

  3. Data Quality in Electronic Health Records Research.

    PubMed

    Feder, Shelli L

    2017-01-01

    The proliferation of the electronic health record (EHR) has led to increasing interest and opportunities for nurse scientists to use EHR data in a variety of research designs. However, methodological problems pertaining to data quality may arise when EHR data are used for nonclinical purposes. Therefore, this article describes common domains of data quality and approaches for quality appraisal in EHR research. Common data quality domains include data accuracy, completeness, consistency, credibility, and timeliness. Approaches for quality appraisal include data validation with data rules, evaluation and verification of data abstraction methods with statistical measures, data comparisons with manual chart review, management of missing data using statistical methods, and data triangulation between multiple EHR databases. Quality data enhance the validity and reliability of research findings, form the basis for conclusions derived from the data, and are, thus, an integral component in EHR-based study design and implementation.

  4. Insights into the concept of vitality: associations with participation and societal costs.

    PubMed

    van Steenbergen, E; van Dongen, J M; Wendel-Vos, G C W; Hildebrandt, V H; Strijk, J E

    2016-04-01

    In healthcare, the focus is currently shifting from someone's disabilities to someone's abilities, which is also evident from the increasing focus on vitality. Vitality (here defined as energy, motivation and resilience) is an often used concept, which also aims at someone's capabilities. However, little is known about vitality yet; in particular about its association with participation and societal costs. Within a cross-sectional design, information regarding vitality, participation and societal costs was collected among 8015 Dutch adults aged 20 years and over. Vitality was measured using the validated Dutch Vitality Questionnaire (Vita-16). Information on economic (i.e. want/able to work, work absenteeism, work performance), societal (i.e. voluntary work, informal care giving) and social participation (i.e. quantity and quality of social contacts) and societal costs (i.e. healthcare and work-related costs) was collected using an internet survey. Significant associations were found between vitality and various economic (i.e.sustainable employability:want to work: β = 1.21, 95% CI: 0.99-1.43,able to work:β = 2.09, 95% CI: 1.79-2.38;work absenteeism: OR = 0.75, 95% CI: 0.71-0.79;work performance:β = 0.49, 95% CI: 0.46-0.52), societal (i.e.voluntary work, informal care) and social (i.e.quantity and quality of social contacts) participation measures, as well as between vitality and societal costs (i.e.healthcare costs:β = -213.73, 95% CI: €-311.13 to €-107.08),absenteeism costs: β = -338.57, 95% CI: €-465.36 to €-214.14 and presenteeism costs:β = -1293.31, 95% CI: €-1492.69 to €-1088.95). This study showed significant positive associations between vitality and economic, societal and social participation and negative associations between vitality and societal costs. This may stimulate research on interventions enhancing and maintaining vitality and thereby contributing to improved participation and reduced costs. © The Author 2015. Published by

  5. [Quality assurance in occupational health services].

    PubMed

    Michalak, J

    1996-01-01

    The general conditions influencing the quality assurance and audit in Polish occupational health services are presented. The factors promoting or hampering the implementation of quality assurance and audits are also discussed. The major influence on the transformation of Polish occupational health services in exorted by employers who are committed to cover the costs of the obligatory prophylactic examination of their employees. This is the factor which also contributes to the improvement of quality if services. The definitions of the most important terms are reviewed to highlight their accordance with the needs of occupational health services in Poland. The examples of audit are presented and the elements of selected methods of auditing are suggested to be adopted in Poland.

  6. Quality and Certification of Electronic Health Records

    PubMed Central

    Hoerbst, A.; Ammenwerth, E.

    2010-01-01

    Background Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited. Objectives The present paper aims at the description and comparison of the current major quality certification approaches to EHRs. Methods A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis. Results The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance. Discussion The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems. PMID:23616834

  7. Indoor air quality and human health

    SciTech Connect

    Turiel, I.

    1985-01-01

    The air inside buildings can contain various threats to human health: cigarette smoke, fumes from fires and cookers, microbes, gases, allergens and fumes produced by household products or building materials. Higher standards of insulation and draught-proofing and more use of air conditioning can increase the problems. This book provides a summary of indoor air quality problems in homes, offices and public buildings. Contents: Preface; Introduction; Formaledhyde and other household contaminants; Radon; Particulates; Combustion products; Involuntary smoking; Energy-efficient buildings and indoor air quality; Control of indoor air pollutants; Indoor air quality problems in office buildings; Legal and regulatory issues; Appendices; Sources and suggested reading; Glossary; Index.

  8. Incorporating health care quality into health antitrust law

    PubMed Central

    2008-01-01

    Background Antitrust authorities treat price as a proxy for hospital quality since health care quality is difficult to observe. As the ability to measure quality improved, more research became necessary to investigate the relationship between hospital market power and patient outcomes. This paper examines the impact of hospital competition on the quality of care as measured by the risk-adjusted mortality rates with the hospital as the unit of analysis. The study separately examines the effect of competition on non-profit hospitals. Methods We use California Office of Statewide Health Planning and Development (OSHPD) data from 1997 through 2002. Empirical model is a cross-sectional study of 373 hospitals. Regression analysis is used to estimate the relationship between Coronary Artery Bypass Graft (CABG) risk-adjusted mortality rates and hospital competition. Results Regression results show lower risk-adjusted mortality rates in the presence of a more competitive environment. This result holds for all alternative hospital market definitions. Non-profit hospitals do not have better patient outcomes than investor-owned hospitals. However, they tend to provide better quality in less competitive environments. CABG volume did not have a significant effect on patient outcomes. Conclusion Quality should be incorporated into the antitrust analysis. When mergers lead to higher prices and lower quality, thus lower social welfare, the antitrust challenge of hospital mergers is warranted. The impact of lower hospital competition on quality of care delivered by non-profit hospitals is ambiguous. PMID:18430219

  9. Under diagnosis of adult ADHD: cultural influences and societal burden.

    PubMed

    Asherson, Philip; Akehurst, Ron; Kooij, J J Sandra; Huss, Michael; Beusterien, Kathleen; Sasané, Rahul; Gholizadeh, Shadi; Hodgkins, Paul

    2012-07-01

    To explore the literature focusing on cultural influences in the diagnosis of adult ADHD and respective societal burden. A review of the literature over the past 10 years was performed using OVID. Although numerous articles focused on diagnosis and burden of adult ADHD, few focused on cultural factors influencing diagnosis. Like other mental health disorders, cultural and social perspectives contribute to our understanding of adult ADHD and may play a significant role in the diagnosis and varying acceptance of the condition. Moreover, adults with ADHD may underestimate the impact of ADHD symptoms, and in many cases have learned to compensate for ADHD related impairments by choosing lifestyles that help compensate for symptoms. Some adults with ADHD may appear to function well, however they may expend excessive amounts of energy to overcome impairments; and they may be distressed by ongoing symptoms such as restlessness, mood instability and low self-esteem. Research shows that ADHD can be detrimental to many areas of life including work, daily activities, social and family relationships and psychological and physical well-being. Patient-reported impairments in productivity due to poor time management, procrastination, and distractibility can translate into significant indirect costs and decreased quality of life. ADHD in adults is also associated with increased accidents, medical resource utilization, antisocial behaviour and drug alcohol abuse. The substantial societal burden of adult ADHD highlights the importance of providing a better understanding of the factors that contribute to accurate diagnosis and of improving the low recognition of the disorder in many world regions.

  10. Utilizing Earth Observations for Societal Issues

    NASA Technical Reports Server (NTRS)

    Habib, Shahid

    2010-01-01

    Over the last four decades a tremendous progress has been made in the Earth science space-based remote sensing observations, technologies and algorithms. Such advancements have improved the predictability by providing lead-time and accuracy of forecast in weather, climate, natural hazards, and natural resources. It has further reduced or bounded the overall uncertainties by partially improving our understanding of planet Earth as an integrated system that is governed by non-linear and chaotic behavior. Many countries such as the US, European Community, Japan, China, Russia, India has and others have invested billions of dollars in developing and launching space-based assets in the low earth (LEO) and geostationary (GEO) orbits. However, the wealth of this scientific knowledge that has potential of extracting monumental socio-economic benefits from such large investments have been slow in reaching the public and decision makers. For instance, there are a number of areas such as water resources and availability, energy forecasting, aviation safety, agricultural competitiveness, disaster management, air quality and public health, which can directly take advantage. Nevertheless, we all live in a global economy that depends on access to the best available Earth Science information for all inhabitants of this planet. This presentation discusses a process to transition Earth science data and products for societal needs including NASA's experience in achieving such objectives. It is important to mention that there are many challenges and issues that pertain to a number of areas such as: (1) difficulties in making a speedy transition of data and information from observations and models to relevant Decision Support Systems (DSS) or tools, (2) data and models inter-operability issues, (3) limitations of spatial, spectral and temporal resolution, (4) communication limitations as dictated by the availability of image processing and data compression techniques. Additionally, the

  11. Utilizing Earth Observations for Societal Issues

    NASA Technical Reports Server (NTRS)

    Habib, Shahid

    2010-01-01

    Over the last four decades a tremendous progress has been made in the Earth science space-based remote sensing observations, technologies and algorithms. Such advancements have improved the predictability by providing lead-time and accuracy of forecast in weather, climate, natural hazards, and natural resources. It has further reduced or bounded the overall uncertainties by partially improving our understanding of planet Earth as an integrated system that is governed by non-linear and chaotic behavior. Many countries such as the US, European Community, Japan, China, Russia, India has and others have invested billions of dollars in developing and launching space-based assets in the low earth (LEO) and geostationary (GEO) orbits. However, the wealth of this scientific knowledge that has potential of extracting monumental socio-economic benefits from such large investments have been slow in reaching the public and decision makers. For instance, there are a number of areas such as water resources and availability, energy forecasting, aviation safety, agricultural competitiveness, disaster management, air quality and public health, which can directly take advantage. Nevertheless, we all live in a global economy that depends on access to the best available Earth Science information for all inhabitants of this planet. This presentation discusses a process to transition Earth science data and products for societal needs including NASA's experience in achieving such objectives. It is important to mention that there are many challenges and issues that pertain to a number of areas such as: (1) difficulties in making a speedy transition of data and information from observations and models to relevant Decision Support Systems (DSS) or tools, (2) data and models inter-operability issues, (3) limitations of spatial, spectral and temporal resolution, (4) communication limitations as dictated by the availability of image processing and data compression techniques. Additionally, the

  12. Quality Improvement Implementation and Disparities: The Case of the Health Disparities Collaboratives

    PubMed Central

    Chin, Marshall H.

    2011-01-01

    Background The Health Disparities Collaboratives (HDC), a quality improvement collaborative incorporating rapid quality improvement (QI), a chronic care model, and learning sessions, have been implemented in over 900 community health centers across the country. Objectives To determine the HDC’s effect on clinical processes and outcomes, their financial impact, and factors important for successful implementation. Research Design Systematic review of the literature. Results The HDC improve clinical processes of care over short-term 1–2 year periods, and clinical processes and outcomes over longer 2–4 year periods. Most participants perceive that the HDC are successful and worth the effort. Analysis of the Diabetes Collaborative reveals that it is societally cost-effective with an incremental cost-effectiveness ratio of $33,386/quality-adjusted life year (QALY), but that consistent revenue streams for the initiative do not exist. Common barriers to improvement include lack of resources, time, and staff burnout. Highest ranked priorities for more funding are money for direct patient services, data entry, and staff time for QI. Other common requests for more assistance are help with patient self-management, information systems, and getting providers to follow guidelines. Relatively low-cost ways to increase staff morale and prevent burnout include personal recognition, skills development opportunities, and fair distribution of work. Conclusions The HDC have successfully improved quality of care and the Diabetes Collaborative is societally cost-effective, but policy reforms are necessary to create a sustainable business case for these health centers that serve many uninsured and underinsured populations. PMID:20613665

  13. Towards medicines regulatory authorities' quality performance improvement: value for public health.

    PubMed

    Pejović, Gordana; Filipović, Jovan; Tasić, Ljiljana; Marinković, Valentina

    2016-01-01

    The purpose of this article is to explore the possibility of implementing total quality management (TQM) principles in national medicines regulatory authorities in Europe to achieve all public health objectives. Bearing in mind that medicines regulation is a governmental function that serves societal objectives to protect and promote public health, measuring the effective achievement of quality objectives related to public health is of utmost importance. A generic TQM model for meeting public health objectives was developed and was tested on 10 European national medicines regulatory authorities with different regulatory performances. Participating national medicines regulatory authorities recognised all TQM factors of the proposed model in implemented systems with different degrees of understanding. An analysis of responses was performed within the framework of two established criteria-the regulatory authority's category and size. The value of the paper is twofold. First, the new generic TQM model proposes to integrate four public health objectives with six TQM factors. Second, national medicines regulatory authorities were analysed as public organisations and health authorities to develop a proper tool for assessing their regulatory performance. The paper emphasises the importance of designing an adequate approach to performance measurement of quality management systems in medicines regulatory authorities that will support their public service missions. Copyright © 2014 John Wiley & Sons, Ltd.

  14. eHealth and quality in health care: implementation time.

    PubMed

    Ossebaard, Hans C; Van Gemert-Pijnen, Lisette

    2016-06-01

    The use of information and communication technologies in health and health care could improve healthcare quality in many ways. Today's evidence base demonstrates the (cost-)effectiveness of online education, self-management support and tele-monitoring in several domains of health and care. While new results gradually provide more evidence for eHealth's impact on quality issues, now is the time to come to grips with implementation issues. Documented drawbacks such as low acceptance, low adoption or low adherence need our attention today to make the most of eHealth' potential. Improvement science is beginning to deliver the tools to address these persistent behavioural and cultural issues. The ceHRes Roadmap, for instance, is a plural and pragmatic approach that includes users' needs. It is now imperative to improve our implementation strategies in order to scale up eHealth technologies. This will accelerate the much needed transformation of our healthcare systems and sustain access, affordability and quality for all in the near future.

  15. Silver nanoparticles: technological advances, societal impacts, and metrological challenges

    NASA Astrophysics Data System (ADS)

    Calderón-Jiménez, Bryan; Johnson, Monique E.; Montoro Bustos, Antonio R.; Murphy, Karen E.; Winchester, Michael R.; Vega Baudrit, José R.

    2017-02-01

    Silver nanoparticles (AgNPs) show different physical and chemical properties compared to their macroscale analogs. This is primarily due to their small size and, consequently, the exceptional surface area of these materials. Presently, advances in the synthesis, stabilization, and production of AgNPs have fostered a new generation of commercial products and intensified scientific investigation within the nanotechnology field. The use of AgNPs in commercial products is increasing and impacts on the environment and human health are largely unknown. This article discusses advances in AgNP production and presents an overview of the commercial, societal, and environmental impacts of this emerging nanoparticle (NP), and nanomaterials in general. Finally, we examine the challenges associated with AgNP characterization, discuss the importance of the development of NP reference materials (RMs) and explore their role as a metrological mechanism to improve the quality and comparability of NP measurements.

  16. Silver Nanoparticles: Technological Advances, Societal Impacts, and Metrological Challenges

    PubMed Central

    Calderón-Jiménez, Bryan; Johnson, Monique E.; Montoro Bustos, Antonio R.; Murphy, Karen E.; Winchester, Michael R.; Vega Baudrit, José R.

    2017-01-01

    Silver nanoparticles (AgNPs) show different physical and chemical properties compared to their macroscale analogs. This is primarily due to their small size and, consequently, the exceptional surface area of these materials. Presently, advances in the synthesis, stabilization, and production of AgNPs have fostered a new generation of commercial products and intensified scientific investigation within the nanotechnology field. The use of AgNPs in commercial products is increasing and impacts on the environment and human health are largely unknown. This article discusses advances in AgNP production and presents an overview of the commercial, societal, and environmental impacts of this emerging nanoparticle (NP), and nanomaterials in general. Finally, we examine the challenges associated with AgNP characterization, discuss the importance of the development of NP reference materials (RMs) and explore their role as a metrological mechanism to improve the quality and comparability of NP measurements. PMID:28271059

  17. The Societal Costs of Schizophrenia in Switzerland.

    PubMed

    Pletscher, Mark; Mattli, Renato; von Wyl, Agnes; Reich, Oliver; Wieser, Simon

    2015-06-01

    Schizophrenia is a severe mental disorder that typically develops in early adulthood and becomes chronic in most cases. The disease is associated with elevated health care utilization, impaired functionality and the loss of life years and quality of life. The prevalence and costs of schizophrenia are not yet known for Switzerland. This study aims to estimate the prevalence of schizophrenia in Switzerland and to assess its burden on patients, caregivers and society as a whole. A hospital registry was combined with an outpatient physician survey and health insurance claims data to capture all patients living in the northern part of the canton of Zurich. Structured interviews with outpatient physicians were held to obtain information on outpatient care in private practices. Total costs included direct medical and nonmedical costs and lost production. All costs were calculated for the year 2012 from a societal perspective using a prevalence-based bottom-up approach. Intangible costs were expressed as quality-adjusted life years (QALY). Uncertainty and its sources were addressed in univariate and probabilistic sensitivity analyses. The point prevalence of schizophrenia in Switzerland was estimated at 0.39% of the population. The average costs of schizophrenia in 2012 were EUR 39,408 per patient. Lost production accounted for 64% (EUR 25,108) of the total cost of illness, direct medical costs for 24% (EUR 9,507) and care by relatives or in residential homes for the mentally ill for 12% (EUR 4,793). Inpatient hospital care amounted to EUR 6,242 per year or 66% of direct medical costs. The results show the high burden of schizophrenia on patients, caregivers and society. The prevalence estimate can be considered a lower bound because undiagnosed cases were not identified by our empirical strategy. The estimated costs are conservative because the costs of comorbidities were not considered. The strengths of this study are the full coverage of the sample region by a

  18. Inflammation, Oxidative Stress, and Antioxidants Contribute to Selected Sleep Quality and Cardiometabolic Health Relationships: A Cross-Sectional Study

    PubMed Central

    Kanagasabai, Thirumagal; Ardern, Chris I.

    2015-01-01

    Sleep is vital for cardiometabolic health, but a societal shift toward poor sleep is a prominent feature of many modern cultures. Concurrently, factors such as diet and lifestyle have also changed and may mediate the relationship between sleep quality and cardiometabolic health. Objectives were to explore (1) the interrelationship and (2) mediating effect of inflammation, oxidative stress, and antioxidants on sleep quality and cardiometabolic health. Cross-sectional data from the US National Health and Nutritional Examination Survey 2005-06 (≥20 y; N = 2,072) was used. Cardiometabolic health was defined as per the Joint Interim Statement; overall sleep quality was determined from six sleep habits and categorized as good, fair, poor, and very poor. Fair quality sleepers had optimal inflammation, oxidative stress, and antioxidant levels. Inflammation was above the current clinical reference range across all sleep quality categories, while oxidative stress was only within the clinical reference range for fair sleep quality. Selected sleep quality-cardiometabolic health relationships were mediated by inflammation, oxidative stress, and antioxidants and were moderated by sex. Our results provide initial evidence of a potential role for inflammation, oxidative stress, and antioxidants in the pathway between poor sleep quality-cardiometabolic decline. Further prospective research is needed to confirm our results. PMID:26568665

  19. Inflammation, Oxidative Stress, and Antioxidants Contribute to Selected Sleep Quality and Cardiometabolic Health Relationships: A Cross-Sectional Study.

    PubMed

    Kanagasabai, Thirumagal; Ardern, Chris I

    2015-01-01

    Sleep is vital for cardiometabolic health, but a societal shift toward poor sleep is a prominent feature of many modern cultures. Concurrently, factors such as diet and lifestyle have also changed and may mediate the relationship between sleep quality and cardiometabolic health. Objectives were to explore (1) the interrelationship and (2) mediating effect of inflammation, oxidative stress, and antioxidants on sleep quality and cardiometabolic health. Cross-sectional data from the US National Health and Nutritional Examination Survey 2005-06 (≥20 y; N = 2,072) was used. Cardiometabolic health was defined as per the Joint Interim Statement; overall sleep quality was determined from six sleep habits and categorized as good, fair, poor, and very poor. Fair quality sleepers had optimal inflammation, oxidative stress, and antioxidant levels. Inflammation was above the current clinical reference range across all sleep quality categories, while oxidative stress was only within the clinical reference range for fair sleep quality. Selected sleep quality-cardiometabolic health relationships were mediated by inflammation, oxidative stress, and antioxidants and were moderated by sex. Our results provide initial evidence of a potential role for inflammation, oxidative stress, and antioxidants in the pathway between poor sleep quality-cardiometabolic decline. Further prospective research is needed to confirm our results.

  20. Quality indicators in ovarian cancer surgery: report from the French Society of Gynecologic Oncology (Societe Francaise d'Oncologie Gynecologique, SFOG).

    PubMed

    Querleu, D; Ray-Coquard, I; Classe, J M; Aucouturier, J S; Bonnet, F; Bonnier, P; Darai, E; Devouassoux, M; Gladieff, L; Glehen, O; Haie-Meder, C; Joly, F; Lécuru, F; Lefranc, J P; Lhommé, C; Morice, P; Salengro, A; Stoeckle, E; Taieb, S; Zeng, Z X; Leblanc, E

    2013-11-01

    Based on registries, the European experience has been that <50% of patients are treated according to protocols and/or benefit from the minimum required surgery for ovarian cancer. The French Cancer Plan 2009-2013 considers the definition of qualitative indicators in ovarian cancer surgery in France. This endeavour was undertaken by the French Society of Gynaecologic Oncology (SFOG) in partnership with the French National College of Obstetricians and Gynecologists and all concerned learned societies in a multidisciplinary mindset. The quality indicators for the initial management of patients with ovarian cancer were based on the standards of practice determined from scientific evidence or expert consensus. The indicators were divided into structural indicators, including material (equipment), human (number and qualification of staff), and organizational resources, process indicators, and outcome indicators. The enforcement of a quality assurance programme in any country would undoubtedly promote improvement in the quality of care for ovarian cancer patients and would result in a dramatic positive impact on their survival. Such a policy is not only beneficial to the patient, but is also profitable for the healthcare system.

  1. Hydroelectric power provides a cheap source of electricity with few carbon emissions. Yet, reservoirs are not operated sustainably, which we define as meeting societal needs for water and power while protecting long-term health of the river ecosystem. Reservoirs that generate hydropower are typically operated with the goal of maximizing energy reve

    SciTech Connect

    Jager, Yetta; Smith, Brennan T

    2008-02-01

    Hydroelectric power provides a cheap source of electricity with few carbon emissions. Yet, reservoirs are not operated sustainably, which we define as meeting societal needs for water and power while protecting long-term health of the river ecosystem. Reservoirs that generate hydropower are typically operated with the goal of maximizing energy revenue, while meeting other legal water requirements. Reservoir optimization schemes used in practice do not seek flow regimes that maximize aquatic ecosystem health. Here, we review optimization studies that considered environmental goals in one of three approaches. The first approach seeks flow regimes that maximize hydropower generation, while satisfying legal requirements, including environmental (or minimum) flows. Solutions from this approach are often used in practice to operate hydropower projects. In the second approach, flow releases from a dam are timed to meet water quality constraints on dissolved oxygen (DO), temperature and nutrients. In the third approach, flow releases are timed to improve the health of fish populations. We conclude by suggesting three steps for bringing multi-objective reservoir operation closer to the goal of ecological sustainability: (1) conduct research to identify which features of flow variation are essential for river health and to quantify these relationships, (2) develop valuation methods to assess the total value of river health and (3) develop optimal control softwares that combine water balance modelling with models that predict ecosystem responses to flow.

  2. Climate change, air quality, and human health.

    PubMed

    Kinney, Patrick L

    2008-11-01

    Weather and climate play important roles in determining patterns of air quality over multiple scales in time and space, owing to the fact that emissions, transport, dilution, chemical transformation, and eventual deposition of air pollutants all can be influenced by meteorologic variables such as temperature, humidity, wind speed and direction, and mixing height. There is growing recognition that development of optimal control strategies for key pollutants like ozone and fine particles now requires assessment of potential future climate conditions and their influence on the attainment of air quality objectives. In addition, other air contaminants of relevance to human health, including smoke from wildfires and airborne pollens and molds, may be influenced by climate change. In this study, the focus is on the ways in which health-relevant measures of air quality, including ozone, particulate matter, and aeroallergens, may be affected by climate variability and change. The small but growing literature focusing on climate impacts on air quality, how these influences may play out in future decades, and the implications for human health is reviewed. Based on the observed and anticipated impacts, adaptation strategies and research needs are discussed.

  3. Health care quality improvement publication trends.

    PubMed

    Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H

    2014-01-01

    To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991. © 2013 by the American College of Medical Quality.

  4. Oral Health-related Quality of Life

    PubMed Central

    Sischo, L.; Broder, H.L.

    2011-01-01

    Despite its relatively recent emergence over the past few decades, oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research. OHRQoL is a multidimensional construct that includes a subjective evaluation of the individual’s oral health, functional well-being, emotional well-being, expectations and satisfaction with care, and sense of self. It has wide-reaching applications in survey and clinical research. OHRQoL is an integral part of general health and well-being. In fact, it is recognized by the World Health Organization (WHO) as an important segment of the Global Oral Health Program (2003). This paper identifies the what, why, and how of OHRQoL and presents an oral health theoretical model. The relevance of OHRQoL for dental practitioners and patients in community-based dental practices is presented. Implications for health policy and related oral health disparities are also discussed. A supplemental Appendix contains a Medline and ProQuest literature search regarding OHRQoL research from 1990-2010 by discipline and research design (e.g., descriptive, longitudinal, clinical trial, etc.). The search identified 300 articles with a notable surge in OHRQoL research in pediatrics and orthodontics in recent years. PMID:21422477

  5. [Basic principles of quality management in public health service].

    PubMed

    Selbmann, H K

    1996-11-01

    Philosophy, objectives and tools of Total Quality Management are applicable in Public Health services as in every other business. However, they need special adaptation. In Public Health offices requirements of an effective Total Quality Management are the commitment of the top management, an appropriate structure of the quality management system, customer orientation and quality awareness of the personnel, quality indicators and the existence of procedures for problem recognition, good command of the tools of quality management, and the knowledge of the effectiveness of implemented traditional quality assurance measures. Certification procedures following the European Quality Award seem to be appropriate for a global evaluation of quality and quality management of a Public Health office.

  6. [Quality management in a public health agency].

    PubMed

    Villalbí, Joan R; Ballestín, Manuela; Casas, Conrad; Subirana, Teresa

    2012-01-01

    This article describes the introduction of quality improvement actions in a public health organization. After ISO 17025 accreditation, which was legally mandated, was granted to the official control laboratory, the management decided to expand a quality policy in 2003, through a series of actions based on process analysis and proposals for improvement, further definition of standard operating procedures, exploration of users' opinions, the creation of improvement groups, and external audits or certification. The organizational response to these initiatives was diverse. External audit or certification of services seems to be the most powerful tool for change. Costing studies showed that up to 75% of the total expenditure of the agency in 2010 was spent on public health services subject to external audit or certification.

  7. Broader Societal Issues of Nanotechnology

    NASA Astrophysics Data System (ADS)

    Roco, M. C.

    2003-08-01

    Nanoscale science and engineering are providing unprecedented understanding and control over the basic building blocks of matter, leading to increased coherence in knowledge, technology, and education. The main reason for developing nanotechnology is to advance broad societal goals such as improved comprehension of nature, increased productivity, better healthcare, and extending the limits of sustainable development and of human potential. This paper outlines societal implication activities in nanotechnology R&D programs. The US National Nanotechnology Initiative annual investment in research with educational and societal implications is estimated at about 30 million (of which National Science Foundation (NSF) awards about 23 million including contributions to student fellowships), and in nanoscale research with relevance to environment at about 50 million (of which NSF awards about 30 million and EPA about 6 million). An appeal is made to researchers and funding organizations worldwide to take timely and responsible advantage of the new technology for economic and sustainable development, to initiate societal implications studies from the beginning of the nanotechnology programs, and to communicate effectively the goals and potential risks with research users and the public.

  8. Societal Development and Social Change

    ERIC Educational Resources Information Center

    Nderu-Boddington, Eulalee

    2008-01-01

    This article compares and contrasts the theories of three major writers on societal change: Chirot discusses the economic power struggles within and among core, peripheral, and semiperipheral societies, Toffler exposes a future in which major power shifts could have cataclysmic results, and Bruner emphasizes the importance of education to temper…

  9. Making Quality Health Websites a National Public Health Priority: Toward Quality Standards

    PubMed Central

    2016-01-01

    Background Most US adults have limited health literacy skills. They struggle to understand complex health information and services and to make informed health decisions. The Internet has quickly become one of the most popular places for people to search for information about their health, thereby making access to quality information on the Web a priority. However, there are no standardized criteria for evaluating Web-based health information. Every 10 years, the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion (ODPHP) develops a set of measurable objectives for improving the health of the nation over the coming decade, known as Healthy People. There are two objectives in Healthy People 2020 related to website quality. The first is objective Health Communication and Health Information Technology (HC/HIT) 8.1: increase the proportion of health-related websites that meet 3 or more evaluation criteria for disclosing information that can be used to assess information reliability. The second is objective HC/HIT-8.2: increase the proportion of health-related websites that follow established usability principles. Objective The ODPHP conducted a nationwide assessment of the quality of Web-based health information using the Healthy People 2020 objectives. The ODPHP aimed to establish (1) a standardized approach to defining and measuring the quality of health websites; (2) benchmarks for measurement; (3) baseline data points to capture the current status of website quality; and (4) targets to drive improvement. Methods The ODPHP developed the National Quality Health Website Survey instrument to assess the quality of health-related websites. The ODPHP used this survey to review 100 top-ranked health-related websites in order to set baseline data points for these two objectives. The ODPHP then set targets to drive improvement by 2020. Results This study reviewed 100 health-related websites. For objective HC/HIT-8.1, a total of 58 out

  10. Quality of Life, Health Status, and Depression

    PubMed Central

    Pike, Nancy A.; Evangelista, Lorraine S.; Doering, Lynn V.; Eastwood, Jo-Ann; Lewis, Alan B.; Child, John S.

    2012-01-01

    Background Quality of life (QOL) in adolescents and adults who have undergone the Fontan procedure and are living with only 1 ventricle is presumed to be diminished. Objectives This study aimed to compare QOL, health status, and prevalence of depression in adolescents/adults after the Fontan procedure with healthy counterparts and to identify predictors of QOL in the Fontan group. Methods Using a comparative, cross-sectional design, 54 adolescents and adults with single ventricle congenital heart disease who have undergone the Fontan procedure were compared with 66 age-matched healthy counterparts. Quality of life, health status, depression, and social support were measured using the Satisfaction With Life Scale, Short Form Survey Version 2, Patient Health Questionnaire Depression Module, and Multidimensional Scale of Perceived Social Support. Clinical variables were abstracted from medical records. Predictors of QOL were determined using multiple linear regression. Results Adolescents and adults in the Fontan group reported lower physical health status (mean [SD] = 46.5 [9.3] vs mean [SD] = 55.9 [5.1], P < .001) and were more depressed (mean [SD] = 7.3 [5.9] vs mean [SD] = 4.5 [4.3], P < .004) than their healthy counterparts. There were no differences in QOL, mental health status, or social support between the 2 groups. Functional status (New York Heart Association class), depression, and social support accounted for 55% of the variance in QOL in the Fontan group. Conclusions Despite lower levels of physical health, the QOL of Fontan patients was comparable with that of their healthy counterparts; this finding contradicts previous proxy reports, self-reports, and assumptions that QOL is lower in patients with complex single ventricle congenital heart disease. However, because Fontan patients were more depressed than their healthy counterparts, the need for early screening and detection is warranted. PMID:21912272

  11. Quality of health care: the responsibility of health care professionals in delivering high quality services.

    PubMed

    Giangrande, A

    1998-11-01

    According to a recent definition, quality of care consists of the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge; a definition that introduces both requirements of outcomes and the appropriateness of the process used. Clearly many different figures are interested in quality assessment initiatives in the health care field and these include patients, administrators and doctors each having different perspective. Doctors obviously pay greater attention to technical quality and results, giving greater emphasis to the health of the individual patient, tending to give priority to technical excellence and interaction between patient and doctor. Although the perspective of health care professionals is widely acknowledged to be important and useful, other perspectives on quality have been emphasised in recent years. The most important of these is the recognition that care must be responsive to the preferences and values of the consumers of health care services. In complete harmony with one's own professional commitment, the attention to the perspectives of patients must give physician the chance to identify methods of measuring and verifying quality which take account of the expectations of the many groups with an interest in improving the functioning of the health system. A global approach in the health field is needed the more specialization advances. The quality of medicine lies in its capacity to integrate what science says is appropriate and to be recommended, what can be reconciled with human rights and the self determination of the patient and what can be achieved by optimising available resources. In this complex context, the doctor could take on both the role of the person who decides on the use of resources and the one of social mediator.

  12. [Chronic pain management: societal impact].

    PubMed

    Serrie, Alain

    2015-01-01

    Pain is a real issue of public health, quality and evolution of a system of health test: this is a major social problem. Pain management meets a humanistic, ethical purpose and dignity of man because of the physical and psychological implications. It induces a disability which excludes the patient of society gradually or suddenly. The physical pain and mental suffering to all ages of life make more vulnerable people weakened by disease. Rebel chronic pain are sources of disability, disabilities, disability and major alterations in the quality of life. All of these data shows the impact of pain and its intensity on the professional conditions, on professional activity and productivity, on the use of care systems (very significant increase in medical consultations, hospitalizations), as well as on the mental and physical health. These results confirmed analyses which consider that the unrelieved pain has a major economic impact on care systems and constitutes a public health problem with around two thirds of persons professionally impacted by pain. The progress of medicine has helped the healing of certain serious diseases, but also favoured acute diseases to turn to chronic diseases. The result is an increase in of lifetime sometimes without disease, but this survival may be also accompanied by disease or disability. Progress, pain and suffering, the end of life, ethics will be the core of the basic thoughts of tomorrow.

  13. Human Health Water Quality Criteria and Methods for Toxics

    EPA Pesticide Factsheets

    Documents pertaining to Human Health Water Quality Criteria and Methods for Toxins. Includes 2015 Update for Water Quality Criteria, 2002 National Recommended Human Health Criteria, and 2000 EPA Methodology.

  14. Using a survey to estimate health expectancy and quality-adjusted life expectancy to assess inequalities in health and quality of life.

    PubMed

    Collins, Brendan

    2013-06-01

    There has been a policy debate in the United Kingdom about moving beyond traditional measures of life expectancy and economic output to developing more meaningful ways of measuring national well-being. To test whether quality adjusted life expectancy (QALE) was a useful indicator of health inequalities. EuroQol five-dimensional questionnaire data from a well-being survey was combined with actuarial life expectancy (LE) data to estimate healthy LE (HLE), that is, years of life lived in good health, and QALE, that is, quality-adjusted life-years (QALYs) lived for Wirral, a borough in the north west of England. The gap between Wirral and the most deprived areas was 4.45 years for LE, 5.34 for QALE, and 7.55 for HLE. The gap in QALE was 20% greater than the gap in LE, while the gap in HLE was 70% greater. The fact that the QALE gap value lies between the HLE value and the LE value suggests that QALE is a more sensitive indicator than HLE, as in this study QALE is derived from 243 possible EuroQol five-dimensional questionnaire profiles whereas HLE is based only on whether or not an individual rates his or her health as good, a binary variable. This study discusses how QALE could be a useful indicator for measuring health inequalities in future, especially as cost utility and QALYs are seen as the gold standard used by the National Institute for Health and Clinical Excellence in the United Kingdom to measure outcomes for health interventions in England, and discusses how a monetary valuation of QALYs could be used to put a societal cost on health inequalities. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  15. United States societal experiments via the Communications Technology Satellite

    NASA Technical Reports Server (NTRS)

    Donoughe, P. L.

    1976-01-01

    After a brief description of the Communication Technology Satellite and its U.S. coverage, the U.S. societal experiments via the CTS are discussed. These include education (college curriculum sharing, and project interchange), health care (biomedical communications, health communications, and communication support for decentralized education), and community and special experiments (satellite library information network, and transportable earth terminal).

  16. United States societal experiments via the Communications Technology Satellite

    NASA Technical Reports Server (NTRS)

    Donoughe, P. L.

    1976-01-01

    After a brief description of the Communication Technology Satellite and its U.S. coverage, the U.S. societal experiments via the CTS are discussed. These include education (college curriculum sharing, and project interchange), health care (biomedical communications, health communications, and communication support for decentralized education), and community and special experiments (satellite library information network, and transportable earth terminal).

  17. [Quality management is associated with high quality services in health care].

    PubMed

    Nielsen, Tenna Hassert; Riis, Allan; Mainz, Jan; Jensen, Anne-Louise Degn

    2013-12-09

    In these years, quality management has been the focus in order to meet high quality services for the patients in Danish health care. This article provides information on quality management and quality improvement and it evaluates its effectiveness in achieving better organizational structures, processes and results in Danish health-care organizations. Our findings generally support that quality management is associated with high quality services in health care.

  18. Assuring quality health care outcomes: lessons learned from car dealers?

    PubMed Central

    Dimsdale, Joel E

    2017-01-01

    Health care systems want quality but struggle to find the right tools because, typically, they track quality in only one or two ways. Because of the complexity of health care, high quality will emerge only when health care systems employ multiple approaches, including, importantly, patient-reported outcome perspectives. Sustained changes are unlikely to emerge in the absence of such multipronged interventions. PMID:28123314

  19. Deming's quality principles: a health care application.

    PubMed

    Lynn, M L; Osborn, D P

    1991-01-01

    W. Edwards Deming is considered a guru of quality by many international manufacturers. His ideas revolutionized Japan's auto industry in the 1950s, but did not make a substantial impact in the United States until 1980. Increasingly, service organizations, from hotels to public utility companies, are experimenting with his principles. This article explains how a 165-bed community hospital--Brazosport Memorial Hospital in Lake Jackson, Texas--is putting Deming's ideas to work in health care. Deming's philosophy and principles are described as is the hospital's application and implementation of his ideas; preliminary results are encouraging.

  20. Quality of indoor residential air and health

    PubMed Central

    Dales, Robert; Liu, Ling; Wheeler, Amanda J.; Gilbert, Nicolas L.

    2008-01-01

    About 90% of our time is spent indoors where we are exposed to chemical and biological contaminants and possibly to carcinogens. These agents may influence the risk of developing nonspecific respiratory and neurologic symptoms, allergies, asthma and lung cancer. We review the sources, health effects and control strategies for several of these agents. There are conflicting data about indoor allergens. Early exposure may increase or may decrease the risk of future sensitization. Reports of indoor moulds or dampness or both are consistently associated with increased respiratory symptoms but causality has not been established. After cigarette smoking, exposure to environmental tobacco smoke and radon are the most common causes of lung cancer. Homeowners can improve the air quality in their homes, often with relatively simple measures, which should provide health benefits. PMID:18625986

  1. [Evaluation of Mexican 'Sicalidad' health quality program].

    PubMed

    Rivera-Buendía, Frida; Bello-Chavolla, Omar Y; Zubieta-Zavala, Adriana; Hernández-Ramírez, Luz; Zepeda-Tena, Carolina; Durán-Arenas, Luis

    2015-01-01

    To analize the implementation of the Sistema Integral de Calidad en Salud (Sicalidad) program of the Ministry of Health in the 2011. The study follows a cross sectional design, hybrid, with a qualitative and quantitative components. A cluster probabilístic sample was used with two stages. A total of 3 034 interviews were carried out in 13 states to evaluate the implementation of the eight components of the Sicalidad program. General indexes of performance (GIP) were formulated for structure process and satisfaction of users, physicians and nurses with the program. The GIP with the lower score was accreditation of health facilities with a range of scores between 25.4 and 28% in the medical units evaluated; The highest range of scores was in the component of nosocomial infection prevention between 78.3 and 92%. In brief the Sicalidad components evaluated suggest problems with both structure and critical process elements in the implementation of the quality initiatives.

  2. Designing for interaction quality in health telematics.

    PubMed

    Stephanidis, C

    2000-01-01

    This paper focuses on emerging Human Computer Interaction (HCI) challenges in the context of Health Telematics. Specifically, assumptions in traditional approaches to product and process quality are discussed, in order to unfold the reasons behind the loose and partial insight offered to the design of technology for the broadest possible end-user population. The premises of "Universal Design" are briefly discussed and the concept of "User Interfaces for All" is presented, as an articulation of Universal Design in the area of HCI. Following this, the paper discusses how such a perspective improves upon conventional methods and tools for HCI design and presents some of its relative merits in the context of Health Telematics.

  3. The Role of Vitality in the Relationship Between a Healthy Lifestyle and Societal Costs of Health Care and Lost Productivity: A Mediation Analysis.

    PubMed

    Hartman, L; van Dongen, J M; Hildebrandt, V H; Strijk, J E

    2016-07-01

    To examine the mediating effect of vitality in the relationship between healthy lifestyle characteristics and health-care and productivity-related costs. Observational prospective cohort study with 2 measurements. Online questionnaires were filled out in 2013 (T0) and 2014 (T1). A random sample of a Dutch online interview panel was obtained. Data of 4231 Dutch adults who had complete data at T0 and T1 were used in the present study. Participants were representative for the Dutch adult population in terms of age, gender, and having chronic disease(s). Healthy Lifestyle Index (HLI), vitality, and health-care and productivity-related costs. The HLI consisted of the sum of 6 healthy lifestyle characteristics, including a healthy BMI (yes/no), meeting physical activity, fruit, vegetable, and alcohol consumption guidelines (yes/no), and smoking status (yes: non or former smoker/no: current smoker). Health-care and productivity-related costs were measured using a utilization questionnaire. Linear regression analysis. The HLI was related to vitality. In addition, vitality was related to health-care costs and productivity-related costs. Furthermore, vitality was found to transmit 28.4% of the effect of HLI on health-care costs and 39.4% of the effect of HLI on productivity-related costs. Lifestyle was related to vitality and vitality to health-care and productivity-related costs. Vitality mediated the relationship between lifestyle and health-care and productivity-related costs. Therefore, we recommend to sustain and improve both vitality and lifestyle. © The Author(s) 2016.

  4. Patient issues in health research and quality of care: an inventory and data synthesis.

    PubMed

    Teunissen, Truus; Visse, Merel; de Boer, Pim; Abma, Tineke A

    2013-12-01

    The purpose of this review is to generate an inventory of issues that matter from a patient perspective in health research and quality of care. From these issues, criteria will be elicited to support patient(s) (groups) in their role as advisor or advocate when appraising health research, health policy and quality of health care. Literature shows that patients are beginning to develop their own voice and agenda's with issues in order to be prepared for the collaboration with professionals. Yet, patient issues have not been investigated systematically. This review addresses what patients find important and help to derive patient criteria for appraising research and quality of care. METHODS/SEARCH STRATEGY: Information was gathered from Western countries with similar economic, societal and health-care situations. We searched (from January 2000 to March 2010) for primary sources, secondary sources and tertiary sources; non-scientific publications were also included. The international inventory of issues that were defined by patients is covering a large array of domains. In total, 35 issue clusters further referred to as criteria were found ranging from dignity to cost effectiveness and family involvement. Issues from a patient perspective reveal patient values and appear to be adding to professional issues. Patient issues cover a broad domain, including fundamental values, quality of life, quality of care and personal development. Quite a few issues do not find its reflection in the scientific literature in spite of their clear and obvious appearance from tertiary sources. This may indicate a gap between the scientific research community and patient networks. © 2011 John Wiley & Sons Ltd.

  5. Water Quality and Sustainable Environmental Health

    NASA Astrophysics Data System (ADS)

    Setegn, S. G.

    2014-12-01

    Lack of adequate safe water, the pollution of the aquatic environment and the mismanagement of resources are major causes of ill-health and mortality, particularly in the developing countries. In order to accommodate more growth, sustainable fresh water resource management will need to be included in future development plans. One of the major environmental issues of concern to policy-makers is the increased vulnerability of ground water quality. The main challenge for the sustainability of water resources is the control of water pollution. To understand the sustainability of the water resources, one needs to understand the impact of future land use and climate changes on the natural resources. Providing safe water and basic sanitation to meet the Millennium Development Goals will require substantial economic resources, sustainable technological solutions and courageous political will. A balanced approach to water resources exploitation for development, on the one hand, and controls for the protection of health, on the other, is required if the benefits of both are to be realized without avoidable detrimental effects manifesting themselves. Meeting the millennium development goals for water and sanitation in the next decade will require substantial economic resources, sustainable technological solutions and courageous political will. In addition to providing "improved" water and "basic" sanitation services, we must ensure that these services provide: safe drinking water, adequate quantities of water for health, hygiene, agriculture and development and sustainable sanitation approaches to protect health and the environment.

  6. Obstacles to employers' pursuit of health care quality.

    PubMed

    Hargraves, J Lee; Trude, Sally

    2002-01-01

    Large employers' roles in improving health care quality are shifting away from value-based purchasing toward direct efforts to improve health care delivery within local markets. Although most large employers adopted the tools required for value-based purchasing, inadequate information on quality has frustrated employers and limited their ability to make choices based on quality. More recent quality initiatives aimed at directly improving local health delivery systems may be limited to specific markets where the largest employers can exert substantial influence.

  7. Status of total quality management in Australian public health organisations.

    PubMed

    Turner, R; Hartley, R

    1998-01-01

    Research suggests that there is some confusion among quality improvement managers about the differences between quality management and traditional quality assurance. This lack of understanding would appear to be the same among rural and urban health staff, although there is a higher percentage of staff engaged in multidisciplinary activities in the rural health services. Education of staff and commitment from top management would seem to be the factors inhibiting the health industry from incorporating quality management into their cultures.

  8. [Influence of stomatological health upon the quality of life].

    PubMed

    Simanovskaia, O E

    2008-01-01

    The parameters of quality of life of 58 stomatological patients were investigated. 3 groups of dentist health were allocated. On the basis of correlation dependence was proved that stomatological diseases sharply reduced the quality of life and health. The application for the invention quality of a life on indexes of stomatologic health> is issued, allowing to define individual volume of treatment-and-prophylactic actions depending the parameters of quality of life.

  9. [Quality of health care, accreditation, and health technology assessment in Croatia: role of agency for quality and accreditation in health].

    PubMed

    Mittermayer, Renato; Huić, Mirjana; Mestrović, Josipa

    2010-12-01

    Avedis Donabedian defined the quality of care as the kind of care, which is expected to maximize an inclusive measure of patient welfare, after taking into account the balance of expected gains and losses associated with the process of care in all its segments. According to the World Medical Assembly, physicians and health care institutions have an ethical and professional obligation to strive for continuous quality improvement of services and patient safety with the ultimate goal to improve both individual patient outcomes as well as population health. Health technology assessment (HTA) is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner, with the aim to formulate safe and effective health policies that are patient focused and seek to achieve the highest value. The Agency for Quality and Accreditation in Health was established in 2007 as a legal, public, independent, nonprofit institution under the Act on Quality of Health Care. The Agency has three departments: Department of Quality and Education, Department of Accreditation, and Department of Development, Research, and Health Technology Assessment. According to the Act, the Agency should provide the procedure of granting, renewal and cancellation of accreditation of healthcare providers; proposing to the Minister, in cooperation with professional associations, the plan and program for healthcare quality assurance, improvement, promotion and monitoring; proposing the healthcare quality standards as well as the accreditation standards to the Minister; keeping a register of accreditations and providing a database related to accreditation, healthcare quality improvement, and education; providing education in the field of healthcare quality assurance, improvement and promotion; providing the HTA procedure and HTA database, supervising the healthcare insurance

  10. Patient issues in health research and quality of care: an inventory and data synthesis

    PubMed Central

    Teunissen, Truus; Visse, Merel; de Boer, Pim; Abma, Tineke A.

    2011-01-01

    Abstract Aim  The purpose of this review is to generate an inventory of issues that matter from a patient perspective in health research and quality of care. From these issues, criteria will be elicited to support patient(s) (groups) in their role as advisor or advocate when appraising health research, health policy and quality of health care. Background  Literature shows that patients are beginning to develop their own voice and agenda’s with issues in order to be prepared for the collaboration with professionals. Yet, patient issues have not been investigated systematically. This review addresses what patients find important and help to derive patient criteria for appraising research and quality of care. Methods/search strategy  Information was gathered from Western countries with similar economic, societal and health‐care situations. We searched (from January 2000 to March 2010) for primary sources, secondary sources and tertiary sources; non‐scientific publications were also included. Results  The international inventory of issues that were defined by patients is covering a large array of domains. In total, 35 issue clusters further referred to as criteria were found ranging from dignity to cost effectiveness and family involvement. Issues from a patient perspective reveal patient values and appear to be adding to professional issues. Conclusions  Patient issues cover a broad domain, including fundamental values, quality of life, quality of care and personal development. Quite a few issues do not find its reflection in the scientific literature in spite of their clear and obvious appearance from tertiary sources. This may indicate a gap between the scientific research community and patient networks. PMID:21771226

  11. Health districts as quality improvement collaboratives and multijurisdictional entities.

    PubMed

    Livingood, William; Marshall, Nandi; Peden, Angela; Gonzalez, Ketty; Shah, Gulzar H; Alexander, Dayna; Penix, Kellie; Lawrence, Raymona; Toal, Russell; Woodhouse, Lynn

    2012-11-01

    Local health departments are increasingly challenged to meet emerging health problems at the same time that they are being challenged with dwindling resources and the demands of accreditation. To assess the capacity of Multicounty health districts to serve as "Quality Improvement Collaboratives" and support local health departments to meet accreditation standards. The study used an online survey tool and follow-up phone calls with key informants in health districts and county health departments in Georgia. Data collection was primarily based on an instrument to measure Quality Improvement Collaboratives that was adapted and tested for use with public health agencies in Georgia. The Georgia PBRN conducted this study of health districts and county health departments. The Georgia Department of Public Health supports 18 health districts and 159 county health departments (GA DPH, 2011). The health districts range in county composition from 1 to 16 counties in each district. Key informants comprised district and county health department staff and county health department board members were identified by 13 participating health district offices. Key opinion leaders from both the rural and nonrural counties agreed that the Districts were important for providing essential services and supporting quality improvement collaboration. Psychometric testing of the Quality Improvement Collaborative assessment public health instrument yielded high scores for validity and reliability. Regionalization of local public health capacity is a critical emerging issue for public health accreditation and quality improvement. This study demonstrated the utility of regionalization across traditional local geopolitical boundaries.

  12. Optimal quality reporting in markets for health plans.

    PubMed

    Glazer, Jacob; McGuire, Thomas G

    2006-03-01

    Quality reports about health plans and providers are becoming more prevalent in health care markets. This paper casts the decision about what information to report to consumers about health plans as a policy decision. In a market with adverse selection, complete information about quality leads to inefficient outcomes. In a Rothschild-Stiglitz model, we show that averaging quality information into a summary report can enforce pooling in health insurance, and by choice of the right weights in the averaged report, a payer or regulator can induce first-best quality choices. The optimal quality report is as powerful as optimal risk adjustment in correcting adverse selection inefficiencies.

  13. The Effects of School Quality on Long-Term Health

    ERIC Educational Resources Information Center

    Sansani, Shahar

    2011-01-01

    In this paper I estimate the relationship between school quality and mortality. Although many studies have linked the quantity of education to health outcomes, the effect of school quality on health has yet to be examined. I construct synthetic birth cohorts and relate the quality of education they attained to their mortality rates. I find that…

  14. Theory and practice for measuring health care quality

    PubMed Central

    Berwick, Donald M.; Knapp, Marian Gilbert

    1987-01-01

    As competition, cost control, and new modes of delivery emerge in health care, there is a need to reexamine both the traditional definitions of health care quality and the methods by which it is measured. Industries other than health care have much to teach regarding the methods for obtaining, analyzing, and displaying data; techniques for problem identification, problem solving, and reassessment; and ideas about organizational factors that produce a high quality product or service. The Quality-of-Care Measurement Department at the Harvard Community Health Plan has built a program that draws from a distinguished health care quality assurance tradition and incorporates techniques that have been successful in other industries. PMID:10312319

  15. Hospital heterogeneity: what drives the quality of health care.

    PubMed

    Ali, Manhal; Salehnejad, Reza; Mansur, Mohaimen

    2017-04-24

    A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals' human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.

  16. Quality in occupational health care: management's view.

    PubMed

    Callahan, E W

    1994-04-01

    Total Quality Management (TQM) is a continual improvement process that requires common sense, education and training, and the ability to communicate and work as part of a team. TQM can improve all aspects of a business, including health, safety, and environmental functions. Physicians and nonphysician managers can use TQM to identify and respond to customer needs and improve the efficiency and effectiveness of programs. Examples of TQM to improve medical programs have included (1) an Audit Program that assesses medical programs and provides specific measurements ("metrics") of medical programs, and (2) a team that developed an Alternative Return-to-Work Program, which now assists in early rehabilitation of injured employees. In addition to expecting its physicians to be knowledgeable, fair, and objective, management expects them to use and understand TQM principles.

  17. Quality assurance in health care: past, present and future.

    PubMed

    Bilawka, E; Craig, B J

    2003-08-01

    Quality of health care delivery is a growing concern globally given current budget restraints and increasing demands on health care providers. The variety of quality assurance and quality management activities equals the numerous ways health care practitioners of all genres provide health care. Dental hygienists around the world must be knowledgeable about quality assurance and management in health care as it is a significant factor in the evolution of the dental hygiene profession and the quality of oral health care provided by dental hygienists. The objective of this research was to conduct a literature review on quality assurance and quality management. A MEDLINE search from 1966 to 2002 was conducted. The search resulted in approximately 145 articles. Additional references from works generated by the search were also obtained. The literature revealed information on the background and history of quality assurance and quality management. Much of the literature was devoted to discussions of the validity, reliability and effectiveness of most prominent quality management activities being utilised in health care today. The investigation revealed numerous issues and barriers surrounding quality management. This article concludes with suggestions for future directions of quality assurance and quality management.

  18. Indoor air quality and health in schools.

    PubMed

    Ferreira, Ana Maria da Conceição; Cardoso, Massano

    2014-01-01

    To determine whether indoor air quality in schools is associated with the prevalence of allergic and respiratory diseases in children. We evaluated 1,019 students at 51 elementary schools in the city of Coimbra, Portugal. We applied a questionnaire that included questions regarding the demographic, social, and behavioral characteristics of students, as well as the presence of smoking in the family. We also evaluated the indoor air quality in the schools. In the indoor air of the schools evaluated, we identified mean concentrations of carbon dioxide (CO2) above the maximum reference value, especially during the fall and winter. The CO2 concentration was sometimes as high as 1,942 ppm, implying a considerable health risk for the children. The most prevalent symptoms and respiratory diseases identified in the children were sneezing, rales, wheezing, rhinitis, and asthma. Other signs and symptoms, such as poor concentration, cough, headache, and irritation of mucous membranes, were identified. Lack of concentration was associated with CO2 concentrations above the maximum recommended level in indoor air (p = 0.002). There were no other significant associations. Most of the schools evaluated presented with reasonable air quality and thermal comfort. However, the concentrations of various pollutants, especially CO2, suggest the need for corrective interventions, such as reducing air pollutant sources and improving ventilation. There was a statistically significant association between lack of concentration in the children and exposure to high levels of CO2. The overall low level of pollution in the city of Coimbra might explain the lack of other significant associations.

  19. Indoor air quality and health in schools*

    PubMed Central

    Ferreira, Ana Maria da Conceição; Cardoso, Massano

    2014-01-01

    Objective: To determine whether indoor air quality in schools is associated with the prevalence of allergic and respiratory diseases in children. Methods: We evaluated 1,019 students at 51 elementary schools in the city of Coimbra, Portugal. We applied a questionnaire that included questions regarding the demographic, social, and behavioral characteristics of students, as well as the presence of smoking in the family. We also evaluated the indoor air quality in the schools. Results: In the indoor air of the schools evaluated, we identified mean concentrations of carbon dioxide (CO2) above the maximum reference value, especially during the fall and winter. The CO2 concentration was sometimes as high as 1,942 ppm, implying a considerable health risk for the children. The most prevalent symptoms and respiratory diseases identified in the children were sneezing, rales, wheezing, rhinitis, and asthma. Other signs and symptoms, such as poor concentration, cough, headache, and irritation of mucous membranes, were identified. Lack of concentration was associated with CO2 concentrations above the maximum recommended level in indoor air (p = 0.002). There were no other significant associations. Conclusions: Most of the schools evaluated presented with reasonable air quality and thermal comfort. However, the concentrations of various pollutants, especially CO2, suggest the need for corrective interventions, such as reducing air pollutant sources and improving ventilation. There was a statistically significant association between lack of concentration in the children and exposure to high levels of CO2. The overall low level of pollution in the city of Coimbra might explain the lack of other significant associations. PMID:25029649

  20. Improving the quality of health care through contracting: a study of health authority practice.

    PubMed Central

    Gray, J D; Donaldson, L J

    1996-01-01

    OBJECTIVES: To investigate approaches of district health authorities to quality in contracting. DESIGN: Descriptive survey. SETTING: All district health authorities in one health region of England in a National Health Service accounting year. MATERIAL: 129 quality specifications used in contracting for services in six specialties (eight general quality specifications and 121 service specific quality specifications) MAIN MEASURES: Evaluation of the use of quality specifications; their scope and content in relation to established criteria of healthcare quality. RESULTS: Most district health authorities developed quality specifications which would be applicable to their local hospital. When purchasing care outside their boundaries they adopted the quality specifications developed by other health authorities. The service specific quality specifications were more limited in scope than the general quality specifications. The quality of clinical care was referred to in 75% of general and 43% of service specific quality specifications. Both types of specification considered quality issues in superficial and broad terms only. Established features of quality improvement were rarely included. Prerequisites to ensure provider accountability and satisfactory delivery of service specifications were not routinely included in contracts. CONCLUSION: Quality specifications within service contracts are commonly used by health authorities. This study shows that their use of this approach to quality improvement is inconsistent and unlikely to achieve desired quality goals. Continued reliance on the current approach is holding back a more fundamental debate on how to create effective management of quality improvement through the interaction between purchasers and providers of health care. PMID:10164143

  1. Accreditation as a path to achieving universal quality health coverage.

    PubMed

    Mate, Kedar S; Rooney, Anne L; Supachutikul, Anuwat; Gyani, Girdhar

    2014-10-17

    As many low- and middle-income countries (LMICs) pursue health care reforms in order to achieve universal health coverage (UHC), development of national accreditation systems has become an increasingly common quality-enhancing strategy endorsed by payers, including Ministries of Health. This article describes the major considerations for health system leaders in developing and implementing a sustainable and successful national accreditation program, using the 20-year evolution of the Thai health care accreditation system as a model. The authors illustrate the interface between accreditation as a continuous quality improvement strategy, health insurance and other health financing schemes, and the overall goal of achieving universal health coverage.

  2. Quality Enhancement Research Initiative in Mental Health.

    PubMed

    Fischer, E P; Marder, S R; Smith, G R; Owen, R R; Rubenstein, L; Hedrick, S C; Curran, G M

    2000-06-01

    The Veterans Administration (VA) recently introduced its Quality Enhancement Research Initiative (QUERI) to facilitate the translation of best practices into usual clinical care. The Mental Health QUERI (MHQ) was charged with developing strategic plans for major depressive disorder (MDD) and schizophrenia. Twenty percent or more of VA service users are affected by 1 of these 2 disorders, disorders that often have a devastating impact on affected individuals. Despite the increasing availability of efficacious treatments for each disorder, substantial gaps remain between best practices and routine care. In this context, the MHQ identified steps critical to the success of a sustained process of rapid-cycle health care improvement for MDD and schizophrenia, including research initiatives to close gaps in knowledge of best treatment practices, demonstration projects to close gaps in practice and to expand understanding of effective strategies for implementing clinical guidelines, targeted enhancements of the VA information system, and research and dissemination initiatives to increase the availability of resources to support the accelerated incorporation of best practices into routine care. This article presents an overview of the elements in the initial MHQ strategic plans and the rationale behind them.

  3. Air quality standards must protect public health

    SciTech Connect

    Norman Edelman

    2006-06-15

    Leading medical and public health organizations are deeply concerned about the proposed revisions to the National Ambient Air Quality Standard (NAAQS) that the US Environmental Protection Agency (EPA) announced in December 2005. Led by the American Lung Association (ALA), these groups are fighting to force EPA to finalize stricter standards for fine and coarse particles when the final decision is announced in September 2006. The ALA disagrees strongly with the proposal to exempt coarse particles from agriculture and mining sources, and to exclude communities with populations fewer than 100,000 from protection and monitoring requirements. ALA urges EPA to set the following health-based NAAQS for PM: Annual average PM2.5 standard of 12 {mu}mg/m{sup 3}; 24 hour average PM2.5 standard of 25 {mu}mg.m{sup 3} (99th percentile); 24-hour average PM10-2.5 standard of 25-30 {mu}g/m{sup 3} (99th percentile), applied equally to all areas of the country and to all types of particles. 72 refs., 2 figs., 1 tab.

  4. Insights into the Societal Risk of Nuclear Power Plant Accidents.

    PubMed

    Denning, Richard; Mubayi, Vinod

    2017-01-01

    The elements of societal risk from a nuclear power plant accident are clearly illustrated by the Fukushima accident: land contamination, long-term relocation of large numbers of people, loss of productive farm area, loss of industrial production, and significant loss of electric capacity. NUREG-1150 and other studies have provided compelling evidence that the individual health risk of nuclear power plant accidents is effectively negligible relative to other comparable risks, even for people living in close proximity to a plant. The objective of this study is to compare the societal risk of nuclear power plant accidents to that of other events to which the public is exposed. We have characterized the monetized societal risk in the United States from major societally disruptive events, such as hurricanes, in the form of a complementary cumulative distribution function. These risks are compared with nuclear power plant risks, based on NUREG-1150 analyses and new MACCS code calculations to account for differences in source terms determined in the more recent SOARCA study. A candidate quantitative societal objective is discussed for potential adoption by the NRC. The results are also interpreted with regard to the acceptability of nuclear power as a major source of future energy supply. © 2016 Society for Risk Analysis.

  5. Afghanistan's national strategy for improving quality in health care

    PubMed Central

    Rahimzai, Mirwais; Amiri, Mirwais; Burhani, Nadera Hayat; Leatherman, Sheila; Hiltebeitel, Simon; Rahmanzai, Ahmed Javed

    2013-01-01

    Quality problem or issue When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services. Initial assessment A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed. Plan of action In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity. Implementation The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan. Lessons Learned Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented. PMID:23485422

  6. Applications and societal benefits of plastics

    PubMed Central

    Andrady, Anthony L.; Neal, Mike A.

    2009-01-01

    This article explains the history, from 1600 BC to 2008, of materials that are today termed ‘plastics’. It includes production volumes and current consumption patterns of five main commodity plastics: polypropylene, polyethylene, polyvinyl chloride, polystyrene and polyethylene terephthalate. The use of additives to modify the properties of these plastics and any associated safety, in use, issues for the resulting polymeric materials are described. A comparison is made with the thermal and barrier properties of other materials to demonstrate the versatility of plastics. Societal benefits for health, safety, energy saving and material conservation are described, and the particular advantages of plastics in society are outlined. Concerns relating to littering and trends in recycling of plastics are also described. Finally, we give predictions for some of the potential applications of plastic over the next 20 years. PMID:19528050

  7. Applications and societal benefits of plastics.

    PubMed

    Andrady, Anthony L; Neal, Mike A

    2009-07-27

    This article explains the history, from 1600 BC to 2008, of materials that are today termed 'plastics'. It includes production volumes and current consumption patterns of five main commodity plastics: polypropylene, polyethylene, polyvinyl chloride, polystyrene and polyethylene terephthalate. The use of additives to modify the properties of these plastics and any associated safety, in use, issues for the resulting polymeric materials are described. A comparison is made with the thermal and barrier properties of other materials to demonstrate the versatility of plastics. Societal benefits for health, safety, energy saving and material conservation are described, and the particular advantages of plastics in society are outlined. Concerns relating to littering and trends in recycling of plastics are also described. Finally, we give predictions for some of the potential applications of plastic over the next 20 years.

  8. Experiencing health care service quality: through patients' eyes.

    PubMed

    Schembri, Sharon

    2015-02-01

    The primary aim of the present study was to consider health care service quality from the patients' perspective, specifically through the patient's eyes. A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients' eyes in an authentic and accurate, experiential manner. The findings show that there are variant and complex ways that patients experience health care service quality. Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways.

  9. [Quality of life and oral health in children].

    PubMed

    Versloot, J; Klaassen, M A

    2011-03-01

    In recent years, research on the influence of oral health on quality of life among children has become increasingly popular Half of the children and adolescents will have had moments of diminished oral health and that can lead to functional problems, pain and decreased quality of life. While measuring oral health-related quality of life of children, reports of parents are frequently used as a proxy. Diminished oral health not only has an impact on the child's quality of life, but also on that of his family members. Results from studies on oral health-related quality of life in children may be used as the basis for useful guidance for parents and children on improving oral health and quality of life.

  10. Understanding the relationships between air quality and human health

    SciTech Connect

    S.T. Rao

    2006-09-15

    Although there has been substantial progress in improving ambient air quality in the United States, atmospheric concentrations of ozone and fine particulate matter (PM2.5) continue to exceed the National Ambient Air Quality Standards in many locations. Consequently, a large portion of the U.S. population continues to be exposed to unhealthful levels of ozone and fine particles. This issue of EM, entitled 'Understanding the relationships between air quality and human health' presents a series of articles that focus on the relationships between air quality and human health - what we know so far and the challenges that remain. Their titles are: Understanding the effects of air pollution on human health; Assessing population exposures in studies of human health effects of PM2.5; Establishing a national environmental public health tracking network; Linking air quality and exposure models; and On alert: air quality forecasting and health advisory warnings.

  11. Crossing the quality chasm: lessons from health care quality improvement efforts in England

    PubMed Central

    2002-01-01

    The second report from the US Institute of Medicine Crossing the Quality Chasm, highlighted the deficiencies in health care quality in the USA, analyzed the contributory factors, and proposed 13 recommendations for improvements. Clearly, the challenges are enormous. Can anything be learned from the experiences of other countries? This article describes the author's experiences of health care quality improvement efforts in the National Health Service in England and their implications for the USA and for Baylor Health Care System. PMID:16333409

  12. The Unique Impact of Abolition of Jim Crow Laws on Reducing Inequities in Infant Death Rates and Implications for Choice of Comparison Groups in Analyzing Societal Determinants of Health

    PubMed Central

    Chen, Jarvis T.; Coull, Brent; Waterman, Pamela D.; Beckfield, Jason

    2013-01-01

    Objectives. We explored associations between the abolition of Jim Crow laws (i.e., state laws legalizing racial discrimination overturned by the 1964 US Civil Rights Act) and birth cohort trends in infant death rates. Methods. We analyzed 1959 to 2006 US Black and White infant death rates within and across sets of states (polities) with and without Jim Crow laws. Results. Between 1965 and 1969, a unique convergence of Black infant death rates occurred across polities; in 1960 to 1964, the Black infant death rate was 1.19 times higher (95% confidence interval [CI] = 1.18, 1.20) in the Jim Crow polity than in the non–Jim Crow polity, whereas in 1970 to 1974 the rate ratio shrank to and remained at approximately 1 (with the 95% CI including 1) until 2000, when it rose to 1.10 (95% CI = 1.08, 1.12). No such convergence occurred for Black–White differences in infant death rates or for White infants. Conclusions. Our results suggest that abolition of Jim Crow laws affected US Black infant death rates and that valid analysis of societal determinants of health requires appropriate comparison groups. PMID:24134378

  13. Air, Climate And Energy (ACE) Centers: Supporting Air Quality And Climate Solutions

    EPA Pesticide Factsheets

    EPA, through its Science to Achieve Results program, is funding three university-based research centers to investigate regional differences in air pollution and effects of climate change, technology, and societal choices on local air quality and health.

  14. Creating Quality Improvement Culture in Public Health Agencies

    PubMed Central

    Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

    2014-01-01

    Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

  15. Creating quality improvement culture in public health agencies.

    PubMed

    Davis, Mary V; Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

    2014-01-01

    We conducted case studies of 10 agencies that participated in early quality improvement efforts. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

  16. Attributes of Quality in Audiovisual Materials for Health Professionals.

    ERIC Educational Resources Information Center

    Suter, Emanuel; Waddell, Wendy H.

    1981-01-01

    Defines attributes of quality in content, instructional design, technical production, and packaging of audiovisual materials used in the education of health professionals. Seven references are listed. (FM)

  17. Attributes of Quality in Audiovisual Materials for Health Professionals.

    ERIC Educational Resources Information Center

    Suter, Emanuel; Waddell, Wendy H.

    1981-01-01

    Defines attributes of quality in content, instructional design, technical production, and packaging of audiovisual materials used in the education of health professionals. Seven references are listed. (FM)

  18. Afghanistan's national strategy for improving quality in health care.

    PubMed

    Rahimzai, Mirwais; Amiri, Mirwais; Burhani, Nadera Hayat; Leatherman, Sheila; Hiltebeitel, Simon; Rahmanzai, Ahmed Javed

    2013-07-01

    When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services. A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed. In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity. The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan. Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented.

  19. Research on Health and Environmental Effects of Air Quality

    EPA Pesticide Factsheets

    Research has linked regulated air pollutants such as ozone and particulate matter, to lung, heart disease and other health problems. Further investigation is needed to understand the role poor air quality plays on health and disease

  20. AIR QUALITY CHARACTERIZATION OF ENVIRONMENTAL PUBLIC HEALTH TRACKING

    EPA Science Inventory

    The EPA and the CDC have conducted a collaborative effort entitled the Public Health Air Surveillance Evaluation (PHASE) to pilot the development of integrated air quality data sets, from routinely available sources, for specific use by public health officials.

  1. Electronic Health Records and Quality of Care

    PubMed Central

    Yanamadala, Swati; Morrison, Doug; Curtin, Catherine; McDonald, Kathryn; Hernandez-Boussard, Tina

    2016-01-01

    Abstract Electronic health records (EHRs) were implemented to improve quality of care and patient outcomes. This study assessed the relationship between EHR-adoption and patient outcomes. We performed an observational study using State Inpatient Databases linked to American Hospital Association survey, 2011. Surgical and medical patients from 6 large, diverse states were included. We performed univariate analyses and developed hierarchical regression models relating level of EHR utilization and mortality, readmission rates, and complications. We evaluated the effect of EHR adoption on outcomes in a difference-in-differences analysis, 2008 to 2011. Medical and surgical patients sought care at hospitals reporting no EHR (3.5%), partial EHR (55.2%), and full EHR systems (41.3%). In univariate analyses, patients at hospitals with full EHR had the lowest rates of inpatient mortality, readmissions, and Patient Safety Indicators followed by patients at hospitals with partial EHR and then patients at hospitals with no EHR (P < 0.05). However, these associations were not robust when accounting for other patient and hospital factors, and adoption of an EHR system was not associated with improved patient outcomes (P > 0.05). These results indicate that patients receiving medical and surgical care at hospitals with no EHR system have similar outcomes compared to patients seeking care at hospitals with a full EHR system, after controlling for important confounders. To date, we have not yet seen the promised benefits of EHR systems on patient outcomes in the inpatient setting. EHRs may play a smaller role than expected in patient outcomes and overall quality of care. PMID:27175631

  2. [Quality planning of Family Health Units using Quality Function Deployment (QFD)].

    PubMed

    Volpato, Luciana Fernandes; Meneghim, Marcelo de Castro; Pereira, Antonio Carlos; Ambrosano, Gláucia Maria Bovi

    2010-08-01

    Quality is an indispensible requirement in the health field, and its pursuit is necessary in order to meet demands by a population that is aware of its rights, as part of the essence of good work relations, and to decrease technological costs. Quality thus involves all parties to the process (users and professionals), and is no longer merely an attribute of the health service. This study aimed to verify the possibility of quality planning in the Family Health Units, using Quality Function Deployment (QFD). QFD plans quality according to user satisfaction, involving staff professionals and identifying new approaches to improve work processes. Development of the array, called the House of Quality, is this method's most important characteristics. The results show a similarity between the quality demanded by users and the quality planned by professionals. The current study showed that QFD is an efficient tool for quality planning in public health services.

  3. The societal cost of schizophrenia in Sweden.

    PubMed

    Ekman, Mattias; Granstrom, Ola; Omerov, Sead; Jacob, Johanna; Landen, Mikael

    2013-03-01

    Schizophrenia is a disabling psychiatric disorder that has severe consequences for patients and their families. Moreover, the expensive treatment of schizophrenia imposes a burden on health care providers and the wider society. Existing cost estimates for Sweden, however, are based on relatively small patient populations and need to be confirmed in a large register-based study. To investigate the health care resource utilization and cost-of-illness in patients with schizophrenia in Sweden and to relate the costs to hospitalizations and global assessment of functioning (GAF). Hospital-based registry data were combined with national registry data from a large patient population to get reliable estimates of the costs of schizophrenia in Sweden. Schizophrenia was defined by ICD-10 codes F20; F21; F23.1,2,8,9; F25.1,8,9. Registry data on socio-demographics and disease-related healthcare resource use in outpatient and inpatient care were obtained from Northern Stockholm Psychiatry. Data on pharmaceuticals were obtained from the National Board of Health and Welfare, and data on sick leave and early retirement were obtained from the Swedish Social Insurance Agency. Costs for community mental health care were not available at the individual level, but were estimated based on previous studies and aggregate cost data from Stockholm. Resource use data from the registries were combined with unit costs from publicly available sources. The study was conducted from a societal perspective, with indirect costs valued according to the human capital method. The average annual psychiatric cost per patient with schizophrenia in 2008 was EUR 42700 (95% CI: EUR 41500-44000), based on a sample of 2161 patients. To this should be added costs for community mental health care of EUR 12400 per patient, giving a total cost of EUR 55100 per patient. The two largest cost items in the total costs were indirect costs due to lost productivity (60%) and community mental health care (22% of the total

  4. Societal Benefits of Ocean Altimetry Data

    NASA Technical Reports Server (NTRS)

    Srinivasen, Margaret; Leben, Robert

    2004-01-01

    The NASA/CNES Jason satellite, follow-on to the highly successful TOPEX/Poseidon mission, continues to provide oceanographers and marine operators across the globe with a continuous twelve-year, high quality stream of sea surface height data. The mission is expected to extend through 2007, when the NASA/NOAA/CNES follow-on mission, OSTM, will be launched with the wide-swath ocean altimeter on board. This unprecedented resource of valuable ocean data is being used to map sea surface height, geostrophic velocity, significant wave height, and wind speed over the global oceans. Altimeter data products are currently used by hundreds of researchers and operational users to monitor ocean circulation and improve our understanding of the role of the oceans in climate and weather. Ocean altimeter data has many societal benefits and has proven invaluable in many practical applications including; a) Ocean forecasting systems; b) Climate research and forecasting; c) Ship routing; d) Fisheries management; e) Marine mammal habitat monitoring; f) Hurricane forecasting and tracking; g) Debris tracking; and h) Precision marine operations such as cable-laying and oil production. The data has been cited in nearly 2,000 research and popular articles since the launch of TOPEX/Poseidon in 1992, and almost 200 scientific users receive the global coverage altimeter data on a monthly basis. In addition to the scientific and operational uses of the data, the educational community has seized the unique concepts highlighted by these altimeter missions as a resource for teaching ocean science to students from grade school through college. This presentation will highlight societal benefits of ocean altimetry data in the areas of climate studies, marine operations, marine research, and non-ocean investigations.

  5. Societal Benefits of Ocean Altimetry Data

    NASA Technical Reports Server (NTRS)

    Srinivasen, Margaret; Leben, Robert

    2004-01-01

    The NASA/CNES Jason satellite, follow-on to the highly successful TOPEX/Poseidon mission, continues to provide oceanographers and marine operators across the globe with a continuous twelve-year, high quality stream of sea surface height data. The mission is expected to extend through 2007, when the NASA/NOAA/CNES follow-on mission, OSTM, will be launched with the wide-swath ocean altimeter on board. This unprecedented resource of valuable ocean data is being used to map sea surface height, geostrophic velocity, significant wave height, and wind speed over the global oceans. Altimeter data products are currently used by hundreds of researchers and operational users to monitor ocean circulation and improve our understanding of the role of the oceans in climate and weather. Ocean altimeter data has many societal benefits and has proven invaluable in many practical applications including; a) Ocean forecasting systems; b) Climate research and forecasting; c) Ship routing; d) Fisheries management; e) Marine mammal habitat monitoring; f) Hurricane forecasting and tracking; g) Debris tracking; and h) Precision marine operations such as cable-laying and oil production. The data has been cited in nearly 2,000 research and popular articles since the launch of TOPEX/Poseidon in 1992, and almost 200 scientific users receive the global coverage altimeter data on a monthly basis. In addition to the scientific and operational uses of the data, the educational community has seized the unique concepts highlighted by these altimeter missions as a resource for teaching ocean science to students from grade school through college. This presentation will highlight societal benefits of ocean altimetry data in the areas of climate studies, marine operations, marine research, and non-ocean investigations.

  6. Does Medical Malpractice Law Improve Health Care Quality?

    PubMed

    Frakes, Michael; Jena, Anupam B

    2016-11-01

    We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability's influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards.

  7. Defining Information Quality Into Health Websites: A Conceptual Framework of Health Website Information Quality for Educated Young Adults.

    PubMed

    Tao, Donghua; LeRouge, Cynthia; Smith, K Jody; De Leo, Gianluca

    2017-10-06

    Today's health care environment encourages health care consumers to take an active role in managing their health. As digital natives, young educated adults do much of their health information management through the Internet and consider it a valid source of health advice. However, the quality of information on health websites is highly variable and dynamic. Little is known about the understandings and perceptions that young educated adults have garnered on the quality of information on health websites used for health care-related purposes. To fill this gap, the aim of this study was to develop a conceptual framework of health website information quality with quality dimensions (ie, criteria) and associated quality drivers (ie, attributes) specified in the context of young educated adults' use of health websites for health care-related purposes. This aim was achieved by (1) identifying information quality dimensions of health websites from the perspective of young educated adults; (2) identifying the importance ratings of these quality dimensions; and (3) constructing a framework of health website information quality with quality dimensions and associated drivers specified in the context of young educated adults' use of health websites for health care-related purposes. The study employed both qualitative and quantitative methods. Methods included semistructured group interviews and an individual quality assessment exercise grounded in visiting various websites and responding to Likert scale questions regarding the importance ratings of information quality dimensions and open-ended questions with specifying website quality drivers. Study participants included junior and senior undergraduate and graduate students in business, allied health, and public health majors. Qualitative, open-coding procedures were used to develop the conceptual framework reflecting the participants' means of assessing information quality on health websites. Five dimensions of information

  8. Economic and societal dimensions of nanotechnology-enabled drug delivery.

    PubMed

    te Kulve, Haico; Rip, Arie

    2013-05-01

    There is an increasing interest in nanotechnology-enabled drug delivery systems which are expected to have significant impacts for health care. The economic and societal aspects are uncertain, even ambiguous, at this stage of development, and often not addressed, or only as part of the promises about present options. In our review we will report on assessments of actors regarding economic and societal aspects and, occasionally, of expected impacts. Topics discussed include: present and future markets of nano-enabled drug delivery, industry dynamics, regulation, cost-effectiveness, and broader ethical issues. We also include a brief discussion of anticipatory activities of actors who are concerned about these aspects. Performance of nano-enabled drug delivery, a necessary step to have future impacts at all, needs to be improved further, and in interaction with demands of users along the product value chain and with further stakeholder such as regulatory agencies and health insurers. When supported by analysis of societal embedding of new products and scenarios, this allows relevant societal and economic aspects to be taken into account at an early stage. A key issue in realizing impacts will be liability, and roles and responsibilities of technology developers and stakeholders more generally.

  9. EPA's Environmental Quality Index Supports Public Health

    EPA Pesticide Factsheets

    The Environmental Quality Index (EQI) pulls data from five domains: air, water, land, built, and sociodemographic environments to provide a county-by-county snapshot of overall environmental quality across the entire U.S.

  10. Childhood obesity: a societal problem to solve.

    PubMed

    Schwartz, M B; Puhl, R

    2003-02-01

    In contrast to other threats to American children's health, the treatment and prevention of childhood obesity are considered the responsibility of individual children and their parents. This pressure exists in the context of the societal stigmatization of overweight children and the powerful environmental inducements aimed directly at children to eat nutritionally poor foods. Parents of overweight children are left in the difficult position of fearing the social and health consequences of their child's obesity, and fighting a losing battle against the omnipotent presence of the media and constant exposure to unhealthy foods. This paper brings together several literatures to provide a comprehensive examination of the major challenges facing obese children and their families. In particular, this paper documents the extent of stigmatization towards overweight children and reviews evidence of the conflicting advice given to parents about how to help children develop healthful eating in the face of biological and learned food preferences. We conclude with a call for a shift in thinking about the role of our society in the aetiology, treatment and prevention of childhood obesity.

  11. INTEGRATING AIR QUALITY DATA TO INFORM HUMAN HEALTH DECISIONS

    EPA Science Inventory

    The August 1-2, 2005 EPA-NIEHS workshop is addressing the linkages between air quality and human health. My presentation will discuss the strengths and limitations of various databases for relating air quality to health impacts. Specifically, the need for fusing ground-based, s...

  12. INTEGRATING AIR QUALITY DATA TO INFORM HUMAN HEALTH DECISIONS

    EPA Science Inventory

    The August 1-2, 2005 EPA-NIEHS workshop is addressing the linkages between air quality and human health. My presentation will discuss the strengths and limitations of various databases for relating air quality to health impacts. Specifically, the need for fusing ground-based, s...

  13. Towards evaluation of the quality of care in health centres.

    PubMed

    Saturno, P J

    1995-01-01

    There is wide acknowledgement that quality assurance is desirable in primary health care. Considerable success has been achieved in this field by the Iberian Programme of Training and Implementation of Quality Assurance Activities in Primary Health Care, the basis for which is outlined below.

  14. UNDERSTANDING THE RELATIONSHIPS BETWEEN AIR QUALITY AND HUMAN HEALTH

    EPA Science Inventory

    This issue of EM presents a series of articles that focus on air quality and human health--what we know so far and the challenges that remain. The first article provides an overview of the problem at hand and approaches to properly address air quality and human health issues. Fo...

  15. Quality and Evaluation in a Comprehensive Health Organization.

    ERIC Educational Resources Information Center

    Anderson, Malcolm; Brazil, Kevin

    1995-01-01

    An innovative approach to delivering health care is being developed in several Ontario (Canada) communities. This report describes the initial framework for quality and evaluation for a comprehensive health organization (CHO). As CHOs become operational, there is great opportunity to develop a comprehensive approach to quality and evaluation. (SLD)

  16. UNDERSTANDING THE RELATIONSHIPS BETWEEN AIR QUALITY AND HUMAN HEALTH

    EPA Science Inventory

    This issue of EM presents a series of articles that focus on air quality and human health--what we know so far and the challenges that remain. The first article provides an overview of the problem at hand and approaches to properly address air quality and human health issues. Fo...

  17. Social/economic costs and health-related quality of life in patients with histiocytosis in Europe.

    PubMed

    Iskrov, Georgi; Astigarraga, Itziar; Stefanov, Rumen; López-Bastida, Julio; Linertová, Renata; Oliva-Moreno, Juan; Serrano-Aguilar, Pedro; Posada-de-la-Paz, Manuel; Schieppati, Arrigo; Taruscio, Domenica; Péntek, Márta; von der Schulenburg, Johann Matthias Graf; Kanavos, Panos; Chevreul, Karine; Persson, Ulf; Fattore, Giovanni

    2016-04-01

    The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with histiocytosis in Europe. We conducted a cross-sectional study of patients with histiocytosis from France, Germany, Italy, Spain, Bulgaria, the UK, and Sweden. Data on demographic characteristics, health resource utilisation, informal care, loss of labour productivity and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. A total of 134 patients (35 France, 32 Germany, 30 Italy, 24 Spain, 7 Bulgaria, 4 UK and 2 Sweden) completed the questionnaire. The average annual costs ranged from € 6832 to € 33,283 between countries, the year of reference being 2012. Estimated direct healthcare costs ranged from € 1698 to € 18,213; direct nonhealthcare costs ranged from € 2936 to € 17,622 and labour productivity losses ranged from € 1 to € 8855. The mean EQ-5D score for adult histiocytosis patients was estimated at between 0.32 and 0.85, and the mean EQ-5D visual analogue scale score was estimated at between 50.00 and 66.50. The main strengths of this study lie in our bottom-up approach to costing and in the evaluation of histiocytosis patients from a broad perspective (societal costs). This type of analysis is very scarce in international literature for rare diseases in comparison with other illnesses. We conclude that histiocytosis patients incur considerable societal costs and experience substantial deterioration in HRQOL.

  18. Air quality and respiratory health in Delhi.

    PubMed

    Nidhi; Jayaraman, Girija

    2007-12-01

    Delhi is an instructive location for studying the impact of air pollution since it is a rapidly expanding centre of government, trade commerce and industry. We have made an attempt to (1) determine the association between environmental pollution and respiratory morbidity in Delhi for the period 1998-2004, (2) assess the impact on hospital admission of the implementation of recent governmental regulations and (3) calculate the relative risk of hospitalization due to respiratory ailments caused by air pollutants. Seven hospitals from different parts of Delhi were selected. The pollution profiles of these areas were assessed and subsequently Poisson regression model was performed for the patient population. There was a remarkable decrease in monthly average concentration of sulphur dioxide (from 17.9 to 11.1 microg m(-3)) and increase in monthly average concentration of nitrogen dioxide (from 34.2 to 49.1 microg m(-3)) after the newly introduced regulations. Particulates were observed to have marginal fall in their concentration but still remained above the permissible limits. Gaseous pollutants, in spite of being at a level lower than the permissible level, showed more consistent significant association with respiratory admissions. The relative risks of hospitalization due to respiratory diseases were in the range of 1.07-2.82 in residential cum commercial areas. Comparative study of pre and post new stringent governmental regulation showed significant positive association of NO(2) with respiratory disorders in southern (RR: 1.10; CI: 1.09-1.12) and northern regions (RR: 1.33; CI: 1.27-1.39), both mixed use areas. In spite of the improvement in the air quality, the associated health effects were found to be substantial.

  19. Cultural Diversity, Economic Development and Societal Instability

    PubMed Central

    Nettle, Daniel; Grace, James B.; Choisy, Marc; Cornell, Howard V.; Guégan, Jean-François; Hochberg, Michael E.

    2007-01-01

    Background Social scientists have suggested that cultural diversity in a nation leads to societal instability. However, societal instability may be affected not only by within-nation or α diversity, but also diversity between a nation and its neighbours or β diversity. It is also necessary to distinguish different domains of diversity, namely linguistic, ethnic and religious, and to distinguish between the direct effects of diversity on societal instability, and effects that are mediated by economic conditions. Methodology/Principal Findings We assembled a large cross-national dataset with information on α and β cultural diversity, economic conditions, and indices of societal instability. Structural equation modeling was used to evaluate the direct and indirect effects of cultural diversity on economics and societal stability. Results show that different types and domains of diversity have interacting effects. As previously documented, linguistic α diversity has a negative effect on economic performance, and we show that it is largely through this economic mechanism that it affects societal instability. For β diversity, the higher the linguistic diversity among nations in a region, the less stable the nation. But, religious β diversity has the opposite effect, reducing instability, particularly in the presence of high linguistic diversity. Conclusions Within-nation linguistic diversity is associated with reduced economic performance, which, in turn, increases societal instability. Nations which differ linguistically from their neighbors are also less stable. However, religious diversity between neighboring nations has the opposite effect, decreasing societal instability. PMID:17895970

  20. Cultural diversity, economic development and societal instability.

    PubMed

    Nettle, Daniel; Grace, James B; Choisy, Marc; Cornell, Howard V; Guégan, Jean-François; Hochberg, Michael E

    2007-09-26

    Social scientists have suggested that cultural diversity in a nation leads to societal instability. However, societal instability may be affected not only by within-nation or alpha diversity, but also diversity between a nation and its neighbours or beta diversity. It is also necessary to distinguish different domains of diversity, namely linguistic, ethnic and religious, and to distinguish between the direct effects of diversity on societal instability, and effects that are mediated by economic conditions. We assembled a large cross-national dataset with information on alpha and beta cultural diversity, economic conditions, and indices of societal instability. Structural equation modeling was used to evaluate the direct and indirect effects of cultural diversity on economics and societal stability. Results show that different types and domains of diversity have interacting effects. As previously documented, linguistic alpha diversity has a negative effect on economic performance, and we show that it is largely through this economic mechanism that it affects societal instability. For beta diversity, the higher the linguistic diversity among nations in a region, the less stable the nation. But, religious beta diversity has the opposite effect, reducing instability, particularly in the presence of high linguistic diversity. Within-nation linguistic diversity is associated with reduced economic performance, which, in turn, increases societal instability. Nations which differ linguistically from their neighbors are also less stable. However, religious diversity between neighboring nations has the opposite effect, decreasing societal instability.

  1. Cultural diversity, economic development and societal instability

    USGS Publications Warehouse

    Nettle, D.; Grace, J.B.; Choisy, M.; Cornell, H.V.; Guegan, J.-F.; Hochberg, M.E.

    2007-01-01

    Background. Social scientists have suggested that cultural diversity in a nation leads to societal instability. However, societal instability may be affected not only by within-nation on ?? diversity, but also diversity between a nation and its neighbours or ?? diversity. It is also necessary to distinguish different domains of diversity, namely linguistic, ethnic and religious, and to distinguish between the direct effects of diversity on societal instability, and effects that are mediated by economic conditions. Methodology/Principal Findings. We assembled a large cross-national dataset with information on ?? and ?? cultural diversity, economic conditions, and indices of societal instability. Structural equation modeling was used to evaluate the direct and indirect effects of cultural diversity on economics and societal stability. Results show that different type and domains of diversity have interacting effects. As previously documented, linguistic ?? diversity has a negative effect on economic performance, and we show that it is largely through this economic mechanism that it affects societal instability. For ?? diversity, the higher the linguistic diversity among nations in a region, the less stable the nation. But, religious ?? diversity has the opposite effect, reducing instability, particularly in the presence of high linguistic diversity. Conclusions. Within-nation linguistic diversity is associated with reduced economic performance, which, in turn, increases societal instability. Nations which differ linguistically from their neighbors are also less stable. However, religious diversity between, neighboring nations has the opposite effect, decreasing societal instability.

  2. The role of academic medicine in improving health care quality.

    PubMed

    Brindis, Ralph G; Spertus, John

    2006-09-01

    Academic medicine, often entrenched in biomedical and clinical research, has largely ignored the development and application of quality metrics to ensure the delivery of high-quality health care. Nevertheless, academic medicine has substantial opportunities to lead the charge in building a quality infrastructure with the goal of delivering high-quality and cost-efficient health care to all Americans. The American College of Cardiology (ACC) and American Heart Association (AHA) have worked jointly to measure and improve the quality of cardiovascular care. This effort has led to the development of clinical practice guidelines, performance measures, data standards, national registries, and appropriateness criteria for cardiovascular care. Academic medicine should actively embrace and promote the type of quality metrics and criteria developed by ACC and AHA and apply this model across the entire academic medicine community. Academic medicine, with its many resources, could lead the way in the expanding field of quality science by supporting fundamental research in quality improvement, supporting academicians to improve quality at their own institutions, developing educational models for quality assessment and improvement, creating and implementing data registries, and serving as a conduit for developing the emerging science of quality assessment. In this and many other ways, academic medicine must offer the health care community leadership for improving our nation's health care quality with the same fervor presently exhibited for the advancement of basic science, the development of specialized and experimental therapy, and as centers for tertiary and quaternary patient care.

  3. Financial Health of Child Care Facilities Affects Quality of Care.

    ERIC Educational Resources Information Center

    Brower, Mary R.; Sull, Theresa M.

    2003-01-01

    Contends that child care facility owners, boards of directors, staff, and parents need to focus on financial management, as poor financial health compromises the quality of care for children. Specifically addresses the issues of: (1) concern for providing high quality child care; (2) the connection between quality and money; and (3) strengthening…

  4. Cultural values and health service quality in China.

    PubMed

    Polsa, Pia; Fuxiang, Wei; Sääksjärvi, Maria; Shuyuan, Pei

    2013-01-01

    Several service quality studies show how cultural features may influence the way service quality is perceived. However, few studies specifically describe culture's influence on health service quality. Also, there are few studies that take into account patients' health service quality perceptions. This article seeks to present a first step to fill these gaps by examining patients' cultural values and their health service quality assessments. The study draws on published work and applies its ideas to Chinese healthcare settings. Data consist of hospital service perceptions in the People's Republic of China (PRC), a society that is socially, economically and culturally undergoing major changes. In total, 96 patients were surveyed. Data relationships were tested using partial least square (PLS) analysis. Findings show that Chinese patients' cultural values and their health service assessments are related and that the cultural values themselves seem to be changing. Additionally, further analyses provided interesting results pointing to which cultural values influenced service quality perceptions. The strongest service quality predictor was power distance. The sample is relatively small and collected from only one major hospital in China. Therefore, future research should extend the sample size and scope. Follow-up research could also include cross-cultural investigations of perceived health service quality to substantiate cultural influences on health service quality perceptions. In line with similar research in other contexts, the study confirms that power distance has a significant relationship with service quality perceptions. The study contributes to existing health service literature by offering patients' views on health service quality and by describing relationships between health service perceptions and cultural values--the study's main contribution.

  5. Mystery shopping as a quality adjunct in public health organizations.

    PubMed

    Hartley, R

    1995-12-01

    Public health in Australia is undergoing unprecedented emphasis on meeting customers' needs, wants and expectations. Mystery shopping, common in the commercial world, has much to offer health organizations in their push towards quality. This paper describes this inexpensive technique and reports on its use in North West Health Service, a large rural health provider. The potential exists for its widescale adoption in health to better meet customer focus objectives.

  6. Societal acceptance of unnecessary evacuation

    NASA Astrophysics Data System (ADS)

    McCaughey, Jamie W.; Mundzir, Ibnu; Patt, Anthony; Rosemary, Rizanna; Safrina, Lely; Mahdi, Saiful; Daly, Patrick

    2017-04-01

    Uncertainties in forecasting extreme events force an unavoidable tradeoff between false alarms and misses. The appropriate balance depends on the level of societal acceptance of unnecessary evacuations, but there has been little empirical research on this. Intuitively it may seem that an unnecessary evacuation would make people less likely to evacuate again in the future, but our study finds no support for this intuition. Using new quantitative (n=800) and qualitative evidence, we examine individual- and household-level evacuation decisions in response to the strong 11-Apr-2012 earthquake in Aceh, Indonesia. This earthquake did not produce a tsunami, but the population had previously experienced the devastating 2004 tsunami. In our sample, the vast majority of people (86%) evacuated in the 2012 earthquake, and nearly all (94%) say they would evacuate again if a similar earthquake happened in the future. Self-reported level of fear at the moment of the 2012 earthquake explains more of the variance in evacuation decisions and intentions than does a combination of perceived tsunami risk and perceived efficacy of evacuation modeled on protection motivation theory. These findings suggest that the appropriate balance between false alarms and misses may be highly context-specific. Investigating this in each context would make an important contribution to the effectiveness of early-warning systems.

  7. Sexual Activity and Psychological Health As Mediators of the Relationship Between Physical Health and Marital Quality

    PubMed Central

    2014-01-01

    Objectives. The pathways linking spousal health to marital quality in later life have been little examined at the population level. We develop a conceptual model that links married older adults’ physical health and that of their spouse to positive and negative dimensions of marital quality via psychological well-being of both partners and their sexual activity. Methods. We use data from 1,464 older adults in 732 marital dyads in the 2010–2011 wave of the National Social Life Health and Aging Project. Results. We find that own fair or poor physical health is linked to lower positive and higher negative marital quality, spouse’s health to positive quality, and that own and spouse’s mental health and more frequent sex are associated with higher positive and lower negative marital quality. Further, we find that (a) sexual activity mediates the association between own and partner’s physical health and positive marital quality, (b) own mental health mediates the association between one’s own physical health and both positive and negative marital quality, and (c) partner’s mental health mediates the associations of spouse’s physical health with positive marital quality. These results are robust to alternative specifications of the model. Discussion. The results suggest ways to protect marital quality among older adults who are struggling with physical illness in themselves or their partners. PMID:24470175

  8. LINKING PUBLIC HEALTH AND AIR QUALITY DATA FOR ACCOUNTABILITY

    EPA Science Inventory

    Program Area: Environmental Health

    Topic Area: Linking Public Health Data into Action

    Title of Presentation: Linking Public Health and Air Quality Data for Accountability

    Background and Significance

    Tracking environmental exposures to air pollutan...

  9. Health-Related Quality of Life in Cardiovascular Disease.

    ERIC Educational Resources Information Center

    Kaplan, Robert M.

    1988-01-01

    Reviews several current approaches to the assessment of health outcomes in cardiovascular disease, including health-related quality of life. Offers a general health policy model as a method for comparing program options in cardiovascular disease that may have very different objectives. Uses examples from hypertension screening and treatment, heart…

  10. Health-Related Quality of Life in Cardiovascular Disease.

    ERIC Educational Resources Information Center

    Kaplan, Robert M.

    1988-01-01

    Reviews several current approaches to the assessment of health outcomes in cardiovascular disease, including health-related quality of life. Offers a general health policy model as a method for comparing program options in cardiovascular disease that may have very different objectives. Uses examples from hypertension screening and treatment, heart…

  11. Health-Related Quality of Life in HIV Disease.

    ERIC Educational Resources Information Center

    Hays, Ron D.; And Others

    1995-01-01

    The structure of health-related quality of life (HRQOL) in persons with human immunodeficiency virus (HIV) was studied in 205 symptomatic adults. Confirmatory factor analysis supported a two-factor model of HRQOL, with physical and mental health dimensions. Correlations of HRQOL with other aspects of health and support are discussed. (SLD)

  12. LINKING PUBLIC HEALTH AND AIR QUALITY DATA FOR ACCOUNTABILITY

    EPA Science Inventory

    Program Area: Environmental Health

    Topic Area: Linking Public Health Data into Action

    Title of Presentation: Linking Public Health and Air Quality Data for Accountability

    Background and Significance

    Tracking environmental exposures to air pollutan...

  13. Client relations in South Asia: programmatic and societal determinants.

    PubMed

    Simmons, R; Koblinsky, M A; Phillips, J F

    1986-01-01

    Client relations constitute a neglected area of research in family planning. Findings from studies in northern India and Bangladesh reveal considerable variation in both the quantity and quality of contacts in programs that function under roughly comparable socioeconomic conditions. Client relations are determined by a complex set of forces in which both programmatic factors and conditions pertaining to the societal environment play a key role. Worker-client exchanges have a net, incremental effect on contraceptive use.

  14. Corporate management of quality in employee health plans.

    PubMed

    Maxwell, James; Temin, Peter

    2003-01-01

    As large companies move their employees into managed care, they must concern themselves with the quality and price of their employees' health care. Based on a survey of Fortune 500 companies, we show that most are integrating several aspects of quality into their purchasing and contracting decisions by focusing on three dimensions--customer service, network composition, and clinical quality. Companies focus on the customer service dimension while the medical community emphasizes clinical quality.

  15. [Health related quality of life and disease burden of patients with schizophrenia in Hungary].

    PubMed

    Péntek, Márta; Harangozó, Judit; Egerházi, Anikó; Kelemen, Oguz; Gulácsi, László; Baji, Petra; Máttyássy, Adrienn; Erdélyi, Rita; Lehoczky, Szilvia; Orlewska, Ewa; Vártokné Hevér, Noémi; Ferencz, Akos; Brodszky, Valentin

    2012-01-01

    According to the international literature disease burden of schizophrenia is substantial, however data from Eastern Central Europe is scarce. Our aim was to assess the quality of life and costs of patients with schizophrenia in Hungary. A cross sectional questionnaire survey was performed in 3 hospital based psychiatry centres involving patients with schizophrenia. Demographics, disease severity (Clinical Global Impression, CGI), functional ability (Global Assessment of Functioning, GAF) and general health status (EQ-5D) was assessed. Health care utilisation and aids were surveyed for the past 12 months. Costing was performed from the societal perspective and human capital approach was applied. Altogether 78 patients (female 43.6%) were involved with a mean age of 44.2 (SD=13.1) years, disease duration was >10 years at 49 (62.8%) cases, 66 (84.6%) patients were disability pensioners. Distribution between CGI 3-4-5-6 levels were 12 (16%), 33 (43%), 21 (28%), 10 (13%) patients, respectively, mean GAF was 52.6 (SD=13.9). The average EQ-5D score was 0.64 (SD=0.3) and it was significantly worse than the age-matched general population's score in Hungary (p < 0.01). Mean yearly cost was 13 878 Euros/patient (conversion 1 Euro=280.6 HUF), the rate of direct medical,direct non-medical and indirect costs was 28.5%, 5.4% and 66.1%, respectively. Among direct costs hospitalisation and drug costs were dominant. Total cost correlates with disease severity (CGI). Schizophrenia leads to notable deterioration in health related quality of life and induce high costs to society, mainly due to the productivity loss of the patients. Nevertheless disease related costs in Hungary are lower than in economically more developed European countries. Our study offers basic data about disease burden of schizophrenia in Hungary to support clinical and health policy decision making.

  16. Small and big quality in health care.

    PubMed

    Lillrank, Paul Martin

    2015-01-01

    The purpose of this paper is to clarify healthcare quality's ontological and epistemological foundations; and examine how these lead to different measurements and technologies. Conceptual analysis. Small quality denotes conformance to ex ante requirements. Big quality includes product and service design, based on customer requirements and expectations. Healthcare quality can be divided into three areas: clinical decision making; patient safety; and patient experience, each with distinct measurement and improvement technologies. The conceptual model is expected to bring clarity to constructing specific definitions, measures, objectives and technologies for improving healthcare. This paper claims that before healthcare quality can be defined, measured and integrated into systems, it needs to be clearly separated into ontologically and epistemologically different parts.

  17. Quality and Health Literacy Demand of Online Heart Failure Information.

    PubMed

    Cajita, Maan Isabella; Rodney, Tamar; Xu, Jingzhi; Hladek, Melissa; Han, Hae-Ra

    The ubiquity of the Internet is changing the way people obtain their health information. Although there is an abundance of heart failure information online, the quality and health literacy demand of these information are still unknown. The purpose of this study is to evaluate the quality and health literacy demand (readability, understandability, and actionability) of the heart failure information found online. Google, Yahoo, Bing, Ask.com, and DuckDuckGo were searched for relevant heart failure Web sites. Two independent raters then assessed the quality and health literacy demand of the included Web sites. The quality of the heart failure information was assessed using the DISCERN instrument. Readability was assessed using 7 established readability tests. Finally, understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Print Materials. A total of 46 Web sites were included in this analysis. The overall mean quality rating was 46.0 ± 8.9 and the mean readability score was 12.6 grade reading level. The overall mean understandability score was 56.3% ± 16.2%. Finally, the overall mean actionability score was 34.7% ± 28.7%. The heart failure information found online was of fair quality but required a relatively high health literacy level. Web content authors need to consider not just the quality but also the health literacy demand of the information found in their Web sites. This is especially important considering that low health literacy is likely prevalent among the usual audience.

  18. Issues in Measuring and Improving Health Care Quality

    PubMed Central

    Friedman, Maria A.

    1995-01-01

    This issue of the Health Care Financing Review focuses on issues and advances in measuring and improving the quality of care, particularly for Medicare and Medicaid beneficiaries. Discussions of quality-related topics are especially timely, given the growing and widespread interest in improving quality in the organization, financing, and delivery of health care services. This article has several purposes. The first is to provide a brief description of some of the causes underlying the growth of the health care quality movement; the second is to provide a contextual framework for discussion of some of the overarching themes that emerge in this issue. These themes include examining conceptual issues, developing quality measures for specific sites and populations, and creating or adapting data sets for quality-measurement purposes. PMID:10151882

  19. Health information technology and quality of health care: strategies for reducing disparities in underresourced settings.

    PubMed

    Millery, Mari; Kukafka, Rita

    2010-10-01

    Health information technology (health IT) has potential for facilitating quality improvement and reducing quality disparities found in underresourced settings (URSs). With this systematic literature review, complemented by key informant interviews, the authors sought to identify evidence regarding health IT and quality outcomes in URSs. The review included 105 peer-reviewed studies (2004-2009) in all settings. Only 15 studies included URSs, and 8 focused on URSs. Based on literature across settings, most evidence was available for quality impact of order entry, clinical decision support systems, and computerized reminders. Study designs were predominantly quasi-experimental (37%) or descriptive (35%); 90% of the studies focused on the microsystem level of quality improvement, indicating a need for expanding research into patient experience and organizational and environmental levels. Key informants highlighted organizational partnerships and health IT champions and emphasized that for health IT to have an impact on quality, there must be an organizational culture of quality improvement.

  20. Health, Quality of Care and Quality of Life: A Case of Frail Older Adults

    ERIC Educational Resources Information Center

    Hsieh, Chang-Ming

    2009-01-01

    This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…

  1. Health, Quality of Care and Quality of Life: A Case of Frail Older Adults

    ERIC Educational Resources Information Center

    Hsieh, Chang-Ming

    2009-01-01

    This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…

  2. CHARACTERIZING AIR QUALITY FOR ENVIRONMENTAL PUBLIC HEALTH

    EPA Science Inventory

    NERL's Human Exposure and Atmospheric Sciences Division and other participants in the Public Health Air Surveillance Evaluation (PHASE) project will be presenting their results to the Environmnetal Public Health Tracking (EPHT) workshop in Tampa FL. The PHASE project is a collab...

  3. Innovative and responsible governance of nanotechnology for societal development

    NASA Astrophysics Data System (ADS)

    Roco, Mihail C.; Harthorn, Barbara; Guston, David; Shapira, Philip

    2011-09-01

    Governance of nanotechnology is essential for realizing economic growth and other societal benefits of the new technology, protecting public health and environment, and supporting global collaboration and progress. The article outlines governance principles and methods specific for this emerging field. Advances in the last 10 years, the current status and a vision for the next decade are presented based on an international study with input from over 35 countries.

  4. Impact of Influenza on Health-Related Quality of Life among Confirmed (H1N1)2009 Patients

    PubMed Central

    Hollmann, Malen; Garin, Olatz; Galante, Mariana; Ferrer, Montserrat; Dominguez, Angela; Alonso, Jordi

    2013-01-01

    Background We aimed to assess the changes in health-related quality of life (HRQL) in patients with confirmed diagnosis of influenza (H1N1)2009, and to estimate the individual and societal loss of quality-adjusted life years (QALYs) caused by the pandemic. Methods and Results Longitudinal study of patients recruited at major hospitals and primary care centers in Spain. Patients reported their HRQL (EQ-5D) during their influenza episode and seven days prior to it. A subsample was monitored to evaluate HRQL after recovery. HRQL loss was estimated as the difference between EQ-5D prior to the influenza episode and during it. Individual QALY loss (disutility multiplied by the duration of the influenza episode in days) for confirmed cases was calculated and used to estimate the societal loss in Spain (with the official estimations). A total of 432 inpatients and 563 outpatients were included, of whom 145 and 184, respectively, were followed up. Baseline mean HRQL loss was 0.58 (95% CI, 0.53–0.63) for inpatients and 0.43 (95% CI, 0.40–0.46) for outpatients. The majority of the 145 inpatients and 184 outpatients who were followed up regained initial HRQL levels, presenting a mean difference of 0.01 between the EQ-5D score prior to and after the influenza episode. Individual QALY losses for inpatients (0.031, 95% CI, 0.025–0.037) were higher than for outpatients (0.009, 95% CI, 0.007–0.011), while societal QALY losses were reversed: 94 years for inpatients and 6,778 years for outpatients. For fatal cases (an official number of 318), we estimated a QALY loss of 11,981. Conclusions The influenza (H1N1)2009 pandemic had a significant but temporary impact on the HRQL of the majority of confirmed in- and outpatients. The societal impact of the influenza pandemic in Spain was estimated to be higher than other acute conditions. These results provide useful data for future cost-utility analyses. PMID:23555979

  5. Advancing health care quality and safety through action learning.

    PubMed

    Mathews, Simon; Golden, Sherita; Demski, Renee; Pronovost, Peter; Ishii, Lisa

    2017-05-02

    Purpose The purpose of this study is to demonstrate how action learning can be practically applied to quality and safety challenges at a large academic medical health system and become fundamentally integrated with an institution's broader approach to quality and safety. Design/methodology/approach The authors describe how the fundamental principles of action learning have been applied to advancing quality and safety in health care at a large academic medical institution. The authors provide an academic contextualization of action learning in health care and then transition to how this concept can be practically applied to quality and safety by providing detailing examples at the unit, cross-functional and executive levels. Findings The authors describe three unique approaches to applying action learning in the comprehensive unit-based safety program, clinical communities and the quality management infrastructure. These examples, individually, provide discrete ways to integrate action learning in the advancement of quality and safety. However, more importantly when combined, they represent how action learning can form the basis of a learning health system around quality and safety. Originality/value This study represents the broadest description of action learning applied to the quality and safety literature in health care and provides detailed examples of its use in a real-world context.

  6. Diabetes in China: a societal solution for a personal challenge.

    PubMed

    Chan, Juliana C N; Zhang, Yuying; Ning, Guang

    2014-12-01

    China has a large burden of diabetes: in 2013, one in four people with diabetes worldwide were in China, where 11·6% of adults had diabetes and 50·1% had prediabetes. Many were undiagnosed, untreated, or uncontrolled. This epidemic is the result of rapid societal transition that has led to an obesogenic environment against a backdrop of traditional lifestyle and periods of famine, which together puts Chinese people at high risk of diabetes and multiple morbidities. Societal determinants including social disparity and psychosocial stress interact with factors such as low-grade infection, environmental pollution, care fragmentation, health illiteracy, suboptimal self-care, and insufficient community support to give rise to diverse subphenotypes and consequences, notably renal dysfunction and cancer. In the China National Plan for Non-Communicable Disease Prevention and Treatment (2012-15), the Chinese Government proposed use of public measures, multisectoral collaborations, and social mobilisation to create a health-enabling environment and to reform the health-care system. While awaiting results from these long-term strategies, we advocate the use of a targeted and proactive approach to identify people at high risk of diabetes for prevention, and of private-public-community partnerships that make integrated care more accessible and sustainable, focusing on registry, empowerment, and community support. The multifaceted nature of the societal and personal challenge of diabetes requires a multidimensional solution for prevention in order to reduce the growing disease burden.

  7. School-Based Health Education Programmes, Health-Learning Capacity and Child Oral Health--related Quality of Life

    ERIC Educational Resources Information Center

    Freeman, Ruth; Gibson, Barry; Humphris, Gerry; Leonard, Helen; Yuan, Siyang; Whelton, Helen

    2016-01-01

    Objective: To use a model of health learning to examine the role of health-learning capacity and the effect of a school-based oral health education intervention (Winning Smiles) on the health outcome, child oral health-related quality of life (COHRQoL). Setting: Primary schools, high social deprivation, Ireland/Northern Ireland. Design: Cluster…

  8. School-Based Health Education Programmes, Health-Learning Capacity and Child Oral Health--related Quality of Life

    ERIC Educational Resources Information Center

    Freeman, Ruth; Gibson, Barry; Humphris, Gerry; Leonard, Helen; Yuan, Siyang; Whelton, Helen

    2016-01-01

    Objective: To use a model of health learning to examine the role of health-learning capacity and the effect of a school-based oral health education intervention (Winning Smiles) on the health outcome, child oral health-related quality of life (COHRQoL). Setting: Primary schools, high social deprivation, Ireland/Northern Ireland. Design: Cluster…

  9. Social/economic costs and health-related quality of life of mucopolysaccharidosis patients and their caregivers in Europe.

    PubMed

    Péntek, Márta; Gulácsi, László; Brodszky, Valentin; Baji, Petra; Boncz, Imre; Pogány, Gábor; López-Bastida, Julio; Linertová, Renata; Oliva-Moreno, Juan; Serrano-Aguilar, Pedro; Posada-de-la-Paz, Manuel; Taruscio, Domenica; Iskrov, Georgi; Schieppati, Arrigo; von der Schulenburg, Johann Matthias Graf; Kanavos, Panos; Chevreul, Karine; Persson, Ulf; Fattore, Giovanni

    2016-04-01

    To assess the health-related quality of life (HRQOL) of patients with mucopolysaccharidosis (MPS) and their caregivers and to quantify the disease-related costs from a societal perspective. In the context of a multi-country study of rare diseases (BURQOL-RD project), a cross-sectional survey was performed among MPS patients in seven European countries. Data on demographic characteristics, health resource utilization, informal care, and loss of labor productivity were collected. The EQ-5D, Barthel index (BI), and Zarit burden interview (ZBI) questionnaires were used to assess patients' and their informal caregivers' quality of life, patients' functional ability, and caregivers' burden, respectively. Altogether, 120 patients (children 62 %, females 40 %) and 66 caregivers completed the questionnaire. Patients' mean age was 16.5 years and median age at diagnosis was 3 years. Adult patients' average EQ-5D and EQ VAS scores varied across countries from 0.13 to 0.43 and 30.0 to 62.2, respectively, mean BI was 46.7, and ZBI was 32.7. Mean informal care time was 51.3 h/week. The mean total annual cost per patient (reference year 2012) was €24,520 in Hungary, €25,993 in France, €84,921 in Italy, €94,384 in Spain, and €209,420 in Germany. Costs are also shown to differ between children and adults. Direct costs accounted for most of the costs in all five countries (80, 100, 99, 98, and 93 %, respectively). MPS patients experience substantial loss of HRQOL and their families take a remarkable part in their care. Although utilization of health and social care resources varies significantly across countries, MPS incurs considerable societal costs in all the countries studied.

  10. Remote Sensing, Air Quality, and Public Health

    NASA Technical Reports Server (NTRS)

    Quattrochi, Dale A.; Rickman, Douglas; Mohammad, Al-Hamdan; Crosson, William; Estes, Maurice, Jr.; Limaye, Ashutosh; Qualters, Judith

    2008-01-01

    HELIX-Atlanta was developed to support current and future state and local EPHT programs to implement data linking demonstratio'n projects which could be part of the EPHT Network. HELIX-Atlanta is a pilot linking project in Atlanta for CDC to learn about the challenges the states will encounter. NASA/MSFC and the CDC are partners in linking environmental and health data to enhance public health surveillance. The use of NASA technology creates value - added geospatial products from existing environmental data sources to facilitate public health linkages. Proving the feasibility of the approach is the main objective

  11. [Health and quality of life vs. occupational activity].

    PubMed

    Kowalska, Małgorzata; Szemik, Szymon

    The level of quality of life and health status of the population largely depends on the determinants related to occupational activity. The results of reviewed bibliography indicate a significant and growing importance of employment conditions on the quality of life and population health status in most countries of the world, especially in those with market economy. Of the evaluated determinants the following factors should be listed in particular: sources and the amount of income, stability of the income and employment, the nature of work and the degree of job satisfaction, as well as autonomy and career prospects. Moreover, they proved that the situation of persisting and long-term unemployment and precarious employment leads to a significant deterioration in the quality of life and health, especially among young people. In conclusion, the study of quality of life and population health status should take into consideration factors related to occupational activity. Med Pr 2016;67(5):663-671.

  12. Assessing Metadata Quality of a Federally Sponsored Health Data Repository.

    PubMed

    Marc, David T; Beattie, James; Herasevich, Vitaly; Gatewood, Laël; Zhang, Rui

    2016-01-01

    The U.S. Federal Government developed HealthData.gov to disseminate healthcare datasets to the public. Metadata is provided for each datasets and is the sole source of information to find and retrieve data. This study employed automated quality assessments of the HealthData.gov metadata published from 2012 to 2014 to measure completeness, accuracy, and consistency of applying standards. The results demonstrated that metadata published in earlier years had lower completeness, accuracy, and consistency. Also, metadata that underwent modifications following their original creation were of higher quality. HealthData.gov did not uniformly apply Dublin Core Metadata Initiative to the metadata, which is a widely accepted metadata standard. These findings suggested that the HealthData.gov metadata suffered from quality issues, particularly related to information that wasn't frequently updated. The results supported the need for policies to standardize metadata and contributed to the development of automated measures of metadata quality.

  13. Assessing Metadata Quality of a Federally Sponsored Health Data Repository

    PubMed Central

    Marc, David T.; Beattie, James; Herasevich, Vitaly; Gatewood, Laël; Zhang, Rui

    2016-01-01

    The U.S. Federal Government developed HealthData.gov to disseminate healthcare datasets to the public. Metadata is provided for each datasets and is the sole source of information to find and retrieve data. This study employed automated quality assessments of the HealthData.gov metadata published from 2012 to 2014 to measure completeness, accuracy, and consistency of applying standards. The results demonstrated that metadata published in earlier years had lower completeness, accuracy, and consistency. Also, metadata that underwent modifications following their original creation were of higher quality. HealthData.gov did not uniformly apply Dublin Core Metadata Initiative to the metadata, which is a widely accepted metadata standard. These findings suggested that the HealthData.gov metadata suffered from quality issues, particularly related to information that wasn’t frequently updated. The results supported the need for policies to standardize metadata and contributed to the development of automated measures of metadata quality. PMID:28269883

  14. Quality, risk management and governance in mental health: an overview.

    PubMed

    Callaly, Tom; Arya, Dinesh; Minas, Harry

    2005-03-01

    To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.

  15. [Elaboration of health care quality criteria in maxillofacial surgery].

    PubMed

    Kulakov, A A; Butova, V G; Chkadua, T Z

    2015-01-01

    Criteria of quality of care in oral and maxillofacial surgery should reflect not only the quality of the repair functions of chewing, swallowing, breathing, speech, and should take into account the psycho-emotional condition of the patient; satisfaction of its appearance, quality cosmetic fill configuration of the face, tooth defects, smiles; adaptation to implants and dentures; their quality, the conditions and possibilities of their use. The application of the provisions of the international classification of functioning, disability and health in oral and maxillofacial surgery, is a condition that will allow to unify the approaches to the development of quality criteria of this type of medical care.

  16. Commentary: Societal Technology: A New Frontier.

    ERIC Educational Resources Information Center

    Decker, John P.

    1980-01-01

    The role of technology throughout history and its relationship to science is discussed. The new frontier of societal technology is considered in terms of human behavior and misbehavior in the face of conflict. (SA)

  17. Commentary: Societal Technology: A New Frontier.

    ERIC Educational Resources Information Center

    Decker, John P.

    1980-01-01

    The role of technology throughout history and its relationship to science is discussed. The new frontier of societal technology is considered in terms of human behavior and misbehavior in the face of conflict. (SA)

  18. Quality, CQI, and reengineering in health services organizations.

    PubMed

    Rakich, J S

    2001-01-01

    Quality in health care is defined with a focus on satisfying customer needs. The contemporary management philosophies of continuous quality improvement (CQI) and reengineering are defined; attributes and applications of each are described. Criticism of reengineering appearing in the literature is presented. It is likely that CQI will remain a predominate management philosophy in health services, while reengineering may not endure in its form of radical change.

  19. The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.

    PubMed

    Nicholas, D D; Heiby, J R; Hatzell, T A

    1991-01-01

    Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems.

  20. The structural quality of Tanzanian primary health facilities.

    PubMed Central

    Gilson, L.; Magomi, M.; Mkangaa, E.

    1995-01-01

    Structural quality is a key element in the quality of care provided at the primary level, which aims to offer health care interventions of proven efficacy. This assessment of the structural quality of Tanzanian primary health services indicated serious weaknesses in the available physical infrastructure, as well as supervision and other support, both for government and nongovernmental services and for dispensary and first referral-level services. Addressing these weaknesses is likely to require some additional funding and review of the functions of different groups of health care facilities within the primary care system. Although district health management teams have an important role to play in tackling the weaknesses, the existing division of management responsibilities indicates that they can only do so with the support of the regional and national levels of the health management structure. Study methods might be adapted to facilitate improved supervision and management. PMID:7704920

  1. Developing a global ocean observing system that prioritises ecosystem variables from a political and societal point of view

    NASA Astrophysics Data System (ADS)

    Miloslavich, P.; Bax, N. J.; Simmons, S. E.; Appeltans, W.; Garcia, M.

    2016-02-01

    The Biology and Ecosystems Panel of GOOS aims to develop and coordinate efforts to implement a sustained and targeted global ocean observation system. This system will be driven by societal needs (including the Sustainable Development Goals), and identify Essential Ocean Variables (EOVs) to inform priority scientific and societal questions that will facilitate critical policy development and management decision-making on ocean and coastal resource sustainability and health. Mature EOVs need to have global relevance and the capacity for global measurement. Our goal is to implement at least one (set of) mature EOVs by 2019, and identify a further three (sets of) pilot EOVs with a clear pathway to maturity. Our initial work includes (1) identifying drivers and pressures of societal and scientific needs, and (2) identifying internationally agreed goals that need sustained global observations of ocean biological & ecosystem variables for a healthy ocean. We reviewed 24 major conventions/international organizations (including the CBD and 16 UN related) to identify the societal needs these organizations address through their goals, and to produce a set of overlapping objectives. Main drivers identified in these conventions were: knowledge (science/data access), development (sustainable economic growth), conservation (biodiversity & ecosystems), sustainable use (biodiversity & resources), environmental quality (health), capacity building (technology transfer), food security, threat prevention and impact mitigation (to different pressures) and improved management (integrated ecosystem approach). The main pressures identified were climate change, ocean acidification, extreme weather events, overfishing/ overexploitation, pollution/ eutrophication, mining, solid wastes. Our next step will be to develop consensus with the observing community about the EOVs that will meet these needs and support the expansion of these identified EOVs into successful global observing systems.

  2. Construction of an environmental quality index for public health research

    EPA Science Inventory

    A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed. The EQI was developed in four parts: doma...

  3. Construction of an environmental quality index for public health research

    EPA Science Inventory

    A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed. The EQI was developed in four parts: doma...

  4. [Quality in occupational health education and training].

    PubMed

    Manno, M

    2010-01-01

    According to the International Code of Ethics of the International Commission on Occupational Health (ICOH) "occupational health practice must be performed according to the highest professional standards and ethical principles". So, the first ethical requirement for an occupational physician is a scientifically and professionally sound conduct, and vice-versa, the ethical principles must be an integral part of his/her education and training. The different tools and contexts for the education and training in occupational health (OH) in Italy, at both the undergraduate and postgraduate level, are presented. Moreover, the past and present contribution of the academic institutions and professional associations active in occupational health, to improve the professional standards of the occupational physicians is discussed. It is suggested that the objectives and the contents in OH education and training should not be limited to simply fulfil the legal requirements aimed to the protection of health and safety in the workplace (as it seems to be largely the case today), but they should rather anticipate and overcome them, by also including a thorough discussion of the fundamental ethical principles and duties to be accomplished in OH.

  5. [The objective assessment of the quality of oral health care and development of quality indicators].

    PubMed

    Pinke, Ildikó; Paulik, Edit; Kivovics, Péter; Segatto, Emil; Nagy, Katalin

    2011-12-01

    Public health care administration and decision-makers need appropriate tools and information to assess and monitor oral health needs and improve the performance of the oral health system. The aim of the article is to introduce the available methods of measurement of the quality of service, to give a brief summary considering the role of quality indicators in domestic and international sources and the European indicator project (EGOHID) and to introduce ICDAS (International Caries Detection and Assessment System), the method used for clinical examinations. The clinical indicators - that are produced from data gained from the questionnaires and screenings--provide an opportunity to improve and develop quality. Quality indicators are objective measure of the process or outcome of patient care. The 40 indicators were created by the experts of EGOHID program which are described in four categories. Part A is indicators for monitoring the oral health of children and adolescents, Part B is in general population, Part C is indicators for monitoring the oral health systems, Part D concerns indicators for monitoring the oral health quality of life. The purpose of developing public health care and--within it--dental care is the effective use of resources and besides it, reaching the popular level of health gain for which it is a necessary tool when forming and continuously developing the quality approach of providers.

  6. Report Central: quality reporting tool in an electronic health record.

    PubMed

    Jung, Eunice; Li, Qi; Mangalampalli, Anil; Greim, Julie; Eskin, Michael S; Housman, Dan; Isikoff, Jeremy; Abend, Aaron H; Middleton, Blackford; Einbinder, Jonathan S

    2006-01-01

    Quality reporting tools, integrated with ambulatory electronic health records, can help clinicians and administrators understand performance, manage populations, and improve quality. Report Central is a secure web report delivery tool built on Crystal Reports XItrade mark and ASP.NET technologies. Pilot evaluation of Report Central indicates that clinicians prefer a quality reporting tool that is integrated with our home-grown EHR to support clinical workflow.

  7. Report Central: Quality Reporting Tool in an Electronic Health Record

    PubMed Central

    Jung, Eunice; Li, Qi; Mangalampalli, Anil; Greim, Julie; Eskin, Michael S.; Housman, Dan; Isikoff, Jeremy; Abend, Aaron H.; Middleton, Blackford; Einbinder, Jonathan S.

    2006-01-01

    Quality reporting tools, integrated with ambulatory electronic health records, can help clinicians and administrators understand performance, manage populations, and improve quality. Report Central is a secure web report delivery tool built on Crystal Reports XI™ and ASP.NET technologies. Pilot evaluation of Report Central indicates that clinicians prefer a quality reporting tool that is integrated with our home-grown EHR to support clinical workflow. PMID:17238590

  8. Health-related quality of life in patients with urostomies.

    PubMed

    Gomez, Ascension; Barbera, Susana; Lombraña, Maria; Izquierdo, Laura; Baños, Carmen

    2014-01-01

    To assess health-related quality of life in patients with urothelial (bladder) cancer 6 months following radical cystectomy with construction of a urostomy. The target sample was 54 patients with urothelial cancer who underwent radical cystectomy with Bricker-type incontinent urinary diversion between December 2008 and December 2009; 37 out of 54 (68%) of potential respondents agreed to participate. Seven potential subjects died within the 6-month period and we were unable to locate 10 potential respondents. The Stoma-Quality of Life was developed to be valid for measurement of 20 items that query the impact of the ostomy on the health-related quality of life and its impact on daily life. Scores were categorized as 70% to 100% (indicating good quality of life), 30% to 69% (indicating moderate quality of life), and 0 to 29% (indicating poor quality of life). Subjects responded to the Stoma-Quality of Life questionnaire by telephone 6 months after urostomy surgery. Thirty-five were ranked as having a good quality of life. The remaining 2 subjects had scores indicating moderate quality of life; no respondent was ranked as having a poor quality of life. Health-related quality of life was ranked as good in 95% of a group of patients managed by radical cystectomy and Bricker ileal conduit construction and moderate in 5%. Based on these findings, we conclude that the Bricker-type incontinent urinary diversion remains a viable treatment option for bladder cancer that allows an acceptable health-related quality of life.

  9. Health Service Quality Scale: Brazilian Portuguese translation, reliability and validity.

    PubMed

    Rocha, Luiz Roberto Martins; Veiga, Daniela Francescato; e Oliveira, Paulo Rocha; Song, Elaine Horibe; Ferreira, Lydia Masako

    2013-01-17

    The Health Service Quality Scale is a multidimensional hierarchical scale that is based on interdisciplinary approach. This instrument was specifically created for measuring health service quality based on marketing and health care concepts. The aim of this study was to translate and culturally adapt the Health Service Quality Scale into Brazilian Portuguese and to assess the validity and reliability of the Brazilian Portuguese version of the instrument. We conducted a cross-sectional, observational study, with public health system patients in a Brazilian university hospital. Validity was assessed using Pearson's correlation coefficient to measure the strength of the association between the Brazilian Portuguese version of the instrument and the SERVQUAL scale. Internal consistency was evaluated using Cronbach's alpha coefficient; the intraclass (ICC) and Pearson's correlation coefficients were used for test-retest reliability. One hundred and sixteen consecutive postoperative patients completed the questionnaire. Pearson's correlation coefficient for validity was 0.20. Cronbach's alpha for the first and second administrations of the final version of the instrument were 0.982 and 0.986, respectively. For test-retest reliability, Pearson's correlation coefficient was 0.89 and ICC was 0.90. The culturally adapted, Brazilian Portuguese version of the Health Service Quality Scale is a valid and reliable instrument to measure health service quality.

  10. Quality of life, health status, and health service utilization related to a new measure of health literacy: FLIGHT/VIDAS.

    PubMed

    Ownby, Raymond L; Acevedo, Amarilis; Jacobs, Robin J; Caballero, Joshua; Waldrop-Valverde, Drenna

    2014-09-01

    Researchers have identified significant limitations in some currently used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. The new health literacy measure is significantly related to existing measures of health literacy as well as to participants' health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. The new measure of health literacy is valid and shows relations to measures of conceptually related constructs such as quality of life and health behaviors. FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. CHARACTERIZING AIR QUALITY FOR ENVIRONMENTAL PUBLIC HEALTH TRACKING

    EPA Science Inventory

    This presentation provides a brief summary of EPA's perspective on Environmental Public Health Tracking, the Public Health Air Surveillance Evaluation (PHASE), and EPA's efforts to provide air quality data to three states (Maine, New York, and Wisconsin) that are partners with CD...

  12. Quality Improvement and School-Based Mental Health Programs.

    ERIC Educational Resources Information Center

    Nabors, Laura; Weist, Mark; Acosta, Olga; Tashman, Nancy

    This report discusses the outcomes of a study that reviewed activities to ensure quality of care for adolescents receiving mental health services in the School Mental Health Program (SMHP), based in the Department of Psychiatry at the University of Maryland School of Medicine. For this program a team of clinicians, as well as trainees in each…

  13. Health Conditions and Perceived Quality of Life in Retirement.

    ERIC Educational Resources Information Center

    Dorfman, Lorraine T.

    1995-01-01

    Investigates the effects of specific health conditions on perceived quality of life for retirees (n=451). Pulmonary disease was a predictor of dissatisfaction for both sexes. Pulmonary disease and heart attack were the strongest predictors of dissatisfaction with health for men, followed closely by stroke. Arthritis was the strongest predictor of…

  14. The Health-Related Quality of Life of Custodial Grandparents

    ERIC Educational Resources Information Center

    Neely-Barnes, Susan L.; Graff, J. Carolyn; Washington, Gregory

    2010-01-01

    Health-related quality of life (HRQOL) was explored in a sample of 119 custodial grandparents. A latent profile analysis identified three groups of grandparents along a continuum of good to poor HRQOL, with most custodial grandparents reporting Short Form-12 Health Survey (version 2) scores significantly below U.S. population means. Grandparent…

  15. Health Conditions and Perceived Quality of Life in Retirement.

    ERIC Educational Resources Information Center

    Dorfman, Lorraine T.

    1995-01-01

    Investigates the effects of specific health conditions on perceived quality of life for retirees (n=451). Pulmonary disease was a predictor of dissatisfaction for both sexes. Pulmonary disease and heart attack were the strongest predictors of dissatisfaction with health for men, followed closely by stroke. Arthritis was the strongest predictor of…

  16. CHARACTERIZING AIR QUALITY FOR ENVIRONMENTAL PUBLIC HEALTH TRACKING

    EPA Science Inventory

    This presentation provides a brief summary of EPA's perspective on Environmental Public Health Tracking, the Public Health Air Surveillance Evaluation (PHASE), and EPA's efforts to provide air quality data to three states (Maine, New York, and Wisconsin) that are partners with CD...

  17. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

    PubMed Central

    Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

  18. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

    PubMed

    Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

  19. Promoting happiness: the malleability of individual and societal subjective wellbeing.

    PubMed

    Tay, Louis; Kuykendall, Lauren

    2013-01-01

    Is it possible to enhance the subjective wellbeing of individuals and societies? If so, what are the mental health interventions and economic mechanisms by which subjective wellbeing could be enhanced? We address these questions in our review of the literature on subjective wellbeing. Research now shows that although subjective wellbeing is heritable and stable, it can change substantially over time. Long-term changes can be affected by positive or negative life events; subjective wellbeing interventions have also proved to be effective for boosting wellbeing for as long as six months. At the societal level, economic factors matter for the subjective wellbeing of citizens. Economic wealth is shown to be a predictor of societal wellbeing across countries and over time. Also, high unemployment severely lowers the wellbeing of individuals and has spillover effects on other societal members, such as the employed. Given the weight of evidence, we are optimistic that subjective wellbeing can be enhanced. For practitioners, policy makers, and economists interested in the wellbeing of individuals, we propose that these findings have implications for mental health practice and economic policies. Future research and methodological issues are discussed.

  20. Environmental Quality Index and Childhood Mental Health

    EPA Science Inventory

    Childhood mental disorders affect between 13%-20% of children in the United States (US) annually and impact the child, family, and community. Literature suggests associations exist between environmental and children’s mental health such as air pollution with autism and ADHD...

  1. Environmental Quality Index and Childhood Mental Health

    EPA Science Inventory

    Childhood mental disorders affect between 13%-20% of children in the United States (US) annually and impact the child, family, and community. Literature suggests associations exist between environmental and children’s mental health such as air pollution with autism and ADHD...

  2. Defining health-related quality of life for young wheelchair users: A qualitative health economics study.

    PubMed

    Bray, Nathan; Noyes, Jane; Harris, Nigel; Edwards, Rhiannon Tudor

    2017-01-01

    Wheelchairs for children with impaired mobility provide health, developmental and psychosocial benefits, however there is limited understanding of how mobility aids affect the health-related quality of life of children with impaired mobility. Preference-based health-related quality of life outcome measures are used to calculate quality-adjusted life years; an important concept in health economics. The aim of this research was to understand how young wheelchair users and their parents define health-related quality of life in relation to mobility impairment and wheelchair use. The sampling frame was children with impaired mobility (≤18 years) who use a wheelchair and their parents. Data were collected through semi-structured face-to-face interviews conducted in participants' homes. Qualitative framework analysis was used to analyse the interview transcripts. An a priori thematic coding framework was developed. Emerging codes were grouped into categories, and refined into analytical themes. The data were used to build an understanding of how children with impaired mobility define health-related quality of life in relation to mobility impairment, and to assess the applicability of two standard measures of health-related quality of life. Eleven children with impaired mobility and 24 parents were interviewed across 27 interviews. Participants defined mobility-related quality of life through three distinct but interrelated concepts: 1) participation and positive experiences; 2) self-worth and feeling fulfilled; 3) health and functioning. A good degree of consensus was found between child and parent responses, although there was some evidence to suggest a shift in perception of mobility-related quality of life with child age. Young wheelchair users define health-related quality of life in a distinct way as a result of their mobility impairment and adaptation use. Generic, preference-based measures of health-related quality of life lack sensitivity in this population

  3. Defining health-related quality of life for young wheelchair users: A qualitative health economics study

    PubMed Central

    2017-01-01

    Background Wheelchairs for children with impaired mobility provide health, developmental and psychosocial benefits, however there is limited understanding of how mobility aids affect the health-related quality of life of children with impaired mobility. Preference-based health-related quality of life outcome measures are used to calculate quality-adjusted life years; an important concept in health economics. The aim of this research was to understand how young wheelchair users and their parents define health-related quality of life in relation to mobility impairment and wheelchair use. Methods The sampling frame was children with impaired mobility (≤18 years) who use a wheelchair and their parents. Data were collected through semi-structured face-to-face interviews conducted in participants’ homes. Qualitative framework analysis was used to analyse the interview transcripts. An a priori thematic coding framework was developed. Emerging codes were grouped into categories, and refined into analytical themes. The data were used to build an understanding of how children with impaired mobility define health-related quality of life in relation to mobility impairment, and to assess the applicability of two standard measures of health-related quality of life. Results Eleven children with impaired mobility and 24 parents were interviewed across 27 interviews. Participants defined mobility-related quality of life through three distinct but interrelated concepts: 1) participation and positive experiences; 2) self-worth and feeling fulfilled; 3) health and functioning. A good degree of consensus was found between child and parent responses, although there was some evidence to suggest a shift in perception of mobility-related quality of life with child age. Conclusions Young wheelchair users define health-related quality of life in a distinct way as a result of their mobility impairment and adaptation use. Generic, preference-based measures of health-related quality of life

  4. Helping States enhance health care quality through technical assistance.

    PubMed

    Martinez-Vidal, Enrique; Gauthier, Anne K; DiVincenzo, Allison

    2010-01-01

    For the money spent on health care in the United States, far better quality of care should be expected. The Commonwealth Fund and AcademyHealth have created the State Quality Improvement Institute to assist states in implementing sustainable quality improvement strategies. Lessons have emerged about the role of states in advancing fundamental and systemic changes in the way care is delivered, as well as how providers are organized and compensated. The experiences of states participating in the institute may offer insights for other states seeking to achieve similar goals.

  5. Quality as the cornerstone of behavioral health: four critical issues.

    PubMed

    Rosenberg, Linda

    2007-10-01

    The author emphasizes the need to focus on quality in mental health and addictions treatment. High-quality care means care that is personalized, prevention-oriented, and based on evidence about the benefits, costs, and the desires of each person. Whereas the challenges to improving quality are formidable, four critical issues can and must be addressed: focus on whole health, clinical excellence, workforce, and information technology. With strong leadership, commitment, and persistence, we can have a system that supports recovery and ensures a meaningful life in the community for our sickest and poorest citizens.

  6. Racial and Ethnic Disparities in the Quality of Health Care.

    PubMed

    Fiscella, Kevin; Sanders, Mechelle R

    2016-01-01

    The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

  7. [Hypermedia in medical education: quality of health care].

    PubMed

    Kusec, Sanja; Jaksić, Zelimir; Vuletić, Gorka; Kovacić, Luka; Pavleković, Gordana

    2002-09-01

    The recent technological developments have found its place in medical education as well. Hypermedia has become very popular through the widespread use of the Internet. In its research project, the Department of Educational Technology of the Andrija Stampar School of Public Health studied and applied the educational methods in continuing training of health professionals using hypermedia and taking into account the specificities of medical and health practices. Potentials of hypermedia in medical education are presented within the topic on quality of health care. The result of this project is an interactive educational disk designed for physicians and other health professionals in primary health care faced with the issue of quality. This paper gives an overview of the experience gained during the work on the project and describes the created educational disk with all its specificities observed in the development of the educational hypermedia materials.

  8. Internal marketing: creating quality employee experiences in health care organizations.

    PubMed

    Masri, Maysoun Dimachkie; Oetjen, Dawn; Rotarius, Timothy

    2011-01-01

    To cope with the recent challenges within the health care industry, health care managers need to engage in the internal marketing of their various services. Internal marketing has been used as an effective management tool to increase employees' motivation, satisfaction, and productivity (J Mark Commun. 2010;16(5):325-344). Health care managers should understand that an intense focus on internal marketing factors will lead to a quality experience for employees that will ultimately have a positive effect on the patient experiences.

  9. Creating a culture for health care quality and safety.

    PubMed

    Roberts, Velma; Perryman, Martha M

    2007-01-01

    Approximately 67% of hospital quality indicators require some type of laboratory testing to monitor compliance. Unfortunately, in many hospitals, laboratory data information systems remain an untapped resource in eliminating medical errors and improving patient safety. Using case scenarios, this article demonstrates potential consequences for patient safety and quality of care when information sharing between medical technologists and nurses is not a part of a hospital's culture. The outcome for this patient could have been avoided if a more inclusive health care quality and safety culture existed. Creating a culture for health care quality and safety requires consensus building by clinical and administrative leaders. Consensus building occurs by managing relationships among and between a team of independent, autonomous physicians, nurses, allied health professionals, and health care administrators. These relationships are built on mutual respect and effective communication. Creating a quality culture is a challenging but necessary prerequisite for eliminating medical errors and ensuring patient safety. Physician leaders promoting and advancing cultural change in clinical care from one of exclusive decision making authority to a culture that is based on shared decision making are a necessary first step. Shared decision making requires mutual respect, trust, confidentiality, responsiveness, empathy, effective listening, and communication among all clinical team members. Physician and administrative leaders with a focus on patient safety and a willingness to change will ensure a culture of health care quality and safety.

  10. Relation of Health Condition and Quality of Life: Examination of the Quality of Life of the Disadvantaged Population in Nyíregyháza by the FT Quality of Life Index

    ERIC Educational Resources Information Center

    Jávorné-Erdei, Renáta; Takács, Péter; Fábián, Gergely

    2015-01-01

    Improving the health of the population, stopping and changing the disadvantage trends have long been one of the health policy objectives in the regions. Unfortunately, in spite of the declared goals Hungary is far away from giving priority to health issues as they are not given proper attention either on individual or societal level. In modern…

  11. Relation of Health Condition and Quality of Life: Examination of the Quality of Life of the Disadvantaged Population in Nyíregyháza by the FT Quality of Life Index

    ERIC Educational Resources Information Center

    Jávorné-Erdei, Renáta; Takács, Péter; Fábián, Gergely

    2015-01-01

    Improving the health of the population, stopping and changing the disadvantage trends have long been one of the health policy objectives in the regions. Unfortunately, in spite of the declared goals Hungary is far away from giving priority to health issues as they are not given proper attention either on individual or societal level. In modern…

  12. Leveraging Health Information Technology to Improve Quality in Federal Healthcare.

    PubMed

    Weigel, Fred K; Switaj, Timothy L; Hamilton, Jessica

    2015-01-01

    Healthcare delivery in America is extremely complex because it is comprised of a fragmented and nonsystematic mix of stakeholders, components, and processes. Within the US healthcare structure, the federal healthcare system is poised to lead American medicine in leveraging health information technology to improve the quality of healthcare. We posit that through developing, adopting, and refining health information technology, the federal healthcare system has the potential to transform federal healthcare quality by managing the complexities associated with healthcare delivery. Although federal mandates have spurred the widespread use of electronic health records, other beneficial technologies have yet to be adopted in federal healthcare settings. The use of health information technology is fundamental in providing the highest quality, safest healthcare possible. In addition, health information technology is valuable in achieving the Agency for Healthcare Research and Quality's implementation goals. We conducted a comprehensive literature search using the Google Scholar, PubMed, and Cochrane databases to identify an initial list of articles. Through a thorough review of the titles and abstracts, we identified 42 articles as having relevance to health information technology and quality. Through our exclusion criteria of currency of the article, citation frequency, applicability to the federal health system, and quality of research supporting conclusions, we refined the list to 11 references from which we performed our analysis. The literature shows that the use of computerized physician order entry has significantly increased accurate medication dosage and decreased medication errors. The use of clinical decision support systems have significantly increased physician adherence to guidelines, although there is little evidence that indicates any significant correlation to patient outcomes. Research shows that interoperability and usability are continuing challenges for

  13. Quality of sleep and health-related quality of life in renal transplant recipients

    PubMed Central

    Liu, Hong-Xia; Lin, Jun; Lin, Xiao-Hong; Wallace, Linda; Teng, Sha; Zhang, Shu-Ping; Hao, Yu-Fang

    2015-01-01

    Aims and objectives: The purpose of this study was to examine the sleep quality and health-related quality of life (HRQOL) in patients after renal transplantation and to explore the relationship between the quality of sleep and the HRQOL. Background: Sleep disorders are still an important clinical problem after renal transplantation. Previous studies mainly focused on patients’ sleep quality before kidney transplant. More studies are needed to document sleep quality after renal transplantation. Design: A cross-sectional design was used in this study. Methods: A convenience sample of renal transplant recipients was recruited at an outpatient transplant clinic of a general hospital in Beijing, China. The Pittsburgh Sleep Quality Index (PSQI) was used to measure quality of sleep. The Medical Outcomes Study 36-item Short Form (MOS SF-36) was used to measure health-related quality of life. Results: The average PSQI score of the 204 renal transplant recipients was 5.81±3.52, significantly lower than the norm. Fifty (24.5%) recipients were classified as having poor sleep quality (global PSQI > 7). The mean scores of renal transplant recipients for SF-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) were 47.57±6.71 and 48.26±9.66 respectively. Compared with residents in Sichuan province, recipients’ scores for SF-36 dimensions were statistically lower except the dimension of mental health. SF-36 scores of poor sleepers (PSQI > 7) were significantly lower than the good sleepers (PSQI ≤ 7) in both the MCS and PCS. Significant differences exist between the groups in physical function, bodily pain, vitality, and mental health dimensions. Conclusions: Sleep quality and HRQOL of patients after renal transplantation were lower than the norm. Poor sleep is associated with lower HRQOL. Relevance to clinical practice: Health professionals need to pay attention to sleep quality and HRQOL in renal transplant recipients and take appropriate measures to

  14. Impact of a Mental Health Based Primary Care Program on Quality of Physical Health Care.

    PubMed

    Breslau, Joshua; Leckman-Westin, Emily; Yu, Hao; Han, Bing; Pritam, Riti; Guarasi, Diana; Horvitz-Lennon, Marcela; Scharf, Deborah M; Pincus, Harold A; Finnerty, Molly T

    2017-09-07

    We examine the impact of mental health based primary care on physical health treatment among community mental health center patients in New York State using propensity score adjusted difference in difference models. Outcomes are quality indicators related to outpatient medical visits, diabetes HbA1c monitoring, and metabolic monitoring of antipsychotic treatment. Results suggest the program improved metabolic monitoring for patients on antipsychotics in one of two waves, but did not impact other quality indicators. Ceiling effects may have limited program impacts. More structured clinical programs to may be required to achieve improvements in quality of physical health care for this population.

  15. Public health laboratory quality management in a developing country.

    PubMed

    Wangkahat, Khwanjai; Nookhai, Somboon; Pobkeeree, Vallerut

    2012-01-01

    The article aims to give an overview of the system of public health laboratory quality management in Thailand and to produce a strengths, weaknesses, opportunities and threats (SWOT) analysis that is relevant to public health laboratories in the country. The systems for managing laboratory quality that are currently employed were described in the first component. The second component was a SWOT analysis, which used the opinions of laboratory professionals to identify any areas that could be improved to meet quality management systems. Various quality management systems were identified and the number of laboratories that met both international and national quality management requirements was different. The SWOT analysis found the opportunities and strengths factors offered the best chance to improve laboratory quality management in the country. The results are based on observations and brainstorming with medical laboratory professionals who can assist laboratories in accomplishing quality management. The factors derived from the analysis can help improve laboratory quality management in the country. This paper provides viewpoints and evidence-based approaches for the development of best possible practice of services in public health laboratories.

  16. Price and quality transparency: how effective for health care reform?

    PubMed

    Nyman, John A; Li, Chia-Hsuan W

    2009-07-01

    Many in Minnesota and the United States are promoting price and quality transparency as a means for reforming health care. The assumption is that with such information, consumers and providers would be motivated to change their behavior and this would lead to lower costs and higher-quality care.This article attempts to determine the extent to which publicizing information about the cost and quality of medical care does, in fact, improve quality and lower costs, and thus should be included in any reform strategy. The authors reviewed a number of studies and concluded that there is a general lack of empirical evidence on the effect of price transparency on health care costs and that the evidence on the effectiveness of quality transparency is mixed.

  17. The Societal and Economic Value of Rotator Cuff Repair

    PubMed Central

    Mather, Richard C.; Koenig, Lane; Acevedo, Daniel; Dall, Timothy M.; Gallo, Paul; Romeo, Anthony; Tongue, John; Williams, Gerald

    2013-01-01

    Background: Although rotator cuff disease is a common musculoskeletal problem in the United States, the impact of this condition on earnings, missed workdays, and disability payments is largely unknown. This study examines the value of surgical treatment for full-thickness rotator cuff tears from a societal perspective. Methods: A Markov decision model was constructed to estimate lifetime direct and indirect costs associated with surgical and continued nonoperative treatment for symptomatic full-thickness rotator cuff tears. All patients were assumed to have been unresponsive to one six-week trial of nonoperative treatment prior to entering the model. Model assumptions were obtained from the literature and data analysis. We obtained estimates of indirect costs using national survey data and patient-reported outcomes. Four indirect costs were modeled: probability of employment, household income, missed workdays, and disability payments. Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population. Effectiveness was expressed in quality-adjusted life years (QALYs). Results: The age-weighted mean total societal savings from rotator cuff repair compared with nonoperative treatment was $13,771 over a patient’s lifetime. Savings ranged from $77,662 for patients who are thirty to thirty-nine years old to a net cost to society of $11,997 for those who are seventy to seventy-nine years old. In addition, surgical treatment results in an average improvement of 0.62 QALY. Societal savings were highly sensitive to age, with savings being positive at the age of sixty-one years and younger. The estimated lifetime societal savings of the approximately 250,000 rotator cuff repairs performed in the U.S. each year was $3.44 billion. Conclusions: Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of sixty-one years and greater QALYs for all patients. Rotator cuff repair is cost

  18. Air Quality Index (AQI) -- A Guide to Air Quality and Your Health

    MedlinePlus

    ... the AQI value, the greater the level of air pollution and the greater the health concern. For example, ... to 50. Air quality is considered satisfactory, and air pollution poses little or no risk. "Moderate" AQI is ...

  19. Service quality perceptions in primary health care centres in Greece

    PubMed Central

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2012-01-01

    Abstract Context  The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective  To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy  SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results  The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions  This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

  20. Low health-related quality of life among abused women.

    PubMed

    Alsaker, Kjersti; Moen, Bente E; Nortvedt, Monica W; Baste, Valborg

    2006-08-01

    In a cross-sectional study, we sent a self-administered questionnaire to all the women's shelters in Norway to describe health-related quality of life among women who had experienced violence from an intimate partner. Every woman who could understand Norwegian and was staying at a women's shelter in Norway for more than 1 week from October 2002 to May 2003 was asked to participate. We described violence by intimate partners by using the Severity of Violence against Women Scale and the Psychological Maltreatment of Women Index. We used the SF-36 Health Survey to measure health-related quality of life. These women experienced a multitude of threats and actual physical and psychological violence during their partnership. Their health-related quality of life was low and significantly (p<0.001) below the norm for the female population of Norway in all dimensions. The SF-36 mental health dimension was 2.5 standard deviations below the norm. Women at women's shelters in Norway who had experienced domestic violence had very low and clinically significantly reduced health-related quality of life scores. Health care workers must give priority to developing intervention plans for victims of violence from intimate partners.

  1. Service quality perceptions in primary health care centres in Greece.

    PubMed

    Papanikolaou, Vicky; Zygiaris, Sotiris

    2014-04-01

    The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. © 2012 John Wiley & Sons Ltd.

  2. [Valuation of health-related quality of life and utilities in health economics].

    PubMed

    Greiner, Wolfgang; Klose, Kristina

    2014-01-01

    Measuring health-related quality of life is an important aspect in economic evaluation of health programmes. The development of utility-based (preference-based) measures is advanced by the discipline of health economics. Different preference measures are applied for valuing health states to produce a weighted health state index. Those preference weights should be derived from a general population sample in case of resource allocation on a collective level (as in current valuation studies of the EuroQol group).

  3. Quality indicators for primary care mental health services

    PubMed Central

    Shield, T; Campbell, S; Rogers, A; Worrall, A; Chew-Graham, C; Gask, L

    2003-01-01

    Objectives: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement. Design: Modified two-round postal Delphi questionnaire. Setting: Geographical spread across Great Britain. Participants: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations). Main outcome measures: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care. Results: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304). Conclusions: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators

  4. [Perception of health care quality by patients with chronic conditions].

    PubMed

    Couillerot-Peyrondet, A-L; Midy, F; Bruneau, C

    2011-02-01

    Patient opinion is becoming ever more important when considering healthcare quality and the reforms required to improve healthcare quality. The main aim of this study was to explore factors determining perceived healthcare quality among patients with chronic diseases. Data are drawn from the survey carried out in 2008 by the Commonwealth Fund, in partnership with the French Superior Health Authority (Haute Autorité de santé). The prospective telephone survey targeted adults in eight countries who had serious health problems (chronic or severe disease, declared poor state of health, hospital admission or major surgery). Of the 1202 French respondents, 851 had at least one diagnosed chronic disease. A multinomial logistic model was used to identify the relationship between perceived healthcare quality and patients' recent experience with the healthcare system. People with chronic disease in general perceived that healthcare quality was excellent (45%) or good (44%). Only 11% of respondents judged it to be average or poor. There was a hint of "could do better", for example when considering podology and ophthalmology follow-up in diabetes or the management of multiple medications. The explanatory model revealed a positive correlation between excellent perceived healthcare quality and a strong doctor-patient relationship, taking into account both the length of this relationship and the ability of the doctor to involve the patient at all stages of decision-making concerning therapeutic management. There was no major link between the perceived quality of care and objective care quality, the quality of procedures, the cost of care to the patient or how frequently patients access the healthcare system. The quality of the relationship between the patient and his/her doctor is a determining factor in the patient's judgement of the quality of healthcare he/she receives. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  5. Service Quality Assessment Scale (SQAS): An Instrument for Evaluating Service Quality of Health-Fitness Clubs

    ERIC Educational Resources Information Center

    Lam, Eddie T. C.; Zhang, James J.; Jensen, Barbara E.

    2005-01-01

    This study was designed to develop the Service Quality Assessment Scale to evaluate the service quality of health-fitness clubs. Through a review of literature, field observations, interviews, modified application of the Delphi technique, and a pilot study, a preliminary scale with 46 items was formulated. The preliminary scale was administered to…

  6. [Nosocomial infections and quality of health care].

    PubMed

    Navarrete-Navarro, S; Rangel-Frausto, M S

    1999-01-01

    The main objective of a hospital-acquired infections control program is to decrease the risk of acquisition and the morbidity and costs associated. The organization of a team with technical and humanistic leadership is essential. Every infection control program must also develop strategies that allow: a) identification of the problems, b) to establish the importance of each one, c) to determine their causes, d) to develop solutions and e) the evaluation of the recommended solutions. The development of technical and humanistic abilities by the leader and the members of the team, and the use of the tools mentioned above have produced the only validate and highly effective program of quality improvement in the hospital.

  7. COMPETITION AND QUALITY IN HOME HEALTH CARE MARKETS†

    PubMed Central

    JUNG, KYOUNGRAE; POLSKY, DANIEL

    2013-01-01

    SUMMARY Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients’ homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition. PMID:23670849

  8. Competition and quality in home health care markets.

    PubMed

    Jung, Kyoungrae; Polsky, Daniel

    2014-03-01

    Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients' homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition.

  9. Improving Data Quality in Mass-Gatherings Health Research.

    PubMed

    Guy, Andrew; Prager, Ross; Turris, Sheila; Lund, Adam

    2017-03-09

    Mass gatherings attract large crowds and can strain the planning and health resources of the community, city, or nation hosting an event. Mass-Gatherings Health (MGH) is an evolving niche of prehospital care rooted in emergency medicine, emergency management, public health, and disaster medicine. To explore front-line issues related to data quality in the context of mass gatherings, the authors draw on five years of management experience with an online, mass-gathering event and patient registry, as well as clinical and operational experience amassed over several decades. Here the authors propose underlying human, environmental, and logistical factors that may contribute to poor data quality at mass gatherings, and make specific recommendations for improvement through pre-event planning, on-site actions, and post-event follow-up. The advancement of MGH research will rely on addressing factors that influence data quality and developing strategies to mitigate or enhance those factors. This is an exciting time for MGH research as higher order questions are beginning to be addressed; however, quality research must start from the ground up to ensure optimal primary data capture and quality. Guy A , Prager R , Turris S , Lund A . Improving data quality in mass-gatherings health research. Prehosp Disaster Med. 2017;32(3):1-4.

  10. Integrative medicine: enhancing quality in primary health care.

    PubMed

    Grace, Sandra; Higgs, Joy

    2010-09-01

    Integrative medicine (IM) is an emerging model of health care in Australia. However, little is known about the contribution that IM makes to the quality of health care. The aim of the research was to understand the contribution IM can make to the quality of primary care practices from the perspectives of consumers and providers of IM. This interpretive research used hermeneutic phenomenology to understand meanings and significance that patients and practitioners attach to their experiences of IM. Various qualitative research techniques were used: case studies; focus groups; and key informant interviews. Data sets were generated from interview transcripts and field notes. Data analysis consisted of repeatedly reading and examining the data sets for what they revealed about experiences of health care and health outcomes, and constantly comparing these to allow themes and patterns to emerge. The setting for this research was Australian IM clinics where general medical practitioners and CAM practitioners were co-located. From the perspective of patients and practitioners, IM: (1) provided authentically patient-centered care; (2) filled gaps in treatment effectiveness, particularly for certain patient populations (those with complex, chronic health conditions, those seeking an alternative to pharmaceutical health care, and those seeking health promotion and illness prevention); and (3) enhanced the safety of primary health care (because IM retained a general medical practitioner as the primary contact practitioner and because IM used strategies to increase disclosure of treatments between practitioners). According to patients and practitioners, IM enhanced the quality of primary health care through its provision of health care that was patient-centered, effective (particularly for chronic health conditions, nonpharmaceutical treatments, and health promotion) and safe.

  11. Health-Related Quality of Life and Health-Promoting Behaviors in Black Men

    ERIC Educational Resources Information Center

    Calvert, Wilma J.; Isaac,, E. Paulette; Johnson, Sharon

    2012-01-01

    This study examined the health-related quality of life and health-promoting behaviors in a convenience sample of low-income black men. Almost three-fourths reported their overall health as good or better. However, the mean number of recent (that is, past 30 days) mentally unhealthy days was 13.12, and more than half reported frequent (greater than…

  12. Health-Related Quality of Life and Health-Promoting Behaviors in Black Men

    ERIC Educational Resources Information Center

    Calvert, Wilma J.; Isaac,, E. Paulette; Johnson, Sharon

    2012-01-01

    This study examined the health-related quality of life and health-promoting behaviors in a convenience sample of low-income black men. Almost three-fourths reported their overall health as good or better. However, the mean number of recent (that is, past 30 days) mentally unhealthy days was 13.12, and more than half reported frequent (greater than…

  13. When Weather Matters: Science and Service to Meet Critical Societal Needs

    NASA Technical Reports Server (NTRS)

    2010-01-01

    The goal of weather prediction is to provide information people and organizations can use to reduce weather-related losses and enhance societal benefits, including protection of life and property, public health and safety, and support of economic prosperity and quality of life. In economic terms, the benefit of the investment in public weather forecasts and warnings is substantial: the estimated annualized benefit is about $31.5 billion, compared to the $5.1 billion cost of generating the information. Between 1980 and 2009, 96 weather disasters in the United States each caused at least $1 billion in damages, with total losses exceeding $700 billion. Between 1999 and 2008, there were an average of 629 direct weather fatalities per year. The annual impacts of adverse weather on the national highway system and roads are staggering: 1.5 million weather-related crashes with 7,400 deaths, more than 700,000 injuries, and $42 billion in economic losses.

  14. When Weather Matters: Science and Service to Meet Critical Societal Needs

    NASA Technical Reports Server (NTRS)

    2010-01-01

    The goal of weather prediction is to provide information people and organizations can use to reduce weather-related losses and enhance societal benefits, including protection of life and property, public health and safety, and support of economic prosperity and quality of life. In economic terms, the benefit of the investment in public weather forecasts and warnings is substantial: the estimated annualized benefit is about $31.5 billion, compared to the $5.1 billion cost of generating the information. Between 1980 and 2009, 96 weather disasters in the United States each caused at least $1 billion in damages, with total losses exceeding $700 billion. Between 1999 and 2008, there were an average of 629 direct weather fatalities per year. The annual impacts of adverse weather on the national highway system and roads are staggering: 1.5 million weather-related crashes with 7,400 deaths, more than 700,000 injuries, and $42 billion in economic losses.

  15. [Dying and death in societal transformation].

    PubMed

    Heller, Andreas; Wegleitner, Klaus

    2017-01-01

    Dying and death in modern societies are subject to profound social, professional and cultural-religious changes. Secularization and a stronger differentiation of societies have led to a change in the way humans handle the dying process. Normatively ritualized collective behaviour has been replaced by an individual, subjectivized approach. In late modern societies there are many different views of what "successful" or "good" dying means.In the article this change is described by the following seven theses: 1. We live longer and we die longer. 2. We no longer die suddenly and unexpectedly but slowly and foreseeably. 3. Even though our biological life on earth has become longer, our life has been shortened by the loss of eternity. 4. We no longer die on the stage of ritualized relationships with our family and neighbours but behind the curtains of organizations. 5. We live and die in a society of organizations and have to get organized for the final phase of our life. 6. Living and dying are no large, state-owned enterprises but small, private enterprises. 7. The hospice movement as well as palliative medicine have created public awareness, made dying a matter of discussion and offered a new set of options.In late modernism end-of-life care requires new approaches based on individual and shared responsibility as well as cooperation between professional institutions and community-based voluntary care.A change towards community care is visible. Thus "dying" is a topic in the discussion about the future of public health and societal solidarity.

  16. Sleep Quality and Health-Related Quality of Life in Pregnancy.

    PubMed

    Sut, Hatice Kahyaoglu; Asci, Ozlem; Topac, Nalan

    The aim of this study was to investigate sleep quality and health-related quality of life in pregnancy. In a cross-sectional design, 492 women (292 pregnant and 200 nonpregnant healthy controls) were included in this study between November 2014 and June 2015. Participants completed a survey on sociodemographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the European Quality of Life-5 Dimensions (EQ-5D). The PSQI total and EQ-5D scores of pregnant women were significantly worse than the controls (P = .017 and P < .001, respectively). Linear regression analysis showed that only pregnancy status was related to PSQI scores (β = .117; P = .009). Compared with the first trimester, the risk of poor sleep quality increased 2.11-fold in the second trimester (P = .048) and 1.86-fold in the third trimester (P = .054). Compared with the first trimester, EQ-5D scores significantly decreased in the second (P = .038) and third (P < .001) trimesters. Sleep quality and health-related quality of life of pregnant women were worse than those of nonpregnant healthy controls. Healthcare professionals need to be aware of deteriorations in sleep quality and health-related quality of life of pregnant women.

  17. Perception of quality of health delivery and health insurance subscription in Ghana.

    PubMed

    Amo-Adjei, Joshua; Anku, Prince Justin; Amo, Hannah Fosuah; Effah, Mavis Osei

    2016-07-29

    National health insurance schemes (NHIS) in developing countries and perhaps in developed countries as well is a considered a pro-poor intervention by helping to bridge the financial burden of access to quality health care. Perceptions of quality of health service could have immense impacts on enrolment. This paper shows how perception of service quality under Ghana's insurance programme contributes to health insurance subscription. The study used the 2014 Ghana Demographic and Health Survey (GDHS) dataset. Both descriptive proportions and binary logistic regression techniques were applied to generate results that informed the discussion. Our results show that a high proportion of females (33 %) and males (35 %) felt that the quality of health provided to holders of the NHIS card was worse. As a result, approximately 30 % of females and 22%who perceived health care as worse by holding an insurance card did not own an insurance policy. While perceptions of differences in quality among females were significantly different (AOR = 0.453 [95 % CI = 0.375, 0.555], among males, the differences in perceptions of quality of health services under the NHIS were independent in the multivariable analysis. Beyond perceptions of quality, being resident in the Upper West region was an important predictor of health insurance ownership for both males and females. For such a social and pro-poor intervention, investing in quality of services to subscribers, especially women who experience enormous health risks in the reproductive period can offer important gains to sustaining the scheme as well as offering affordable health services.

  18. Air Quality and Heart Health: Managing an Emerging ...

    EPA Pesticide Factsheets

    Dr. Cascio will share with a broad range of federal agencies current understanding of the links between air quality and cardiovascular health. The key facts include that air pollution contributes a high attributable health burden. That certain well-defined vulnerable subpopulations are at higher risk. At-risk populations include those with heart disease, lung disease and diabetes, older adults, children and individuals living in low socioeconomic neighborhoods. There is no established threshold level for safe long-term exposure to air particle pollution, and some of the basic biological mechanisms that account for adverse health effects are now known. This knowledge is giving us insight into how we might mitigate the effects apart from the regulatory efforts to improve overall air quality. Moreover, the work that each State has done to improve air quality has resulted in improved health outcomes including cardiovascular outcomes, and longer lives. The presentation will address: 1) What do we know? 2) Who are the at-risk populations? 3) What can communities do to reduce risk? 4) What can healthcare professionals do to reduce risk of the at-risk population? And 5) What tools are available to help healthcare professionals and their patients reduce exposure and risk from air pollutants? The talk will feature a description of the Air Quality Index and associated EPA tools and health information that can be used by health care providers to educate their at-ris

  19. Cocoa agronomy, quality, nutritional, and health aspects.

    PubMed

    Badrie, Neela; Bekele, Frances; Sikora, Elzbieta; Sikora, Marek

    2015-01-01

    The history of cocoa and chocolate including the birth and the expansion of the chocolate industry was described. Recent developments in the industry and cocoa economy were briefly depicted. An overview of the classification of cacao as well as studies on phenotypic and genetic diversity was presented. Cocoa agronomic practices including traditional and modern propagation techniques were reviewed. Nutrition-related health benefits derived from cocoa consumption were listed and widely reviewed. The specific action of cocoa antioxidants was compared to those of teas and wines. Effects of adding milk to chocolate and chocolate drinks versus bioavailability of cocoa polyphenols were discussed. Finally, flavor, sensory, microbiological, and toxicological aspects of cocoa consumption were presented.

  20. Measuring perceived quality of measuring quality health care services in India.

    PubMed

    Narang, Ritu

    2010-01-01

    The objective of this paper is to understand the perception of patients towards health care services in Lucknow based on the 20-item scale. The 20-item scale was administered to 500 users of health care centres comprising a tertiary health centre, a state medical university and two missionary hospitals in Lucknow, India. The scale was found to be reliable to a great extent with an overall Cronbach alpha value of 0.74. "Health personnel and practices" and "health care delivery" were found to be statistically significant in impacting the perception. Respondents were relatively less positive on items related to "access to services" and "adequacy of doctors for women". The tertiary health centre was rated poorer than the medical university and missionary hospitals. This tool may be applied for qualitative assessment of the services of health care programmes as well as health care centres of India. The paper draws the attention of health policy makers in considering the requirements and opinions of patients to effect substantial change and significant improvement in the quality of the health care services for better and increased utilization of the services. The paper fulfils the need of measuring perceived quality of health care services and points out that the improvement in health care services requires immediate and urgent attention from policy makers.

  1. The presence of total quality management and continuous quality improvement processes in California public health clinics.

    PubMed

    Scutchfield, F D; Zúñiga de Nuncio, M L; Bush, R A; Fainstein, S H; LaRocco, M A; Anvar, N

    1997-05-01

    Total quality management (TQM) and continuous quality improvement (CQI) processes have not been fully integrated into public health practice. Current levels of participation and interest in TQM/CQI were assessed in California's 62 county departments of health services. Survey results indicated that only 18.5 percent of the 54 respondents were using TQM/CQI. Of those not using TQM/CQI, 75 percent were interested in these activities. Improvement of public health clinic ability to compete and to survive in a rapidly changing health care environment requires fostering this interest through public health decision-maker support, increased TQM/CQI training opportunities, and demonstration of TQM/CQI cost-effectiveness in public health.

  2. Work environment characteristics of high-quality home health agencies.

    PubMed

    Tullai-McGuinness, Susan; Riggs, Jennifer S; Farag, Amany A

    2011-10-01

    This concurrent mixed-method study examines the nurse work environment of high-quality Medicare-certified home health agencies. High-quality (n=6) and low-quality (n=6) home health agencies were recruited using agency-level publicly reported patient outcomes. Direct care registered nurses (RNs) from each agency participated in a focus group and completed the Practice Environment Scale of the Nurse Work Index (PES-NWI). No significant differences were found in the PES-NWI results between nurses working in high- and low-quality agencies, though nurses in high-quality agencies scored higher on all subscales. Nurses working in all the high-quality agencies identified themes of adequate staffing, supportive managers, and team work. These themes were not consistently identified in low-quality agencies. Themes of supportive managers and team work are reflective of effective leadership at the manager level. Agencies struggling to improve quality of care might consider developing their managers' leadership skills.

  3. The integration of quality management into chronic disease health services.

    PubMed

    Shayesteh, Sheila Golnaz; Kliewer, Gordon; Morrin, Louise

    2010-01-01

    Quality management strategies can be integrated into health services and processes to evaluate, measure, and improve the health services delivered to patients. Over a 6-month period, Living Well with a Chronic Condition program, a chronic disease management health service, had its support services evaluated and significantly improved, reducing the delays that participants experienced trying to access education and exercise classes. Through the use of quality management tools, including process mapping, performance data collection and evaluation, and participant feedback, the program intake process was improved significantly. Wait times of up to 90 days, with an average of 45 days, were reduced to less than 1 week. Postimprovement measures continued to demonstrate improved service, indicating that involving the staff and participants in quality management strategies can lead to significant optimization of services to participants.

  4. Three different ways mental health nurses develop quality therapeutic relationships.

    PubMed

    Dziopa, Fiona; Ahern, Kathy

    2009-01-01

    The purpose of this study was to determine if there were different ways in which mental health nurses develop quality therapeutic relationships with patients. A taxonomy of 140 attributes were identified as important to the formation of a quality therapeutic relationship in mental health nursing. These attributes provided the basis for the development of a Q-sort instrument, which was piloted. Results led to the identification of three clusters of mental health nurses who share similar beliefs regarding the attributes required to develop a quality therapeutic relationship with patients. These groupings of attributes were called "Equal Partner," "Senior Partner," and "Protective Partner." Recommendations are provided and include that nurses consider their nursing style in their choice of employment environment and that managers consider their nurses' individual styles in determination of an optimal case mix.

  5. Patient perceptions of the quality of health services.

    PubMed

    Sofaer, Shoshanna; Firminger, Kirsten

    2005-01-01

    As calls are made for a more patient-centered health care system, it becomes critical to define and measure patient perceptions of health care quality and to understand more fully what drives those perceptions. This chapter identifies conceptual and methodological issues that make this task difficult, including the confusion between patient perceptions and patient satisfaction and the difficulty of determining whether systematic variations in patient perceptions should be attributed to differences in expectations or actual experiences. We propose a conceptual model to help unravel these knotty issues; review qualitative studies that report directly from patients on how they define quality; provide an overview of how health plans, hospitals, physicians, and health care in general are currently viewed by patients; assess whether and how patient health status and demographic characteristics relate to perceptions of health care quality; and identify where further, or more appropriately designed, research is needed. Our aim is to find out what patients want, need and experience in health care, not what professionals (however well-motivated) believe they need or get.

  6. [ISO 9000: guidelines for a total quality system in health].

    PubMed

    Pasini, E; Opasich, C; Scherillo, M

    1998-04-01

    The Italian National Health System has recently been revised and reorganized. In the new scenario, the quality of the service being provided is considered extremely important. The international ISO 9000 standard has made it possible to implement a total-quality management system that can be documented and certified independently by a third party. Several hospitals in Italy and abroad have implemented a total-quality system according to ISO 9000 standards in order to provide a service that can satisfy the expectations of the patients in a controlled and efficient way. This article describes ISO 9000, proposes its application to ensure quality in the structures and organizations involved in the national health system and reports several examples of how the standard has been implemented in hospitals.

  7. Assessing Quality across Health Care Subsystems in Mexico

    PubMed Central

    Puig, Andrea; Pagán, José A.; Wong, Rebeca

    2012-01-01

    Recent healthcare reform efforts in Mexico have focused on the need to improve the efficiency and equity of a fragmented healthcare system. In light of these reform initiatives, there is a need to assess whether healthcare subsystems are effective at providing high-quality healthcare to all Mexicans. Nationally representative household survey data from the 2006 Encuesta Nacional de Salud y Nutrición (National Health and Nutrition Survey) were used to assess perceived healthcare quality across different subsystems. Using a sample of 7234 survey respondents, we found evidence of substantial heterogeneity in healthcare quality assessments across healthcare subsystems favoring private providers over social security institutions. These differences across subsystems remained even after adjusting for socioeconomic, demographic, and health factors. Our analysis suggests that improvements in efficiency and equity can be achieved by assessing the factors that contribute to heterogeneity in quality across subsystems. PMID:19305224

  8. Mainstreaming quality and safety: a reformulation of quality and safety education for health professions students

    PubMed Central

    Ironside, Pamela M; Ogrinc, Gregory S

    2011-01-01

    The urgent need to expand the ability of health professionals to improve the quality and safety of patient care in the USA has been well documented. Yet the current methods of teaching quality and safety to health professionals are inadequate for the task. To the extent that quality and safety are addressed at all, they are taught using pedagogies with a narrow focus on content transmission, didactic sessions that are spatially and temporally distant from clinical work, and quality and safety projects segregated from the provision of actual patient care. In this article an argument for a transformative reorientation in quality and safety education for health professions is made. This transformation will require new pedagogies in which a) quality improvement is an integral part of all clinical encounters, b) health professions students and their clinical teachers become co-learners working together to improve patient outcomes and systems of care, c) improvement work is envisioned as the interdependent collaboration of a set of professionals with different backgrounds and perspectives skilfully optimising their work processes for the benefit of patients, and d) assessment in health professions education focuses on not just individual performance but also how the care team's patients fared and how the systems of care were improved. PMID:21450779

  9. Mainstreaming quality and safety: a reformulation of quality and safety education for health professions students.

    PubMed

    Cooke, Molly; Ironside, Pamela M; Ogrinc, Gregory S

    2011-04-01

    The urgent need to expand the ability of health professionals to improve the quality and safety of patient care in the USA has been well documented. Yet the current methods of teaching quality and safety to health professionals are inadequate for the task. To the extent that quality and safety are addressed at all, they are taught using pedagogies with a narrow focus on content transmission, didactic sessions that are spatially and temporally distant from clinical work, and quality and safety projects segregated from the provision of actual patient care. In this article an argument for a transformative reorientation in quality and safety education for health professions is made. This transformation will require new pedagogies in which a) quality improvement is an integral part of all clinical encounters, b) health professions students and their clinical teachers become co-learners working together to improve patient outcomes and systems of care, c) improvement work is envisioned as the interdependent collaboration of a set of professionals with different backgrounds and perspectives skillfully optimising their work processes for the benefit of patients, and d) assessment in health professions education focuses on not just individual performance but also how the care team's patients fared and how the systems of care were improved.

  10. Air Quality and Heart Health: An Emerging Topic for Heart ...

    EPA Pesticide Factsheets

    Air Quality and Heart Health: An Emerging Topic for Heart Month: Ambient air particle pollution increases short- and long-term cardiovascular morbidity and mortality. Older-people, those with pre-existing heart disease and lung disease and diabetes are at higher risk. Mechanisms are under investigation and are likely related to oxidative stress, inflammation and effects on autonomic control. Improvements in air pollution levels reduce health impacts and increase life expectancy. Reductions of short-term exposure in those at highest risk are predicted to mitigate adverse health effects. EPA regularly evaluates the standards, health risks and issues improved standards when needed. Public health action is needed along with EPA standards to reduce the public health burden of short- and long-term adverse health effects of air pollution. Health risks remain and need to be addressed through integrated efforts of public health, health care, environmental health, individuals and communities. Presented at Webinar for the National Association of Clean Air Agencies, February 2, 2017, Chapel Hill, NC- This webinar provided an update of environmental health information related to the effects of air pollution and heart and blood vessel disease. Such information is critically important for the Clean Air Agencies to understand as it provides the justification of their actions.

  11. The management of health care service quality. A physician perspective.

    PubMed

    Bobocea, L; Gheorghe, I R; Spiridon, St; Gheorghe, C M; Purcarea, V L

    2016-01-01

    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer's perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician's perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician's perspective.

  12. The management of health care service quality. A physician perspective

    PubMed Central

    Bobocea, L; Gheorghe, IR; Spiridon, St; Gheorghe, CM; Purcarea, VL

    2016-01-01

    Applying marketing in health care services is presently an essential element for every manager or policy maker. In order to be successful, a health care organization has to identify an accurate measurement scale for defining service quality due to competitive pressure and cost values. The most widely employed scale in the services sector is SERVQUAL scale. In spite of being successfully adopted in fields such as brokerage and banking, experts concluded that the SERVQUAL scale should be modified depending on the specific context. Moreover, the SERVQUAL scale focused on the consumer’s perspective regarding service quality. While service quality was measured with the help of SERVQUAL scale, other experts identified a structure-process-outcome design, which, they thought, would be more suitable for health care services. This approach highlights a different perspective on investigating the service quality, namely, the physician’s perspective. Further, we believe that the Seven Prong Model for Improving Service Quality has been adopted in order to effectively measure the health care service in a Romanian context from a physician’s perspective. PMID:27453745

  13. Merging Air Quality and Public Health Decision Support Systems

    NASA Astrophysics Data System (ADS)

    Hudspeth, W. B.; Bales, C. L.

    2003-12-01

    The New Mexico Air Quality Mapper (NMAQM) is a Web-based, open source GIS prototype application that Earth Data Analysis Center is developing under a NASA Cooperative Agreement. NMAQM enhances and extends existing data and imagery delivery systems with an existing Public Health system called the Rapid Syndrome Validation Project (RSVP). RSVP is a decision support system operating in several medical and public health arenas. It is evolving to ingest remote sensing data as input to provide early warning of human health threats, especially those related to anthropogenic atmospheric pollutants and airborne pathogens. The NMAQM project applies measurements of these atmospheric pollutants, derived from both remotely sensed data as well as from in-situ air quality networks, to both forecasting and retrospective analyses that influence human respiratory health. NMAQM provides a user-friendly interface for visualizing and interpreting environmentally-linked epidemiological phenomena. The results, and the systems made to provide the information, will be applicable not only to decision-makers in the public health realm, but also to air quality organizations, demographers, community planners, and other professionals in information technology, and social and engineering sciences. As an accessible and interactive mapping and analysis application, it allows environment and health personnel to study historic data for hypothesis generation and trend analysis, and then, potentially, to predict air quality conditions from daily data acquisitions. Additional spin off benefits to such users include the identification of gaps in the distribution of in-situ monitoring stations, the dissemination of air quality data to the public, and the discrimination of local vs. more regional sources of air pollutants that may bear on decisions relating to public health and public policy.

  14. Basic issues related to quantity and quality of health care, and quality assurance in Indonesia.

    PubMed

    Jacobalis, S

    1989-01-01

    Issues and problems related to the needs for quantity and quality in health care have been presented. The need for quantity has been quite successfully addressed in the last 20 years. Better quality of health care is very much in the minds of policy makers, providers and the informed public. Quality assessment and assurance as a programmed and on-going process in individual hospitals is systematically promoted and developed. An accreditation system for hospitals is planned for the future. This paper has not been able to contribute anything of value to the current practice of quality assurance. The industrialized world has passed the stages Indonesia is now going through. To some Australian colleagues, this presentation perhaps has revealed that one of their closest neighbours is struggling hard to improve the quality of life of its people, despite the tremendous problems and constraints with which it is confronted. Australia has always provided a helping hand in this struggle.

  15. [Health-related Quality of Life After Oropharyngeal Cancer Treatment].

    PubMed

    Volkenstein, S; Willers, J; Noack, V; Dazert, S; Minovi, A

    2015-08-01

    Oropharyngeal cancer is a diagnosis which means a change in life and even after successful treatment a tremendous reduction in the quality of life. Aim of this study is to analyse the health-related quality of life in patients with oropharyngeal cancer dependent on different treatment options. Charts of 256 patients treated for oropharyngeal cancer between 1997 and 2007 were analysed in a retrospective study. Inclusion criteria for this study has been fulfilled by 98 patients, 82 of these completed the study. Therefore, standardised questionnaires (EORTC QLQ-C30 und EORTC QLQ-H&N35) have been used and 2 groups were compared: patients with primary radiochemotherapy (pRCT) vs. patients treated by an operation and adjuvant radiation. Most of the health-related quality of life domains in our patients were significantly reduced compared to the general population. There have been just very few significant differences in the quality of life domains in between the 2 groups. Health-related quality of life after treatment of oropharyngeal cancer is significantly compromised for these patients compared to the general population, but there have been no obvious differences depending on the compared treatment options. Only regarding the items "physical and cognitive functioning" patients after primary radiochemotherapy showed significantly better results and thus a better quality of life, despite the fact, that this group has a significantly advanced cancer stadium. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Improving the quality of health care: what's taking so long?

    PubMed

    Chassin, Mark R

    2013-10-01

    Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices.

  17. Introducing quality management into primary health care services in Uganda.

    PubMed Central

    Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.

    1997-01-01

    In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements, increased morale of district health team members, improved satisfaction among patients, and greater involvement of local government in the decisions of district health committees have been observed. At the central level, the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health headquarters have led to a greater understanding by central staff of the issues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level, some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving. PMID:9185368

  18. High-quality Health Information Provision for Stroke Patients

    PubMed Central

    Du, Hong-Sheng; Ma, Jing-Jian; Li, Mu

    2016-01-01

    Objective: High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making, better manage the stroke, and make a good recovery. In this study, we reviewed information needs of stroke patients, methods for providing information to patients, and considerations needed by the information providers. Data Sources: The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015. Study Selection: We included all the relevant articles on information provision for stroke patients in English, with no limitation of study design. Results: Stroke is a major public health concern worldwide. High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare, and empowering them to effectively self-manage their long-standing chronic conditions. Different methods for providing information to patients have their relative merits and suitability, and as a result, the effective strategies taken by health professionals may include providing high-quality information, meeting patients’ individual needs, using suitable methods in providing information, and maintaining active involvement of patients. Conclusions: It is suggested that to enable stroke patients to access high-quality health information, greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs. Health professionals should use suitable information delivery methods, and actively involve stroke patients in information provision. PMID:27569241

  19. Analysis of Critical Earth Observation Priorities for Societal Benefit

    NASA Astrophysics Data System (ADS)

    Zell, E. R.; Huff, A. K.; Carpenter, A. T.; Friedl, L.

    2011-12-01

    moisture content, burn scars, and meteorological parameters. Impacts to public health and livelihoods due to food insecurity, algal blooms, and air pollution can be addressed through NRT monitoring of specific events utilizing land cover, atmospheric composition, water quality, and meteorological observations. More broadly, the assessment of water availability for drinking and agriculture and the development of floods and storms rely on continuous feeds of NRT meteorological and atmospheric composition observations. Overall, this multi-disciplinary study of user needs for NRT data and products can inform the design and operation of NRT data systems. Follow-on work for this study will also be presented, focusing on the availability of current and future satellite measurements (including NRT) of the 30 most critical Earth observation priorities, as well as a detailed analysis of users' needs for precipitation data. The results of this study summarize the priorities for critical Earth observations utilized globally for societal benefit.

  20. Health care in small prisons: incorporating high-quality standards.

    PubMed

    Rieder, Jean-Pierre; Casillas, Alejandra; Mary, Gérard; Secretan, Anne-Dominique; Gaspoz, Jean-Michel; Wolff, Hans

    2013-01-01

    In the past, health management in Geneva's six post-trial prisons had been variable and inconsistent. In 2008, the unit of penitentiary medicine of the Geneva University Hospitals was mandated to re-organize and provide health care at all six prison facilities. The specific aim of this paper is to outline the example as a practical solution to some of the common challenges in unifying the structure and process of health services across multiple small facilities, while meeting European prison health and local quality standards. Geneva's post-trial prisons are small and close to one another in geographical proximity - ideal conditions for the construction of a health mobile team (HMT). This multidisciplinary mobile team operated like a community ambulatory care model; it was progressively launched in all prison facilities in Geneva. The authors incorporated an implementation strategy where health providers partnered with prison and community stakeholders in the health delivery model's development and adaption process. The model's strategic initiatives are described along the following areas, in light of other international prison health activity and prior care models: access to a health care professional, equivalence of care, patient consent, confidentiality, humanitarian interventions, and professional competence and independence. From the perspective of the HMT members, the authors provide the "lessons learned" through this experience, especially to providers who are working on prison health services reform and coordination improvement. The paper particularly stresses the importance of partnering with community health stakeholders and prison staff, a key component to the approach.

  1. Building quality mHealth for low resource settings.

    PubMed

    Ettinger, Kate Michi; Pharaoh, Hamilton; Buckman, Reymound Yaw; Conradie, Hoffie; Karlen, Walter

    In low- and middle-income countries (LMIC), community health care workers (CHCW) are the primary point of care for millions of people. Mobile phone health applications (mHealth app) are the preferred technology platform to deliver clinical support to CHCW. In LMIC, limited regulatory oversight exists to guide quality and safety for medical devices, including mHealth. During the development of a mHealth app to assist CHCW with patient assessment and clinical diagnosis in rural South Africa, we applied human-centred design (HCD) and a bioethics consultation. The HCD approach enabled us to develop a mHealth app that responded to the needs and capacities of CHCW. The bioethics consultation prompted early consideration of safety concerns, social implications of our mHealth app and our technology's impact on the CHCW-patient relationship. In this study, we found that combining a HCD approach with bioethics consultation improved the design quality and reduced safety concerns for our mHealth app.

  2. Does Satisfaction Reflect the Technical Quality of Mental Health Care?

    PubMed Central

    Edlund, Mark J; Young, Alexander S; Kung, Fuan Yue; Sherbourne, Cathy D; Wells, Kenneth B

    2003-01-01

    Objective To analyze the relationship between satisfaction and technical quality of care for common mental disorders. Data Source A nationally representative telephone survey of 9,585 individuals conducted in 1997–1998. Study Design Using multinomial logistic regression techniques we investigated the association between a five-level measure of satisfaction with the mental health care available for personal or emotional problems and two quality indicators. The first measure, appropriate technical quality, was defined as use of either appropriate counseling or psychotropic medications during the prior year for a probable depressive or anxiety disorder. The second, active treatment, indicated whether the respondent had received treatment for a psychiatric disorder in the past year. Covariates included measures of physical and mental health and sociodemographic indicators. Principal Findings Appropriate technical quality of care was significantly associated with higher levels of satisfaction. The strength of the association was moderate. Conclusions Satisfaction is associated with technical quality of care. However, profiling quality of care with satisfaction will likely require large samples and case-mix adjustment, which may be more difficult for plans or provider groups to implement than measuring technical indicators. More importantly, satisfaction is not the same as technical quality, and our results suggest that at this time they cannot be made to approach each other closely enough to eliminate either. PMID:12785565

  3. [Quality evaluation of health care service for adolescents].

    PubMed

    Costa, M C; Formigli, V L

    2001-04-01

    To evaluate the technical and scientific quality of care provided adolescents, pregnant adolescents and their offspring by the Emaús community's health service in Belém, state of Pará, Brazil, between 1994 and 1996. Data for population and health care assessment were collected from medical records and compared with the PAHO/WHO and Brazilian Ministry of Health guidelines. The following features were satisfactory: anthropometric measurements and sexual maturity in adolescent health care program; visits scheduling, weight and blood pressure recording and proceedings in the event of medical problem in prenatal care; early registration in the health program, completing of the immunization schedule, weight and motor development recording and adequacy of medical visits in children care. Other aspects were less satisfactory, such as poor recording of clinical procedures and high level of inadequate or partially adequate procedures for the adolescent group; late admission to prenatal care and low recording of pregnant anti-tetanus immunization in prenatal care; high prevalence of early weaning and poor recording of children's height. This easy-to-perform assessment allowed to evaluate the quality of care provided and made it possible to reallocate services and medical procedures to offer health care service better organized and of better quality to meet the population needs.

  4. Health impact assessment of quality wine production in Hungary.

    PubMed

    Adám, Balázs; Molnár, Agnes; Bárdos, Helga; Adány, Róza

    2009-12-01

    Alcohol-related health outcomes show strikingly high incidence in Hungary. The effects of alcohol consumption are influenced not only by the quantity, but also the quality of drinks; therefore, wine production can have an important effect on public health outcomes. Nevertheless, the Hungarian wine sector faces several vital problems and challenges influenced by the country's accession to the European Union and by the need for restructuring. A comprehensive health impact assessment (HIA) based on the evaluation of the Hungarian legislation related to the wine sector has been carried out, aiming to assess the impact of the production of quality wine versus that of table wine, using a range of public health and epidemiological research methods and data as well as HIA guidelines. The study finds that the toxic effects of alcohol can be reduced with an increased supply of quality wine and with decreased overall consumption due to higher cost, although this might drive some people to seek illegal sources. Quality wine production allows for improved use of land, creates employment opportunities and increases the incomes of producers and local communities; however, capital-scarce producers unable to manage restructuring may lose their source of subsistence. The supply of quality wine can promote social relations, contribute to a healthy lifestyle and reduce criminality related to alcohol's influence and adulteration. In general, the production and supply of quality wine can have an overall positive impact on health. Nevertheless, because of the several possible negative effects expected without purposeful restructuring, recommendations for the maximization of favourable outcomes and suggestions for monitoring the success of the analysis have been provided.

  5. Societal response to nanotechnology: converging technologies-converging societal response research?

    NASA Astrophysics Data System (ADS)

    Ronteltap, Amber; Fischer, Arnout R. H.; Tobi, Hilde

    2011-10-01

    Nanotechnology is an emerging technology particularly vulnerable to societal unrest, which may hinder its further development. With the increasing convergence of several technological domains in the field of nanotechnology, so too could convergence of social science methods help to anticipate societal response. This paper systematically reviews the current state of convergence in societal response research by first sketching the predominant approaches to previous new technologies, followed by an analysis of current research into societal response to nanotechnology. A set of 107 papers on previous new technologies shows that rational actor models have played an important role in the study of societal response to technology, in particular in the field of information technology and the geographic region of Asia. Biotechnology and nuclear power have, in contrast, more often been investigated through risk perception and other affective determinants, particularly in Europe and the USA. A set of 42 papers on societal response to nanotechnology shows similarities to research in biotechnology, as it also builds on affective variables such as risk perception. Although there is a tendency to extend the rational models with affective variables, convergence in social science approaches to response to new technologies still has a long way to go. The challenge for researchers of societal response to technologies is to converge to some shared principles by taking up the best parts from the rational actor models dominant in information technology, whilst integrating non-rational constructs from biotechnology research. The introduction of nanotechnology gives a unique opportunity to do so.

  6. Disparities in Health Care Quality among Asian Children with Special Health Care Needs.

    PubMed

    Son, Esther; Parish, Susan L; Igdalsky, Leah

    2017-03-02

    There is a dearth of information on the quality of health care for Asian American children and particularly Asian children with special health care needs (CSHCN). The goal of this article was to determine whether there were disparities in quality of health care for Asian CSHCN, whose experiences have not been studied. Data were derived from the 2009-2010 National Survey of Children with Special Health Care Needs (ns = 355 non-Hispanic Asian children and 4,343 non-Hispanic white CSHCN). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between racial identity (that is, non-Hispanic white and non-Hispanic Asian) and quality of health care. Racial disparities in quality of health care were substantial between Asian and white CSHCN in 2009-2010. Asian parents were significantly less likely than white parents to report that their health care provider provided the specific information they needed, helped them feel like a partner in their child's care, and was sensitive to the family's values and customs. The development and testing of specific, targeted policy and practice interventions to reduce disparities in health care quality for these children are urgently needed.

  7. Health and quality of life of ventilator-dependent children.

    PubMed

    Noyes, Jane

    2006-11-01

    This paper reports a qualitative study with ventilator-dependent children and their parents, describing their experiences and meanings concerning the children's health and quality of life. Recent medical advances have enabled children to survive premature birth, congenital anomalies, critical illness and accidents with long-term use of mechanical ventilation to support breathing. In economically developed countries, the number of ventilator-dependent children is increasing and many require nurse-led home healthcare services. Debate has been polarized as to whether life on a ventilator is in the best interests of all children. The perspectives of ventilator-dependent children are largely absent in the literature. Principles derived from Heideggerian phenomenology were used to describe how children and their parents interpreted and rationalized the quality of the child's 'ventilator-dependent' life and their health. The study had two phases with data collection commencing in 1998 and completed in 2004. The participants were 35 ventilator-dependent children, and 50 mothers and 17 fathers of 53 children. Emergent themes revealed some common features across this heterogeneous group. Ventilation made the children feel better and if they had sufficient breath, they experienced better quality of life. It was not possible to delineate the magnitude of health gain or benefit, especially amongst preverbal children and those with profound sensory impairments. Quality of life equated to quality of life experiences, but some children experienced negative social impacts and low self-esteem. Home healthcare services were not designed to bring about the desired social outcomes that children identified. Parent's accounts showed subtle more negative differences. The acceptance of children's dependence on machines to live has brought about the need for nursing, medical, social and biological boundaries to be redefined, especially around children's meanings of their health, what they

  8. Marital quality and health: A meta-analytic review

    PubMed Central

    Robles, Theodore F.; Slatcher, Richard B.; Trombello, Joseph M.; McGinn, Meghan M.

    2013-01-01

    This meta-analysis reviewed 126 published empirical articles over the past 50 years describing associations between marital relationship quality and physical health in over 72,000 individuals. Health outcomes included clinical endpoints (objective assessments of function, disease severity, and mortality; subjective health assessments) and surrogate endpoints (biological markers that substitute for clinical endpoints, such as blood pressure). Biological mediators included cardiovascular reactivity and hypothalamic-pituitary-adrenal axis activity. Greater marital quality was related to better health, with mean effect sizes from r = .07 to .21, including lower risk of mortality, r = .11, and lower cardiovascular reactivity during marital conflict, r = −.13, but not daily cortisol slopes or cortisol reactivity during conflict. The small effect sizes were similar in magnitude to previously found associations between health behaviors (e.g., diet) and health outcomes. Effect sizes for a small subset of clinical outcomes were susceptible to publication bias. In some studies, effect sizes remained significant after accounting for confounds such as age and socioeconomic status. Studies with a higher proportion of women in the sample demonstrated larger effect sizes, but we found little evidence for gender differences in studies that explicitly tested gender moderation, with the exception of surrogate endpoint studies. Our conclusions are limited by small numbers of studies for specific health outcomes, unexplained heterogeneity, and designs that limit causal inferences. These findings highlight the need to explicitly test affective, health behavior, and biological mechanisms in future research, and focus on moderating factors that may alter the relationship between marital quality and health. PMID:23527470

  9. Atomoxetine's Effect on Societal Costs in Sweden

    ERIC Educational Resources Information Center

    Myren, Karl-Johan; Thernlund, Gunilla; Nylen, Asa; Schacht, Alexander; Svanborg, Par

    2010-01-01

    Objective: To compare societal costs between patients treated with atomoxetine and placebo in Sweden. Method: Ninety-nine pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (n = 49) or placebo (n = 50). All parents received four sessions of psycho-education. Parents filled out a resource utilization…

  10. Atomoxetine's Effect on Societal Costs in Sweden

    ERIC Educational Resources Information Center

    Myren, Karl-Johan; Thernlund, Gunilla; Nylen, Asa; Schacht, Alexander; Svanborg, Par

    2010-01-01

    Objective: To compare societal costs between patients treated with atomoxetine and placebo in Sweden. Method: Ninety-nine pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (n = 49) or placebo (n = 50). All parents received four sessions of psycho-education. Parents filled out a resource utilization…

  11. Minority Group Identification and Societal Integration.

    ERIC Educational Resources Information Center

    Noel, Donald L.

    Strong positive identification with a specific group is potentially both functional and dysfunctional for the solidarity of an encompassing larger social system. The impact of strong ethnic group identification upon societal integration is here explored by analyzing data obtained from 515 Negroes as part of the Cornell Studies in Intergroup…

  12. eEurope 2002: Quality Criteria for Health related Websites

    PubMed Central

    2002-01-01

    Background A number of organisations have begun to provide specific tools for searching, rating, and grading this information, while others have set up codes of conduct by which site providers can attest to their high quality services. The aim of such tools is to assist individuals to sift through the mountains of information available so as to be better able to discern valid and reliable messages from those which are misleading or inaccurate. Objective Recognising that European citizens are avid consumers of health related information on the internet and recognising that they are already using the types of rating system described above, the European Council at Feira on June 19-20 2000 supported an initiative within eEurope 2002 to develop a core set of Quality Criteria for Health Related Websites. The specific aim was to draw up a commonly agreed set of simple quality criteria on which Member States, as well as public and private bodies, may draw in the development of quality initiatives for health related websites. These criteria should be applied in addition to relevant Community law. Methods A meeting was held during 2001 which drew together key players from Government departments, International Organisations, non-governmental organisations and industry, to explore current practices and experiments in this field. Some sixty invited participants from all the Member States, Norway, Switzerland, and the United States of America took part in the meeting of June 7-8, 2001: they included delegates from industrial, medical, and patient interest groups, delegates from Member States' governments, and key invited speakers from the field of health information ethics. These individuals, and many others, also took part in the web-based consultation which was open from august to November 2001. Results The broad headings for quality criteria identified include Transparency and Honesty, Authority, Privacy and data protection, Updating of information, Accountability

  13. Impacts of Climate Policy on Regional Air Quality, Health, and Air Quality Regulatory Procedures

    NASA Astrophysics Data System (ADS)

    Thompson, T. M.; Selin, N. E.

    2011-12-01

    Both the changing climate, and the policy implemented to address climate change can impact regional air quality. We evaluate the impacts of potential selected climate policies on modeled regional air quality with respect to national pollution standards, human health and the sensitivity of health uncertainty ranges. To assess changes in air quality due to climate policy, we couple output from a regional computable general equilibrium economic model (the US Regional Energy Policy [USREP] model), with a regional air quality model (the Comprehensive Air Quality Model with Extensions [CAMx]). USREP uses economic variables to determine how potential future U.S. climate policy would change emissions of regional pollutants (CO, VOC, NOx, SO2, NH3, black carbon, and organic carbon) from ten emissions-heavy sectors of the economy (electricity, coal, gas, crude oil, refined oil, energy intensive industry, other industry, service, agriculture, and transportation [light duty and heavy duty]). Changes in emissions are then modeled using CAMx to determine the impact on air quality in several cities in the Northeast US. We first calculate the impact of climate policy by using regulatory procedures used to show attainment with National Ambient Air Quality Standards (NAAQS) for ozone and particulate matter. Building on previous work, we compare those results with the calculated results and uncertainties associated with human health impacts due to climate policy. This work addresses a potential disconnect between NAAQS regulatory procedures and the cost/benefit analysis required for and by the Clean Air Act.

  14. Societal and ethical aspects of the Fukushima accident.

    PubMed

    Oughton, Deborah

    2016-10-01

    The Fukushima Nuclear Power Station accident in Japan in 2011 was a poignant reminder that radioactive contamination of the environment has consequences that encompass far more than health risks from exposure to radiation. Both the accident and remediation measures have resulted in serious societal impacts and raise questions about the ethical aspects of risk management. This article presents a brief review of some of these issues and compares similarities and differences with the lessons learned from the 1986 Chernobyl Nuclear Power Plant accident in Ukraine. Integr Environ Assess Manag 2016;12:651-653. © 2016 SETAC. © 2016 SETAC.

  15. Hostility, Relationship Quality, and Health among African American Couples

    ERIC Educational Resources Information Center

    Guyll, Max; Cutrona, Carolyn; Burzette, Rebecca; Russell, Daniel

    2010-01-01

    Objective: This study investigated the association between hostility and health and whether it is moderated by the quality of an individual's primary romantic relationship. Method: Longitudinal data were provided by 184 African Americans, including 166 women. Participants averaged 38 years old and were married or in long-term marriagelike…

  16. Health-related quality of life in patients undergoing cholecystectomy.

    PubMed

    Hsueh, Li-Na; Shi, Hon-Yi; Wang, Tsai-Fan; Chang, Chiung-Ying; Lee, King-Teh

    2011-07-01

    This large-scale prospective cohort study of a Taiwan population applied generalized estimating equations to evaluate predictors of health-related quality of life (HRQOL) after open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) procedures performed between February 2007 and November 2008. The Gastrointestinal Quality of Life Index and Short Form-36 were used in a preoperative assessment and in 3(rd) month and 6(th) month postoperative assessments of 38 OC and 259 LC patients. The HRQOL of the cholecystectomy patients were significantly improved at 3 months and 6 months postsurgery (p<0.05). At 3 months postsurgery, HRQOL improvement was significantly larger in LC patients than in OC patients. Patient characteristics, clinical characteristics, and health care quality were also significantly related to HRQOL improvement (p<0.05). Additionally, after controlling for related variables, preoperative health status was significantly and positively associated with each subscale of the Gastrointestinal Quality of Life Index and Short Form-36 throughout the 6 months (p<0.05). Patients should be advised that their postoperative HRQOL may depend not only on their postoperative health care but also on their preoperative functional status.

  17. Ventilation, indoor air quality, and health in homes undergoing weatherization.

    PubMed

    Francisco, P W; Jacobs, D E; Targos, L; Dixon, S L; Breysse, J; Rose, W; Cali, S

    2017-03-01

    Ventilation standards, health, and indoor air quality have not been adequately examined for residential weatherization. This randomized trial showed how ASHRAE 62-1989 (n=39 houses) and ASHRAE 62.2-2010 (n=42 houses) influenced ventilation rates, moisture balance, indoor air quality, and self-reported physical and mental health outcomes. Average total airflow was nearly twice as high for ASHRAE 62.2-2010 (79 vs. 39 cfm). Volatile organic compounds, formaldehyde and carbon dioxide were all significantly reduced for the newer standard and first-floor radon was marginally lower, but for the older standard, only formaldehyde significantly decreased. Humidity in the ASHRAE 62.2-2010 group was only about half that of the ASHRAE 62-1989 group using the moisture balance metric. Radon was higher in the basement but lower on the first floor for ASHRAE 62.2-2010. Children in each group had fewer headaches, eczema, and skin allergies after weatherization and adults had improvements in psychological distress. Indoor air quality and health improve when weatherization is accompanied by an ASHRAE residential ventilation standard, and the 2010 ASHRAE standard has greater improvements in certain outcomes compared to the 1989 standard. Weatherization, home repair, and energy conservation projects should use the newer ASHRAE standard to improve indoor air quality and health. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. The Case for Quality Health Care for the Poor.

    ERIC Educational Resources Information Center

    Allen, Ethel D.

    1978-01-01

    This article shows that, while there has been a modification of health care facilities and new approaches to medical care, little change has been effected in the interrelationship between the poor and the delivery of quality medical care. (Author/GC)

  19. Leadership and management quality: key factors in effective health systems.

    PubMed

    Pfeffermann, Guy

    2012-01-01

    The effectiveness of health care systems in the developing world is related to the quality of their leadership and management, yet that factor has been neglected by academics and funders. Based on replicable existing models, the article proposes an approach to strengthening local management training institutions.

  20. Water Quality Criteria for Human Health and Aquatic Life

    EPA Science Inventory

    Collaborative effort with the Office of Water to provide science in support of the development and implementation of new or revised ambient water quality criteria for microbial and chemical contaminants for human health and aquatic life. The research also addresses implementation...

  1. Health effects of air quality regulations in Delhi, India

    NASA Astrophysics Data System (ADS)

    Foster, Andrew; Kumar, Naresh

    2011-03-01

    This, the first systematic study, quantifies the health effects of air quality regulations in Delhi, which adopted radical measures to improve air quality, including, for example, the conversion of all commercial vehicles to compressed natural gas (CNG), and the closure of polluting industries in residential areas from 2000 to 2002. Air pollution data, collected at 113 sites (spread across Delhi and its neighboring areas) from July-December 2003, were used to compute exposure at the place of residence of 3989 subjects. A socio-economic and respiratory health survey was administered in 1576 households. This survey collected time-use, residence histories, demographic information, and direct measurements of lung function with subjects. The optimal interpolation methods were used to link air pollution and respiratory health data at the place of their residence. Resident histories, in combination with secondary data, were used to impute cumulative exposure prior to the air-quality interventions, and the effects of recent air quality measures on lung function were then evaluated. Three important findings emerge from the analysis. First, the interventions were associated with a significant improvement in respiratory health. Second, the effect of these interventions varied significantly by gender and income. Third, consistent with a causal interpretation of these results, effects were the strongest among those individuals who spend a disproportionate share of their time out-of-doors.

  2. College Student Mental Health and Quality of Workplace Relationships

    ERIC Educational Resources Information Center

    Vaughn, Allison A.; Drake, Richard R.; Haydock, Sarah

    2016-01-01

    Objective: The goal of this study was to examine the effect of quality of workplace relationships on the mental health of employed undergraduates, with work-related variables as a potential mechanism. Participants: Participants were 170 employed students (76% female, average age = 19.9) recruited in March 2011. Most worked part-time and had been…

  3. College Student Mental Health and Quality of Workplace Relationships

    ERIC Educational Resources Information Center

    Vaughn, Allison A.; Drake, Richard R.; Haydock, Sarah

    2016-01-01

    Objective: The goal of this study was to examine the effect of quality of workplace relationships on the mental health of employed undergraduates, with work-related variables as a potential mechanism. Participants: Participants were 170 employed students (76% female, average age = 19.9) recruited in March 2011. Most worked part-time and had been…

  4. Water Quality Criteria for Human Health and Aquatic Life

    EPA Science Inventory

    Collaborative effort with the Office of Water to provide science in support of the development and implementation of new or revised ambient water quality criteria for microbial and chemical contaminants for human health and aquatic life. The research also addresses implementation...

  5. Premenstrual syndrome and life quality in Turkish health science students.

    PubMed

    İşik, Hatice; Ergöl, Şule; Aynioğlu, Öner; Şahbaz, Ahmet; Kuzu, Ayşe; Uzun, Müge

    2016-04-19

    The purpose of the present study was to investigate the incidence of PMS, risk factors affecting PMS symptoms, and life quality in health science students. A total of 608 volunteer female students studying at the health campus of a state university in Turkey were included in the study. The participants were asked to fill out questionnaires on sociodemographic data, PMS symptoms, and SF-36 life quality tests. The overall frequency of PMS among participants was 84.5%. The average PMS and general health SF scores were 118.34 ± 37.3 and 20.03 ± 3.72, respectively. Students who had irregular breakfast, drank ≥2 cups of coffee/day, and consumed alcohol or fast food had higher PMS scores. Irregular menstruation and family history increased PMS scores and decreased life quality (P < 0.05). The life quality of the students significantly decreased as the severity of PMS increased (P < 0.001). Low body mass index, family history, irregular menstruation, bad eating habits such as fast food consumption and irregular breakfasts, and coffee and alcohol consumption increased PMS risk significantly. In order to improve their life quality, students should be informed about the symptoms, risk factors, and management options of PMS.

  6. Challenges in Data Quality Assurance in Pervasive Health Monitoring Systems

    NASA Astrophysics Data System (ADS)

    Sriram, Janani; Shin, Minho; Kotz, David; Rajan, Anand; Sastry, Manoj; Yarvis, Mark

    Wearable, portable, and implantable medical sensors have ushered in a new paradigm for healthcare in which patients can take greater responsibility and caregivers can make well-informed, timely decisions. Health-monitoring systems built on such sensors have huge potential benefit to the quality of healthcare and quality of life for many people, such as patients with chronic medical conditions (such as blood-sugar sensors for diabetics), people seeking to change unhealthy behavior (such as losing weight or quitting smoking), or athletes wishing to monitor their condition and performance. To be effective, however, these systems must provide assurances about the quality of the sensor data. The sensors must be applied to the patient by a human, and the sensor data may be transported across multiple networks and devices before it is presented to the medical team. While no system can guarantee data quality, we anticipate that it will help for the system to annotate data with some measure of confidence. In this paper, we take a deeper look at potential health-monitoring usage scenarios and highlight research challenges required to ensure and assess quality of sensor data in health-monitoring systems.

  7. Impact of Medicaid Reimbursement on Mental Health Quality Indicators

    PubMed Central

    Bellows, Nicole M; Halpin, Helen A

    2008-01-01

    Objective To examine the relationship between the use of the Minimum Data Set (MDS) for determining Medicaid reimbursement to nursing facilities and the MDS Quality Indicators examining nursing facility residents' mental health. Data Sources The 2004 National MDS facility Quality Indicator reports served as the dependent variables. Explanatory variables were based on the 2004 Online Survey Certification and Reporting system (OSCAR) and an examination of existing reports, a review of the State Medicaid Plans, and State Medicaid personnel. Study Design Multilevel regression models were used to account for the hierarchical structure of the data. Data Collection MDS and OSCAR data were linked by facility identifiers and subsequently linked with state-level variables. Principal Findings The use of the MDS for determining Medicaid reimbursement was associated with higher (poorer) quality indicator values for all four mental health quality indicators examined. This effect was not found in four comparison quality indicators. Conclusions The findings indicate that documentation of mental health symptoms may be influenced by economic incentives. Policy makers should be cautioned from using these measures as the basis for decision making, such as with pay-for-performance initiatives. PMID:18370968

  8. Providing quality services. JICA Reproductive Health Project. Thanh Chuong district.

    PubMed

    Nguyen Huu Son

    1999-01-01

    This article concerns the quality of services provided by the different groups sponsored by the Japan International Cooperation Agency (JICA) Reproductive Health project. Nguyen Huu Son, Chairperson of the People's Committee of Thanh Tien Commune, cites that the JICA project has helped improve their Commune Health Center (CHC). The project has provided basic medical equipment that has been lacking in the CHCs, subsequently making the task of providing quality services easier and more comfortable for midwives and other health personnel. For the Thanh Tien Commune Health Center, Nguyen Hoang An reports that the JICA project has brought about improvement in their CHC fields; namely, 1) providing health knowledge to community people; 2) increase in health staff's skills through training; 3) keeping record of management and the CHC services; and 4) renovating health facilities. As a result, clients have increased and many of the community people now have confidence in their services. For the Women's Union of Thanh Tien Commune, Nguyen Thi Loc reports that the assistance provided by JICA has greatly helped in the acquisition of necessary skills for disseminating adequate information to women.

  9. Geospatial decision support systems for societal decision making

    USGS Publications Warehouse

    Bernknopf, R.L.

    2005-01-01

    While science provides reliable information to describe and understand the earth and its natural processes, it can contribute more. There are many important societal issues in which scientific information can play a critical role. Science can add greatly to policy and management decisions to minimize loss of life and property from natural and man-made disasters, to manage water, biological, energy, and mineral resources, and in general, to enhance and protect our quality of life. However, the link between science and decision-making is often complicated and imperfect. Technical language and methods surround scientific research and the dissemination of its results. Scientific investigations often are conducted under different conditions, with different spatial boundaries, and in different timeframes than those needed to support specific policy and societal decisions. Uncertainty is not uniformly reported in scientific investigations. If society does not know that data exist, what the data mean, where to use the data, or how to include uncertainty when a decision has to be made, then science gets left out -or misused- in a decision making process. This paper is about using Geospatial Decision Support Systems (GDSS) for quantitative policy analysis. Integrated natural -social science methods and tools in a Geographic Information System that respond to decision-making needs can be used to close the gap between science and society. The GDSS has been developed so that nonscientists can pose "what if" scenarios to evaluate hypothetical outcomes of policy and management choices. In this approach decision makers can evaluate the financial and geographic distribution of potential policy options and their societal implications. Actions, based on scientific information, can be taken to mitigate hazards, protect our air and water quality, preserve the planet's biodiversity, promote balanced land use planning, and judiciously exploit natural resources. Applications using the

  10. Identifying key hospital service quality factors in online health communities.

    PubMed

    Jung, Yuchul; Hur, Cinyoung; Jung, Dain; Kim, Minki

    2015-04-07

    The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. We defined social media-based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea's two biggest online portals were used to test the effectiveness of detection of social media-based key quality factors for hospitals. To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is 78% on average. Extraction and

  11. Identifying Key Hospital Service Quality Factors in Online Health Communities

    PubMed Central

    Jung, Yuchul; Hur, Cinyoung; Jung, Dain

    2015-01-01

    Background The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. Objective As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. Methods We defined social media–based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea’s two biggest online portals were used to test the effectiveness of detection of social media–based key quality factors for hospitals. Results To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2014-01-01

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

  14. Space Station Environmental Health System water quality monitoring

    NASA Technical Reports Server (NTRS)

    Vincze, Johanna E.; Sauer, Richard L.

    1990-01-01

    One of the unique aspects of the Space Station is that it will be a totally encapsulated environment and the air and water supplies will be reclaimed for reuse. The Environmental Health System, a subsystem of CHeCS (Crew Health Care System), must monitor the air and water on board the Space Station Freedom to verify that the quality is adequate for crew safety. Specifically, the Water Quality Subsystem will analyze the potable and hygiene water supplies regularly for organic, inorganic, particulate, and microbial contamination. The equipment selected to perform these analyses will be commercially available instruments which will be converted for use on board the Space Station Freedom. Therefore, the commercial hardware will be analyzed to identify the gravity dependent functions and modified to eliminate them. The selection, analysis, and conversion of the off-the-shelf equipment for monitoring the Space Station reclaimed water creates a challenging project for the Water Quality engineers and scientists.

  15. Space Station Environmental Health System water quality monitoring

    NASA Technical Reports Server (NTRS)

    Vincze, Johanna E.; Sauer, Richard L.

    1990-01-01

    One of the unique aspects of the Space Station is that it will be a totally encapsulated environment and the air and water supplies will be reclaimed for reuse. The Environmental Health System, a subsystem of CHeCS (Crew Health Care System), must monitor the air and water on board the Space Station Freedom to verify that the quality is adequate for crew safety. Specifically, the Water Quality Subsystem will analyze the potable and hygiene water supplies regularly for organic, inorganic, particulate, and microbial contamination. The equipment selected to perform these analyses will be commercially available instruments which will be converted for use on board the Space Station Freedom. Therefore, the commercial hardware will be analyzed to identify the gravity dependent functions and modified to eliminate them. The selection, analysis, and conversion of the off-the-shelf equipment for monitoring the Space Station reclaimed water creates a challenging project for the Water Quality engineers and scientists.

  16. The quest for quality and productivity in health services.

    PubMed

    Sahney, V K; Warden, G L

    1991-01-01

    The leaders of health care organizations across the country are facing significant pressures to improve the quality of their services while reducing the rate of cost increases within the industry. Total Quality Management (TQM) has been credited, by many leaders in the manufacturing industry, as an effective tool to manage their organizations. This article presents key concepts of TQM as discussed by quality experts, namely, Deming, Juran, and Crosby. It discusses 12 key concepts that have formed the foundation of TQM implementation at Henry Ford Health System. The process of implementation is presented in detail, and the role of TQM in clinical applications is discussed. Success factors and visible actions by senior management designed to reinforce the implementation of TQM in any organization are presented.

  17. College student mental health and quality of workplace relationships.

    PubMed

    Vaughn, Allison A; Drake, Richard R; Haydock, Sarah

    2016-01-01

    The goal of this study was to examine the effect of quality of workplace relationships on the mental health of employed undergraduates, with work-related variables as a potential mechanism. Participants were 170 employed students (76% female, average age = 19.9) recruited in March 2011. Most worked part-time and had been at their jobs over a year. Students were recruited from an undergraduate introductory psychology course and completed online surveys about the quality of workplace relationships, mental health (ie, somatic stress symptoms, depression, anxiety, and life satisfaction), and work-related variables (ie, job satisfaction, support, turnover and burnout). Students who reported having workplace relationships with co-occurring positivity and negativity had worse self-reported mental health outcomes than students reporting having wholly positive relationships. The relationship between workplace relationship quality and mental health was mediated by negative work-related variables. Workplace relationships-even in part-time employment settings-influence college students' mental health.

  18. Changes in Quality of Health Care Delivery after Vertical Integration.

    PubMed

    Carlin, Caroline S; Dowd, Bryan; Feldman, Roger

    2015-08-01

    To fill an empirical gap in the literature by examining changes in quality of care measures occurring when multispecialty clinic systems were acquired by hospital-owned, vertically integrated health care delivery systems in the Twin Cities area. Administrative data for health plan enrollees attributed to treatment and control clinic systems, merged with U.S. Census data. We compared changes in quality measures for health plan enrollees in the acquired clinics to enrollees in nine control groups using a differences-in-differences model. Our dataset spans 2 years prior to and 4 years after the acquisitions. We estimated probit models with errors clustered within enrollees. Data were assembled by the health plan's informatics team. Vertical integration is associated with increased rates of colorectal and cervical cancer screening and more appropriate emergency department use. The probability of ambulatory care-sensitive admissions increased when the acquisition caused disruption in admitting patterns. Moving a clinic system into a vertically integrated delivery system resulted in limited increases in quality of care indicators. Caution is warranted when the acquisition causes disruption in referral patterns. © Health Research and Educational Trust.

  19. Quality at the centre of universal health coverage.

    PubMed

    Sobel, Howard L; Huntington, Dale; Temmerman, Marleen

    2016-05-01

    The last decade of the MDG era witnessed substantial focus on reaching the bottom economic quintiles in low and middle income countries. However, the inordinate focus on reducing financial risk burden and increasing coverage without sufficient focus on expanding quality of services may account for slow progress of the MDGs in many countries. Human Resources for Health underlie quality and service delivery improvements, yet remains under-addressed in many national strategies to achieve Universal Health Coverage. Without adequate investments in improving and expanding health professional education, making and sustaining gains will be unlikely. The transition from the Millennium Development Goals (MDG) to the Sustainable Development Goals (SDG), with exciting new financing initiatives such as the Global Financing Facility brings the potential to enact substantial gains in the quality of services delivered and upgrading human health resources. This focus should ensure effective methodologies to improve health worker competencies and change practice are employed and ineffective and harmful ones eliminated (including undue influence of commercial interests).

  20. Monitoring Indoor Air Quality for Enhanced Occupational Health.

    PubMed

    Pitarma, Rui; Marques, Gonçalo; Ferreira, Bárbara Roque

    2017-02-01

    Indoor environments are characterized by several pollutant sources. Because people spend more than 90% of their time in indoor environments, several studies have pointed out the impact of indoor air quality on the etiopathogenesis of a wide number of non-specific symptoms which characterizes the "Sick Building Syndrome", involving the skin, the upper and lower respiratory tract, the eyes and the nervous system, as well as many building related diseases. Thus, indoor air quality (IAQ) is recognized as an important factor to be controlled for the occupants' health and comfort. The majority of the monitoring systems presently available is very expensive and only allow to collect random samples. This work describes the system (iAQ), a low-cost indoor air quality monitoring wireless sensor network system, developed using Arduino, XBee modules and micro sensors, for storage and availability of monitoring data on a web portal in real time. Five micro sensors of environmental parameters (air temperature, humidity, carbon monoxide, carbon dioxide and luminosity) were used. Other sensors can be added for monitoring specific pollutants. The results reveal that the system can provide an effective indoor air quality assessment to prevent exposure risk. In fact, the indoor air quality may be extremely different compared to what is expected for a quality living environment. Systems like this would have benefit as public health interventions to reduce the burden of symptoms and diseases related to "sick buildings".

  1. Unmasking quality: exploring meanings of health by doing art.

    PubMed

    Kelly, Moira; Rivas, Carol; Foell, Jens; Llewellyn-Dunn, Janet; England, Diana; Cocciadiferro, Anna; Hull, Sally

    2015-02-27

    Quality in healthcare has many potential meanings and interpretations. The case has been made for conceptualisations of quality that place more emphasis on describing quality and less on measuring it through structured, vertically oriented metrics. Through discussion of an interdisciplinary community arts project we explore and challenge the dominant reductionist meanings of quality in healthcare. The model for structured participatory arts workshops such as ours is 'art as conversation'. In creating textile art works, women involved in the sewing workshops engaged at a personal level, developing confidence through sharing ideas, experiences and humour. Group discussions built on the self-assurance gained from doing craft work together and talking in a relaxed way with a common purpose, exploring the health themes which were the focus of the art. For example, working on a textile about vitamin D created a framework which stimulated the emergence of a common discourse about different cultural practices around 'going out in the sun'. These conversations have value as 'bridging work', between the culture of medicine, with its current emphasis on lifestyle change to prevent illness, and patients' life worlds. Such bridges allow for innovation and flexibility to reflect local public health needs and community concerns. They also enable us to view care from a horizontally oriented perspective, so that the interface in which social worlds and the biomedical model meet and interpenetrate is made visible. Through this interdisciplinary art project involving academics, health professionals and the local community we have become more sensitised to conceptualising one aspect of health care quality as ensuring a 'space for the story' in health care encounters. This space gives precedence to the patient narratives, but acknowledges the importance of enabling clinicians to have time to share stories about care.

  2. Assessment of oral health related quality of life

    PubMed Central

    Allen, P Finbarr

    2003-01-01

    In Dentistry, as in other branches of Medicine, it has been recognised that objective measures of disease provide little insight into the impact of oral disorders on daily living and quality of life. A significant body of development work has been undertaken to provide health status measures for use as outcome measures in dentistry. In descriptive population studies, poor oral health related quality of life is associated with tooth loss. There is a less extensive literature of longitudinal clinical trials, and measurement of change and interpretation of change scores continues to pose a challenge. This paper reviews the literature regarding the development and use of these oral health related QoL measures and includes an appraisal of future research needs in this area. PMID:14514355

  3. Quality of Life and Health-Related Quality of Life of Adolescents with Cerebral Palsy

    ERIC Educational Resources Information Center

    Rosenbaum, Peter L.; Livingston, Michael H.; Palisano, Robert J.; Galuppi, Barbara E.; Russell, Dianne J.

    2007-01-01

    This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V…

  4. Quality of Life and Health-Related Quality of Life of Adolescents with Cerebral Palsy

    ERIC Educational Resources Information Center

    Rosenbaum, Peter L.; Livingston, Michael H.; Palisano, Robert J.; Galuppi, Barbara E.; Russell, Dianne J.

    2007-01-01

    This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V…

  5. [Comparative analysis of quality labels of health websites].

    PubMed

    Padilla-Garrido, N; Aguado-Correa, F; Huelva-López, L; Ortega-Moreno, M

    2016-01-01

    The search for health related information on the Internet is a growing phenomenon, buts its main drawback is the lack of reliability of information consulted. The aim of this study was to analyse and compare existing quality labels of health websites. A cross-sectional study was performed by searching Medline, IBECS, Google, and Yahoo, in both English and Spanish, between 8 and 9 March, 2015. Different keywords were used depending on whether the search was conducted in medical databases or generic search engines. The quality labels were classified according to their origin, analysing their character, year of implementation, the existence of the accreditation process, number of categories, criteria and standards, possibility of self-assessment, number of levels of certification, certification scope, validity, analytical quality of content, fee, results of the accreditation process, application and number of websites granted the seal, and quality labels obtained by the accrediting organisation. Seven quality labels, five of Spanish origin (WMA, PAWS, WIS, SEAFORMEC and M21) and two international ones (HONcode and Health Web Site Accreditation), were analysed. There was disparity in carrying out the accreditation process, with some not detailing key aspects of the process, or providing incomplete, outdated, or even inaccurate information. The most rigorous guaranteed the level of confidence that the websites had in relation to the content of information, but none checked the quality of them. Although rigorous quality labels may become useful, the deficiencies in some of them cast doubt on their current usefulness. Copyright © 2015 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Adult Day Health Center Participation and Health-Related Quality of Life

    ERIC Educational Resources Information Center

    Schmitt, Eva M.; Sands, Laura P.; Weiss, Sara; Dowling, Glenna; Covinsky, Kenneth

    2010-01-01

    Purpose: The purpose of this study was to assess the association between Adult Day Health Center (ADHC) participation and health-related quality of life. Design and Methods: Case-controlled prospective study utilizing the Medical Outcomes Survey Form 36 (SF-36) to compare newly enrolled participants from 16 ADHC programs with comparable…

  7. Water, water quality and health (Chapter 3 in Book entitled: Environmental Tracking for Public Health Surveillance).

    EPA Science Inventory

    This chapter identifies the role environmental tracking plays in identifying public health water hazard and water quality issues. It outlines public health issues to be examined and provides an integrated overview of water and diseases by combining knowledge of the hydrological ...

  8. Quality and Health-Optimizing Physical Education: Using Assessment at the Health and Education Nexus

    ERIC Educational Resources Information Center

    Dudley, Dean; Goodyear, Victoria; Baxter, David

    2016-01-01

    Background: The United Nations Educational, Cultural and Scientific Organization (UNESCO) recognizes quality physical education (QPE) must, along with physical, social and affective educative goals, seek to improve the health status of youth (UNESCO, 2015). Health-Optimizing Physical Education (HOPE) is a model of physical education (PE) that…

  9. Quality and Health-Optimizing Physical Education: Using Assessment at the Health and Education Nexus

    ERIC Educational Resources Information Center

    Dudley, Dean; Goodyear, Victoria; Baxter, David

    2016-01-01

    Background: The United Nations Educational, Cultural and Scientific Organization (UNESCO) recognizes quality physical education (QPE) must, along with physical, social and affective educative goals, seek to improve the health status of youth (UNESCO, 2015). Health-Optimizing Physical Education (HOPE) is a model of physical education (PE) that…

  10. Water, water quality and health (Chapter 3 in Book entitled: Environmental Tracking for Public Health Surveillance).

    EPA Science Inventory

    This chapter identifies the role environmental tracking plays in identifying public health water hazard and water quality issues. It outlines public health issues to be examined and provides an integrated overview of water and diseases by combining knowledge of the hydrological ...

  11. Developing a risk-based air quality health index

    NASA Astrophysics Data System (ADS)

    Wong, Tze Wai; Tam, Wilson Wai San; Yu, Ignatius Tak Sun; Lau, Alexis Kai Hon; Pang, Sik Wing; Wong, Andromeda H. S.

    2013-09-01

    We developed a risk-based, multi-pollutant air quality health index (AQHI) reporting system in Hong Kong, based on the Canadian approach. We performed time series studies to obtain the relative risks of hospital admissions for respiratory and cardiovascular diseases associated with four air pollutants: sulphur dioxide, nitrogen dioxide, ozone, and particulate matter with an aerodynamic diameter less than 10 μm (PM10). We then calculated the sum of excess risks of the hospital admissions associated with these air pollutants. The cut-off points of the summed excess risk, for the issuance of different health warnings, were based on the concentrations of these pollutants recommended as short-term Air Quality Guidelines by the World Health Organization. The excess risks were adjusted downwards for young children and the elderly. Health risk was grouped into five categories and sub-divided into eleven bands, with equal increments in excess risk from band 1 up to band 10 (the 11th band is 'band 10+'). We developed health warning messages for the general public, including at-risk groups: young children, the elderly, and people with pre-existing cardiac or respiratory diseases. The new system addressed two major shortcomings of the current standard-based system; namely, the time lag between a sudden rise in air pollutant concentrations and the issue of a health warning, and the reliance on one dominant pollutant to calculate the index. Hence, the AQHI represents an improvement over Hong Kong's existing air pollution index.

  12. Climate change and air quality: the potential impact on health.

    PubMed

    Spickett, Jeff T; Brown, H L; Rumchev, Krassi

    2011-03-01

    The objectives of the study were to: consider the potential health impacts in Australia and the region arising from changes in air quality occurring as a result of climate change, identify vulnerable groups and potential adaptation measures and discuss the implications for policy. The authors provide an overview of international and national information on the potential health impacts of air pollutants that would most likely be affected by climate change and a discussion of the policy implications. Climate change is likely to have an impact on levels of ozone and possibly particulates, both of which are associated with increased mortality and a range of respiratory and cardiovascular health effects. One of the implications is therefore a possible increase in adverse health effects due to air pollutants. Regional health impact assessments of climate change should address the issue of air quality, consider current coping capacity, and determine the need for adaptation, particularly for vulnerable groups. Implications for policy include the need for improved modeling and forecasting of air pollutant levels, increased efforts to reduce emissions of air pollutants, continued monitoring of air pollutant levels, and monitoring of the incidence of health effects associated with air pollutants in all countries in the region.

  13. Clinical Quality Performance in U.S. Health Centers

    PubMed Central

    Shi, Leiyu; Lebrun, Lydie A; Zhu, Jinsheng; Hayashi, Arthur S; Sharma, Ravi; Daly, Charles A; Sripipatana, Alek; Ngo-Metzger, Quyen

    2012-01-01

    Objective To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. Data Sources National data from the 2009 Uniform Data System. Data Collection/Extraction Methods Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Study Design Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Principal Findings Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Conclusions Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. PMID:22594465

  14. Social determinants of health-related quality of life.

    PubMed

    Kivits, J; Erpelding, M-L; Guillemin, F

    2013-08-01

    The concept of health-related quality of life (HRQoL) considers patient's perspective as an essential component of the health care relationship. HRQoL is often assimilated to a set of existing tools aimed at measuring the perspective of patient, more particularly the consequences of ill-health condition on patient's everyday life. Patients' reports of their health is however diverse, as social factors such as age, gender, professional status are likely to impact on health self-perception and reporting. Social aspects of HRQoL are somehow underexplored. This paper presents a secondary analysis of epidemiological HRQoL data issued from two national surveys (Baromètre Santé 2005; Enquête Décennale Santé 2002-2003). The data analysis showed the existence of social determinants of HRQoL. It more specifically demonstrated that four social indicators are determinants of HRQoL namely living in couple, level of education, occupational status and net income per household, independently of age and gender known effect. Social mechanisms governing the impact of social determinants on quality of life could be further explored by adopting a multidisciplinary and mutilevel research approach of HRQoL as well as considering the ability of individuals to engage with social aspect of their health conditions. Copyright © 2013. Published by Elsevier Masson SAS.

  15. Quality of care in reproductive health programmes: education for quality improvement.

    PubMed

    Kwast, B E

    1998-09-01

    The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care.

  16. Bypassing health providers: the quest for better price and quality of health care in Chad.

    PubMed

    Gauthier, Bernard; Wane, Waly

    2011-08-01

    This paper investigates individuals' bypassing behavior in the health sector in Chad and the determinants of individuals' facility choice. We introduce a new way for measuring bypassing which uses the patients' own knowledge of alternative health providers available to them, instead of assuming perfect information as previously done. We analyze how objective and perceived health care quality and prices impact patients' bypassing decisions. The analysis uses data from a health sector survey carried out in 2004 covering 281 primary health care centers and 1801 patients. We observe that income inequalities translate into health service inequalities. We find evidence of two distinct types of bypassing activities in Chad: (1) patients from low-income households bypass high quality facilities they cannot afford and go to low-quality facilities, and (2) rich individuals bypass low-quality facilities and aim for more expensive facilities which also offer a higher quality of care. These significant differences in patients' facility choices are observed across income groups as well as between rural and urban areas.

  17. Health programmes for school employees: improving quality of life, health and productivity.

    PubMed

    Kolbe, Lloyd J; Tirozzi, Gerald N; Marx, Eva; Bobbitt-Cooke, Mary; Riedel, Sara; Jones, Jack; Schmoyer, Michael

    2005-01-01

    School health programmes in the 21st century could include eight components: 1) health services; 2) health education; 3) healthy physical and psychosocial environments; 4) psychological, counselling, and social services; 5) physical education and other physical activities; 6) healthy food services; and 7) integrated efforts of schools, families, and communities to improve the health of school students and employees. The eighth component of modern school health programmes, health programmes for school employees, is the focus of this article. Health programmes for school employees could be designed to increase the recruitment, retention, and productivity of school employees by partially focusing each of the preceding seven components of the school health programme on improving the health and quality of life of school employees as well as students. Thus, efforts to improve the quality of life, health, and productivity of school employees may be distinct from, but integrated with, efforts to improve the quality of life, health, and education of students. School employee health programmes can improve employee: 1) recruitment; 2) morale; 3) retention; and 4) productivity. They can reduce employee: 5) risk behaviours (e.g., physical inactivity); 6) risk factors (e.g., stress, obesity, high blood pressure); (7) illnesses; 8) work-related injuries; 9) absentee days; 10) worker compensation and disability claims; and 11) health care and health insurance costs. Further, if we hope to improve our schools' performance and raise student achievement levels, developing effective school employee health programmes can increase the likelihood that employees will: 12) serve as healthy role models for students; 13) implement effective school health programmes for students; and 14) present a positive image of the school to the community. If we are to improve the quality of life, health, and productivity of school employees in the 21st century: school administrators, employees, and

  18. Health-related quality of life and cancer clinical trials

    PubMed Central

    Osoba, David

    2011-01-01

    The measurement of patient-reported outcomes, including health-related quality of life, is a new initiative which has emerged and grown over the past four decades. Following the development of reliable and valid self-report questionnaires, health-related quality of life has been assessed in tens of thousands of patients and a wide variety of cancers. This review is based on a selection of data published in the last decade and is intended primarily for healthcare professionals. The assessments in clinical trials have been particularly useful for elucidating the effects of various cancers and their treatments on patients’ lives and have provided additional information that enhances the usual clinical endpoints used for determining the benefits and toxicity of treatment. With growing experience the quality of the health-related quality of studies has improved and, in general, recent studies are more likely to be methodologically robust than those that were performed in earlier decades. Health-related quality of life has become a more accurate predictor of survival than some other clinical parameters, such as performance status. The overall outlook for the routine assessment of patient-reported outcomes in clinical trials is assured and, eventually, it is likely to become a standard part of clinical practice. However, there is still a need for a clear method for determining the clinical meaningfulness of changes in scores. The answer will probably come from the greater use of patient-reported outcomes and the consequent growth of experience that is necessary to make such judgements. PMID:21789156

  19. Partnering Health Disparities Research With Quality Improvement Science in Pediatrics

    PubMed Central

    Lion, K. Casey

    2015-01-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. PMID:25560436

  20. Changes in Quality of Health Care Delivery after Vertical Integration

    PubMed Central

    Carlin, Caroline S; Dowd, Bryan; Feldman, Roger

    2015-01-01

    Objectives To fill an empirical gap in the literature by examining changes in quality of care measures occurring when multispecialty clinic systems were acquired by hospital-owned, vertically integrated health care delivery systems in the Twin Cities area. Data Sources/Study Setting Administrative data for health plan enrollees attributed to treatment and control clinic systems, merged with U.S. Census data. Study Design We compared changes in quality measures for health plan enrollees in the acquired clinics to enrollees in nine control groups using a differences-in-differences model. Our dataset spans 2 years prior to and 4 years after the acquisitions. We estimated probit models with errors clustered within enrollees. Data Collection/Extraction Methods Data were assembled by the health plan’s informatics team. Principal Findings Vertical integration is associated with increased rates of colorectal and cervical cancer screening and more appropriate emergency department use. The probability of ambulatory care–sensitive admissions increased when the acquisition caused disruption in admitting patterns. Conclusions Moving a clinic system into a vertically integrated delivery system resulted in limited increases in quality of care indicators. Caution is warranted when the acquisition causes disruption in referral patterns. PMID:25529312

  1. Oral Health Related Quality of Life in Diabetic Patients

    PubMed Central

    Sadeghi, Rokhsareh; Taleghani, Ferial; Farhadi, Sareh

    2014-01-01

    Background and aims. Diabetic patients display an increased risk of oral disorders, and oral health related quality of life (OHRQL) might affect their management and treatment modalities. The aim of the present study was to determine OHRQL and associated parameters in patients with diabetes. Materials and methods. In this study two hundred patients were recruited from the diabetes clinic in Mustafa Khomeini Hospital in Tehran, Iran. OHRQL was assessed using Oral Health Impact Profile Questionnaire (OHIP-20). Also, another questionnaire was designed which contained questions regarding participants’ knowledge about oral complications of diabetes and oral health behavior. OHRQL was categorized as low and good. Data were analyzed using logistic regression at P = 0.05. Results. Of the diabetic patients assessed, 77.5% were in good and 22.5% were in low categories of OHRQL. This quality was significantly associated with age (OR = 4.03, 95% CI = 1.63-11.29), knowledge about diabetes oral complications (OR = 18.17 95% CI = 4.42-158.6), educational level (OR = 26.31 95% CI = 4.2-1080.3), referred for dental visit by physician (OR = 3.16 95% CI = 1.48-6.69), frequency of brushing (OR = 10.29 95% CI = 3.96-31.2) and length of time diagnosed with diabetes (OR = 6.21 95% CI = 2.86-13.63). Conclusion. Oral health related quality of life was not negatively affected by diabetes mellitus in the assessed sample. PMID:25587385

  2. Health-related quality of life in Icelandic school children.

    PubMed

    Svavarsdottir, Erla Kolbrun; Orlygsdottir, Brynja

    2006-06-01

    This study evaluated generic health-related quality of life (HRQOL) among 10 to 12-year-old Icelandic school age children who were either with or without chronic health condition. The children and their parents answered self-report questionnaires. For the 480 children who participated, girls were found to perceive their HRQOL significantly higher than the boys, children who visited the school nurse over a one-week period and children who indicated they were bullied by other children, perceived their HRQOL to be significantly lower than children who did not visit the school nurse over this time period or children who did not indicate they were bullied by other children in school. From the stepwise regression analysis, perception of health, school connectedness, health promotion, bullying victimization, visits to the school nurse and age, significantly predicted 43.8% of the variance of the girls' perception of their HRQOL. However, perception of health, school connectedness, and chronic health condition/illnesses, bullying victimization and after school activities predicted 48.1% of the boys' perception of their HRQOL. Children with chronic health condition or illnesses, reported their HRQOL to be significantly lower than children without chronic health condition. Assessing HRQOL among 10 to 12-year-old children might be helpful to take preventive action early on in children's life and development.

  3. Chronic Ischemic Heart Disease Affects Health Related Quality of Life

    PubMed Central

    Goreishi, Abolfazl; Shajari, Zahra; Mohammadi, Zeinab

    2012-01-01

    Background Chronic diseases endanger not only physical health but also psychological and social health of patient. Thus, evaluation of such patients for psychological treatment decisions is very important. Method This is a descriptive study that was performed with 50 chronic patients (ischemic heart disease) selected from Valiasr and Mousavi at cardiac wards in Zanjan Province. They were given three types of questionnaire: demographic, WHOQOL, and Zung depression and anxiety index. The information was statically analyzed by frequency chart, central indexes, dispersion, Chi-Square and t tests, Pearson’s correlation index (P < 0.05). Results The average of quality of life in all patients were calculated as was respectively 12.19, 11.98, 12.08, and 12.4 in physical, psychological, social and environmental domains respectively, 68 percent of total number of the patients had various degrees of anxiety and 78 percent of them had various degrees of depression. There was a significant relationship between the life quality average in all domains and anxiety intensity and depression intensity (P < 0.05) and there was a significant relationship between life quality average in all domains and income (P < 0.05). Conclusion As the level of depression and anxiety goes up, quality of life decreases pointing out that they have a reverse relationship. Depression and anxiety are one of the most significant factors of quality of life among other variables. Regarding specific conditions of the treatment, it is necessary to pay special attention to psychological aspects.

  4. The business case for health-care quality improvement.

    PubMed

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.

  5. Total quality management and the Army health care system.

    PubMed

    Jeffer, E K

    1991-10-01

    Total quality management (TQM) is the newest in a long line of magic formulas which have been touted as saviors for American industry and medicine. The author discusses the basic concepts of TQM and notes that much of it resembles philosophical beliefs long held by the medical community. TQM does offer many opportunities to refine old concepts and further those goals of quality care to which health care providers have always aspired. If, however, it becomes simply another codified bureaucracy, then a great deal of time and money will be invested for very little gain.

  6. Social and economic costs and health-related quality of life in non-institutionalised patients with cystic fibrosis in the United Kingdom.

    PubMed

    Angelis, Aris; Kanavos, Panos; López-Bastida, Julio; Linertová, Renata; Nicod, Elena; Serrano-Aguilar, Pedro

    2015-09-28

    This study aimed to determine the societal economic burden and health-related quality of life (HRQOL) of cystic fibrosis (CF) patients in the UK. A bottom-up cost-of-illness, cross-sectional, retrospective analysis of 74 patients was conducted aiming to estimate the economic impact of CF. Data on demographic characteristics, health resource utilisation, informal care, productivity losses and HRQOL were collected from questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) instrument. Using unit costs for 2012 we found that the average annual cost for a CF patient was €48,603, with direct health care costs amounting to €20,854 (42.9 % of total costs), direct non-health care costs being €21,528 (44.3 %) and indirect costs attributable to productivity losses being €6,222 (12.8 %). On average, the largest expenditures by far were accounted for by informal care (44.1 %), followed by medications (14.5 %), acute hospitalisations (13.9 %), early retirement (9.1 %) and outpatient and primary health care visits (7.9 %). Sharp differences existed depending on whether CF patients were in need of caregiver help (€76,271 versus €26,335). In adult CF patients, mean EQ-5D index scores were 0.64 (0.93 in the general population) and mean EQ-5D visual analogue scale scores were 62.23 (86.84 in the general population); among caregivers, these scores were 0.836 and 80.85, respectively. Our analysis highlights the importance of the economic and quality of life consequences of CF from a societal perspective. The results highlight that beyond conventional costs such as acute hospitalisations, medication and outpatient and primary care visits, indirect costs related to informal care and early retirement, have significant societal implications. Similarly, our analysis showed that the average EQ-5D index score of adult CF patients was significantly lower than in the general population, an indication that a methodological bias

  7. Exploring Social Quality and Community Health Outcomes: An Ecological Model.

    PubMed

    Jung, Minsoo

    2015-01-01

    Quality of life is widely used as a measure of individual well-being in developed countries. Social quality (SQ), however, describes how favorable the socioenvironmental components are that impact the life chance of an individual. Despite the associations between SQ, including institutional capacity and citizen capacity, and other community indicators, the impact of SQ on community health status has not been fully examined. This study investigated the interrelationships among institutional capacity, citizen capacity, and their associations with community-level health indicators such as mortality and suicide among 230 local governments in South Korea. Under the principles of conceptual suitability, clarity, reliability, consistency, changeability, and comparability, a total of 81 SQ indicators were collected, and 19 indicators of the 81 indicators were selected. The 19 indicators were transformed by the imputation of missing values, standardization, and geographic information system transformation. It was found that the health outcome of local government was superior as social welfare, political participation, and education were higher. According to the result of the regression analysis based on the regional type, social welfare had the most influence on the health level of local government in both metropolises and small-/medium-sized cities. In addition, education and political participation had a positive effect on the health indicator of local metropolis government. However, SQ indicators did not have any meaningful influence at the county level. Therefore, small- and medium-sized cities need to promote the collective health of the local government through improving social welfare, and metropolises need to consider the complex relationship among other indicators while increasing the level of social welfare and education. Meanwhile, counties need to develop health indicators that reflect aged population characteristics and social environment of rural areas

  8. Health, Quality of Life and Population Density: A Preliminary Study on "Contextualized" Quality of Life

    ERIC Educational Resources Information Center

    Fassio, Omar; Rollero, Chiara; De Piccoli, Norma

    2013-01-01

    Quality of life concerns individual (physical and psychological health), interpersonal (social relationships) and contextual (environment) aspects, which are both subjective and objective. In considering contextual characteristics, empirical findings have demonstrated that people's relation to their living environment is a key issue for their…

  9. Health, Quality of Life and Population Density: A Preliminary Study on "Contextualized" Quality of Life

    ERIC Educational Resources Information Center

    Fassio, Omar; Rollero, Chiara; De Piccoli, Norma

    2013-01-01

    Quality of life concerns individual (physical and psychological health), interpersonal (social relationships) and contextual (environment) aspects, which are both subjective and objective. In considering contextual characteristics, empirical findings have demonstrated that people's relation to their living environment is a key issue for their…

  10. Quality of life and oral health in elderly.

    PubMed

    Paredes-Rodríguez, Víctor-Manuel; Torrijos-Gómez, Gema; González-Serrano, José; López-Pintor-Muñoz, Rosa-María; López-Bermejo, Miguel-Ángel; Hernández-Vallejo, Gonzalo

    2016-12-01

    We want to assess quality of life in elderly patients in relation to the number of remaining teeth, the number of ingested drugs and xerostomía and to determine the correlation between an increased intake of drugs and a greater feeling of dry mouth and to know the most commonly used measures to control xerostomia. 30 subjects aged between 65 and 95 years (14 males, 16 females) completed the OHIP questionnaire to determine quality of life. For oral status, the number of remaining teeth according to WHO criteria and xerostomia using the xerostomia index (XI) were studied. In cases of dry mouth sensation, the measures to alleviate it were asked. The average quality of life according to the OHIP rate is 19.23 (Dt = 10.58), being 56 the worst quality of life. The Pearson correlation coefficient indicates that quality of life is not related to the number of remaining teeth (r = -0.046; p = 0.810) nor the number of ingested drugs (r = 0.226; p = 0.23) but a greater sensation of dry mouth is related to a poorer quality of life (r = 0.678; p = 0.230). There is no association between the number of ingested drugs and the xerostomia index (r = 0.144; p = 0.447). The most frequently measures used against dry mouth were drinking water (21 subjects) and sugarless candies (15 subjects). Quality of life is not related to the number of remaining teeth nor the number of ingested drugs. However, a higher level of xerostomia was significantly associated with a poorer quality of life. There is no association between the number of drugs ingested and xerostomia index. Sugarless candies and drinking water are the more frequently used measures to alleviate dry mouth. Key words:Quality of life, oral health, elderly.

  11. Quality of life and oral health in elderly

    PubMed Central

    Torrijos-Gómez, Gema; González-Serrano, José; López-Pintor-Muñoz, Rosa-María; López-Bermejo, Miguel-Ángel; Hernández-Vallejo, Gonzalo

    2016-01-01

    Background We want to assess quality of life in elderly patients in relation to the number of remaining teeth, the number of ingested drugs and xerostomía and to determine the correlation between an increased intake of drugs and a greater feeling of dry mouth and to know the most commonly used measures to control xerostomia. Material and Methods 30 subjects aged between 65 and 95 years (14 males, 16 females) completed the OHIP questionnaire to determine quality of life. For oral status, the number of remaining teeth according to WHO criteria and xerostomia using the xerostomia index (XI) were studied. In cases of dry mouth sensation, the measures to alleviate it were asked. Results The average quality of life according to the OHIP rate is 19.23 (Dt = 10.58), being 56 the worst quality of life. The Pearson correlation coefficient indicates that quality of life is not related to the number of remaining teeth (r = -0.046; p = 0.810) nor the number of ingested drugs (r = 0.226; p = 0.23) but a greater sensation of dry mouth is related to a poorer quality of life (r = 0.678; p = 0.230). There is no association between the number of ingested drugs and the xerostomia index (r = 0.144; p = 0.447). The most frequently measures used against dry mouth were drinking water (21 subjects) and sugarless candies (15 subjects). Conclusions Quality of life is not related to the number of remaining teeth nor the number of ingested drugs. However, a higher level of xerostomia was significantly associated with a poorer quality of life. There is no association between the number of drugs ingested and xerostomia index. Sugarless candies and drinking water are the more frequently used measures to alleviate dry mouth. Key words:Quality of life, oral health, elderly. PMID:27957276

  12. Tools for evaluating oral health and quality of life

    PubMed Central

    Bettie, Nirmal F.; Ramachandiran, Hari; Anand, Vijay; Sathiamurthy, Anusha; Sekaran, Preethi

    2015-01-01

    The seven dimensions of quality of life are required for a healthy living. Any impairment or disability affects any one or more of these dimensions resulting in functional impairment or handicap, which indicates the presence of disease. The success of any oral treatment depends on how far the individual is relieved of his disease process. Relief of symptoms provides patient comfort and enable functional activities. This well-being is considered as a measure of oral health and reflects patient satisfaction. This article presents various instruments or tools available in the form of a questionnaire that estimates patient satisfaction and thereby oral health. PMID:26538889

  13. Health-related quality of life and culture.

    PubMed

    Kagawa-Singer, Marjorie; Padilla, Geraldine V; Ashing-Giwa, Kimlin

    2010-02-01

    To clarify the relationship between quality of life (QOL) and culture. Journal articles, proceedings, and clinical experience. QOL is a subjective, multidimensional experience of well-being that is culturally constructed as individuals seek safety and security, a sense of integrity and meaning in life, and a sense of belonging in one's social network. In a society where health disparities between diverse groups are known to exist, it is incumbent upon nurses to consider the impact of ethnicity/culture on the health care they deliver and on the QOL of their patients. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  14. Health information on internet: quality, importance, and popularity of persian health websites.

    PubMed

    Samadbeik, Mahnaz; Ahmadi, Maryam; Mohammadi, Ali; Mohseni Saravi, Beniamin

    2014-04-01

    The Internet has provided great opportunities for disseminating both accurate and inaccurate health information. Therefore, the quality of information is considered as a widespread concern affecting the human life. Despite the increasingly substantial growth in the number of users, Persian health websites and the proportion of internet-using patients, little is known about the quality of Persian medical and health websites. The current study aimed to first assess the quality, popularity and importance of websites providing Persian health-related information, and second to evaluate the correlation of the popularity and importance ranking with quality score on the Internet. The sample websites were identified by entering the health-related keywords into four most popular search engines of Iranian users based on the Alexa ranking at the time of study. Each selected website was assessed using three qualified tools including the Bomba and Land Index, Google PageRank and the Alexa ranking. The evaluated sites characteristics (ownership structure, database, scope and objective) really did not have an effect on the Alexa traffic global rank, Alexa traffic rank in Iran, Google PageRank and Bomba total score. Most websites (78.9 percent, n = 56) were in the moderate category (8 ≤ x ≤ 11.99) based on their quality levels. There was no statistically significant association between Google PageRank with Bomba index variables and Alexa traffic global rank (P > 0.05). The Persian health websites had better Bomba quality scores in availability and usability guidelines as compared to other guidelines. The Google PageRank did not properly reflect the real quality of evaluated websites and Internet users seeking online health information should not merely rely on it for any kind of prejudgment regarding Persian health websites. However, they can use Iran Alexa rank as a primary filtering tool of these websites. Therefore, designing search engines dedicated to explore accredited

  15. Health Information on Internet: Quality, Importance, and Popularity of Persian Health Websites

    PubMed Central

    Samadbeik, Mahnaz; Ahmadi, Maryam; Mohammadi, Ali; Mohseni Saravi, Beniamin

    2014-01-01

    Background: The Internet has provided great opportunities for disseminating both accurate and inaccurate health information. Therefore, the quality of information is considered as a widespread concern affecting the human life. Despite the increasingly substantial growth in the number of users, Persian health websites and the proportion of internet-using patients, little is known about the quality of Persian medical and health websites. Objectives: The current study aimed to first assess the quality, popularity and importance of websites providing Persian health-related information, and second to evaluate the correlation of the popularity and importance ranking with quality score on the Internet. Materials and Methods: The sample websites were identified by entering the health-related keywords into four most popular search engines of Iranian users based on the Alexa ranking at the time of study. Each selected website was assessed using three qualified tools including the Bomba and Land Index, Google PageRank and the Alexa ranking. Results: The evaluated sites characteristics (ownership structure, database, scope and objective) really did not have an effect on the Alexa traffic global rank, Alexa traffic rank in Iran, Google PageRank and Bomba total score. Most websites (78.9 percent, n = 56) were in the moderate category (8 ≤ x ≤ 11.99) based on their quality levels. There was no statistically significant association between Google PageRank with Bomba index variables and Alexa traffic global rank (P > 0.05). Conclusions: The Persian health websites had better Bomba quality scores in availability and usability guidelines as compared to other guidelines. The Google PageRank did not properly reflect the real quality of evaluated websites and Internet users seeking online health information should not merely rely on it for any kind of prejudgment regarding Persian health websites. However, they can use Iran Alexa rank as a primary filtering tool of these websites

  16. Health Related Quality of Life and Influencing Factors among Welders

    PubMed Central

    Qin, Jingxiang; Liu, Wuzhong; Zhu, Jun; Weng, Wei; Xu, Jiaming; Ai, Zisheng

    2014-01-01

    Background Occupational exposure to welding fumes is a serious occupational health problem all over the world. Welders are exposed to many occupational hazards; these hazards might cause some occupational diseases. The aim of the study was to assess the health related quality of life (HRQL) of electric welders in Shanghai China and explore influencing factors to HRQL of welders. Methods 301 male welders (without pneumoconiosis) and 305 non-dust male workers in Shanghai were enrolled in this study. Short Form-36 (SF-36) health survey questionnaires were applied in this cross-sectional study. Socio-demographic, working and health factors were also collected. Multiple stepwise regress analysis was used to identify significant factors related to the eight dimension scores. Results Six dimensions including role-physical (RP), bodily pain (BP), general health (GH), validity (VT), social function (SF), and mental health (MH) were significantly worse in welders compared to non-dust workers. Multiple stepwise regress analysis results show that native place, monthly income, quantity of children, drinking, sleep time, welding type, use of personal protective equipment (PPE), great events in life, and some symptoms including dizziness, discomfort of cervical vertebra, low back pain, cough and insomnia may be influencing factors for HRQL of welders. Among these factors, only sleep time and the use of PPE were salutary. Conclusions Some dimensions of HRQL of these welders have been affected. Enterprises which employ welders should take measures to protect the health of these people and improve their HRQL. PMID:25048102

  17. Widowhood, Age Heterogamy, and Health: The Role of Selection, Marital Quality, and Health Behaviors

    PubMed Central

    2014-01-01

    Objective. Although the impact of widowhood on the surviving spouse’s health has been widely documented, there is little empirical research examining whether certain spousal choice decisions and marital sorting patterns predispose individuals to be more vulnerable to the adverse consequences of widowhood for health. Design and Method. We use data from the Wisconsin Longitudinal Study and employ ordinary least squares models to (a) document variations in mental and physical health between married and widowed persons, (b) determine whether widowed persons in age heterogamous unions are especially vulnerable to the adverse consequences of widowhood, and (c) investigate to what extent differential selection, marital quality, and health practices account for health disparities by marital status and the spousal age gap. Results. Widowed persons, especially those in age heterogamous unions, have worse mental health than married persons, but they do not seem to be more disadvantaged in terms of physical health. Differential selection, marital quality, and health behaviors partly account for some of the health disparities by marital status and spousal age gap. Discussion. Our findings suggest that marrying a spouse who is very dissimilar in age may enhance one’s vulnerability to the adverse consequences of widowhood for health. PMID:24128991

  18. Widowhood, age heterogamy, and health: the role of selection, marital quality, and health behaviors.

    PubMed

    Choi, Kate H; Vasunilashorn, Sarinnapha

    2014-01-01

    Although the impact of widowhood on the surviving spouse's health has been widely documented, there is little empirical research examining whether certain spousal choice decisions and marital sorting patterns predispose individuals to be more vulnerable to the adverse consequences of widowhood for health. We use data from the Wisconsin Longitudinal Study and employ ordinary least squares models to (a) document variations in mental and physical health between married and widowed persons, (b) determine whether widowed persons in age heterogamous unions are especially vulnerable to the adverse consequences of widowhood, and (c) investigate to what extent differential selection, marital quality, and health practices account for health disparities by marital status and the spousal age gap. Widowed persons, especially those in age heterogamous unions, have worse mental health than married persons, but they do not seem to be more disadvantaged in terms of physical health. Differential selection, marital quality, and health behaviors partly account for some of the health disparities by marital status and spousal age gap. Our findings suggest that marrying a spouse who is very dissimilar in age may enhance one's vulnerability to the adverse consequences of widowhood for health.

  19. Measurement-based management of mental health quality and access in VHA: SAIL mental health domain.

    PubMed

    Lemke, Sonne; Boden, Matthew Tyler; Kearney, Lisa K; Krahn, Dean D; Neuman, Matthew J; Schmidt, Eric M; Trafton, Jodie A

    2017-02-01

    We outline the development of a Mental Health Domain to track accessibility and quality of mental health care in the United States Veterans Health Administration (VHA) as part of a broad-based performance measurement system. This domain adds an important element to national performance improvement efforts by targeting regional and facility leadership and providing them a concise yet comprehensive measure to identify facilities facing challenges in their mental health programs. We present the conceptual framework and rationale behind measure selection and development. The Mental Health Domain covers three important aspects of mental health treatment: Population Coverage, Continuity of Care, and Experience of Care. Each component is a composite of existing and newly adapted measures with moderate to high internal consistency; components are statistically independent or moderately related. Development and dissemination of the Mental Health Domain involved a variety of approaches and benefited from close collaboration between local, regional, and national leadership and from coordination with existing quality-improvement initiatives. During the first year of use, facilities varied in the direction and extent of change. These patterns of change were generally consistent with qualitative information, providing support for the validity of the domain and its component measures. Measure maintenance remains an iterative process as the VHA mental health system and potential data resources continue to evolve. Lessons learned may be helpful to the broader mental health-provider community as mental health care consolidates and becomes increasingly integrated within healthcare systems. (PsycINFO Database Record

  20. QUALITY ASSESSMENT OF ETHICS ANALYSES FOR HEALTH TECHNOLOGY ASSSESSMENT.

    PubMed

    Scott, Anna Mae; Bond, Kenneth; Gutiérrez-Ibarluzea, Iñaki; Hofmann, Björn; Sandman, Lars

    2016-01-01

    Although consideration of ethical issues is recognized as a crucial part of health technology assessment, ethics analysis for HTA is generally perceived as methodologically underdeveloped in comparison to other HTA domains. The aim of our study is (i) to verify existing tools for quality assessment of ethics analyses for HTA, (ii) to consider some arguments for and against the need for quality assessment tools for ethics analyses for HTA, and (iii) to propose a preliminary set of criteria that could be used for assessing the quality of ethics analyses for HTA. We systematically reviewed the literature, reviewed HTA organizations' Web sites, and solicited views from thirty-two experts in the field of ethics for HTA. The database and HTA agency Web site searches yielded 420 references (413 from databases, seven from HTA Web sites). No formal instruments for assessing the quality of ethics analyses for HTA purposes were identified. Thirty-two experts in the field of ethics for HTA from ten countries, who were brought together at two workshops held in Edmonton (Canada) and Cologne (Germany) confirmed the findings from the literature. Generating a quality assessment tool for ethics analyses in HTA would confer considerable benefits, including methodological alignment with other areas of HTA, increase in transparency and transferability of ethics analyses, and provision of common language between the various participants in the HTA process. We propose key characteristics of quality assessment tools for this purpose, which can be applied to ethics analyses for HTA purposes.

  1. Quality of Nursing Documentation: Paper-Based Health Records versus Electronic-Based Health Records.

    PubMed

    Akhu-Zaheya, Laila; Al-Maaitah, Rowaida; Bany Hani, Salam Hasan

    2017-10-05

    To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process, and structure. Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organized within the system known as the Electronic Health Records (EHRs). Nursing documentation must be completed at the highest standards, in order to ensure the safety and quality of health care services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus EHRs) is more qualified. A retrospective, descriptive, comparative design was utilized to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing Audit Instrument. The sample size consisted of 434 records for both paper-based health records and EHRs from medical and surgical wards. EHRs were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than EHRs. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Both forms of documentation revealed drawbacks in terms of content, process, and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nurses practice to improve the quality of nursing care and patients' outcomes. This article is protected by copyright

  2. Assessing willingness to pay for health care quality improvements.

    PubMed

    Pavel, Md Sadik; Chakrabarty, Sayan; Gow, Jeff

    2015-02-01

    Contingent valuation (CV) is used to estimate the willingness to pay (WTP) of consumers for specific attributes to improve the quality of health care they received in three hospitals in Bangladesh. Random sample of 252 patients were interviewed to measure their willingness to pay for seven specified improvements in the quality of delivered medical care. Partial tobit regression and corresponding marginal effects analysis were used to analyze the data and obtain WTP estimates. Patients are willing to pay more if their satisfaction with three attributes of care are increased. These are: a closer doctor-patient relationship, increased drug availability and increased chances of recovery. The doctor patient relationship is considered most important by patients and exhibited the highest willingness to pay. This study provides important information to policy makers about the monetary valuation of patients for improvements in certain attributes of health care in Bangladesh.

  3. [Health indicators associated with poor sleep quality among university students].

    PubMed

    Araújo, Márcio Flávio Moura de; Freitas, Roberto Wagner Júnior Freire de; Lima, Adman Câmara Soares; Pereira, Dayse Christina Rodrigues; Zanetti, Maria Lúcia; Damasceno, Marta Maria Coelho

    2014-12-01

    To associate the sleep quality of Brazilian undergraduate students with health indicators. A cross-sectional study was developed with a random sample of 662 undergraduate students from Fortaleza, Brazil. The demographic data, Pittsburgh Sleep Quality Index and health data indicators (smoking, alcoholism, sedentary lifestyle, nutritional condition and serum cholesterol) were collected through a self-administered questionnaire. Blood was collected at a clinical laboratory. In order to estimate the size of the associations, a Poisson Regression was used. For students who are daily smokers, the occurrence of poor sleep was higher than in non-smokers (p<0.001). Prevalence rate values were nevertheless close to 1. The likelihood of poor sleep is almost the same in smokers and in alcoholics.


  4. State Public Health Laboratory System Quality Improvement Activities

    PubMed Central

    Vagnone, Paula Snippes

    2013-01-01

    The Association of Public Health Laboratories (APHL) and the APHL Laboratory Systems and Standards Committee manage the Laboratory System Improvement Program (L-SIP). One component of L-SIP is an assessment that allows the members and stakeholders of a laboratory system to have an open and honest discussion about the laboratory system's strengths and weaknesses. From these facilitated discussions, gaps and opportunities for improvement are identified. In some cases, ideas for how to best address these gaps emerge, and workgroups are formed. Depending on resources, both monetary and personnel, laboratory staff will then prioritize the next component of L-SIP: which quality improvement activities to undertake. This article describes a sample of quality improvement activities initiated by several public health laboratories after they conducted L-SIP assessments. These projects can result in more robust linkages between system entities, which can translate into improvements in the way the system addresses the needs of stakeholders. PMID:23997301

  5. The Cost Effectiveness of Nalmefene for Reduction of Alcohol Consumption in Alcohol-Dependent Patients with High or Very High Drinking-Risk Levels from a UK Societal Perspective.

    PubMed

    Brodtkorb, Thor-Henrik; Bell, Melissa; Irving, Adam H; Laramée, Philippe

    2016-02-01

    To evaluate costs and health outcomes of nalmefene plus psychosocial support, compared with psychosocial intervention alone, for reducing alcohol consumption in alcohol-dependent patients, specifically focusing on societal costs related to productivity losses and crime. A Markov model was constructed to model costs and health outcomes of the treatments over 5 years. Analyses were conducted for nalmefene's licensed population: adults with both alcohol dependence and high or very high drinking-risk levels (DRLs) who do not require immediate detoxification and who have high or very high DRLs after initial assessment. The main outcome measure was cost per quality-adjusted life-year (QALY) gained as assessed from a UK societal perspective. Alcohol-attributable productivity loss, crime and health events occurring at different levels of alcohol consumption were taken from published risk-relation studies. Health-related and societal costs were drawn from public data and the literature. Data on the treatment effect, as well as baseline characteristics of the modelled population and utilities, came from three pivotal phase 3 trials of nalmefene. Nalmefene plus psychosocial support was dominant compared with psychosocial intervention alone, resulting in QALYs gained and reduced societal costs. Sensitivity analyses showed that this conclusion was robust. Nalmefene plus psychosocial support led to per-patient reduced costs of £3324 and £2483, due to reduced productivity losses and crime events, respectively. Nalmefene is cost effective from a UK societal perspective, resulting in greater QALY gains and lower costs compared with psychosocial support alone. Nalmefene demonstrates considerable public benefits by reducing alcohol-attributable productivity losses and crime events in adults with both alcohol dependence and high or very high DRLs who do not require immediate detoxification and who have high or very high DRLs after initial assessment.

  6. Air quality monitoring in NIS (SERBIA) and health impact assessment.

    PubMed

    Nikic, Dragana; Bogdanovic, Dragan; Nikolic, Maja; Stankovic, Aleksandra; Zivkovic, Nenad; Djordjevic, Amelija

    2009-11-01

    The aim of this study is to indicate the significance of air quality monitoring and to determine the air quality fields for the assessment of air pollution health effects, with special attention to risk population. Radial basis function network was used for air quality index mapping. Between 1991 and 2005, on the territory of Nis, several epidemiological studies were performed on risk groups (pre-school children, school children, pregnant women and persons older than 65). The total number of subjects was 5837. The exposed group comprised individuals living in the areas with unhealthy AQI, while the control group comprised individuals living in city areas with good or moderate AQI. It was determined that even relatively low levels of air pollution had impact on respiratory system and the occurrence of anaemia, allergy and skin symptoms.

  7. Improving Quality of Emergency Care Through Integration of Mental Health.

    PubMed

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

  8. Musicians, postural quality and musculoskeletal health: A literature's review.

    PubMed

    Blanco-Piñeiro, Patricia; Díaz-Pereira, M Pino; Martínez, Aurora

    2017-01-01

    An analysis of the salient characteristics of research papers published between 1989 and 2015 that evaluate the relationship between postural quality during musical performance and various performance quality and health factors, with emphasis on musculoskeletal health variables. Searches of Medline, Scopus and Google Scholar for papers that analysed the subject of the study objective. The following MeSH descriptors were used: posture; postural balance; muscle, skeletal; task performance and analysis; back; and spine and music. A descriptive statistical analysis of their methodology (sample types, temporal design, and postural, health and other variables analysed) and findings has been made. The inclusion criterion was that the body postural quality of the musicians during performance was included among the target study variables. Forty-one relevant empirical studies were found, written in English. Comparison and analysis of their results was hampered by great disparities in measuring instruments and operationalization of variables. Despite the growing interest in the relationships among these variables, the empirical knowledge base still has many limitations, making rigorous comparative analysis difficult. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. [Patient satisfaction as a quality indicator in mental health].

    PubMed

    Fernández-Martín, L C; Iglesias-de-Sena, H; Fombellida-Velasco, C; Vicente-Torres, I; Alonso-Sardón, M; Mirón Canelo, J A

    2016-01-01

    To improve the quality of care in a Mental Health Hospital and identify the level of patient satisfaction. A descriptive, longitudinal, and retrospective study was conducted on 666 patients who completed treatment in the Mental Health Day Hospital of Salamanca, during the period 1994-2012, using the Hospital Management Annual Reports. A questionnaire designed for this purpose was used as the measurement tool. Most of the patients satisfactorily valued aspects, such as the general impression of the treatment (90% said «good/fairly good») and perception of being helped (94% perceived «very/fairly helped»); with 83% believing that the hospital is accessible. As regards empathy-understanding, it was noted that 14% feel discontent. While 18% of patients expected to be completely cured, the 83% of patients that finished their treatment have said that, in their opinion, the symptoms have subsided «very or somewhat». As regards the knowledge that they have about their disease, 30% believe it has advanced «a lot.» Based on the perceptions reported by patients, it may be said that in general, the level of user satisfaction in the Mental Health Day Hospital is high. Assessing quality through the user opinions helps control the quality, considering that patient satisfaction is a good indicator of result of the care received during their hospitalisation. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Air Quality Strategies on Public Health and Health Equity in Europe-A Systematic Review.

    PubMed

    Wang, Li; Zhong, Buqing; Vardoulakis, Sotiris; Zhang, Fengying; Pilot, Eva; Li, Yonghua; Yang, Linsheng; Wang, Wuyi; Krafft, Thomas

    2016-12-02

    Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO₂) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO₂ were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no

  11. Air Quality Strategies on Public Health and Health Equity in Europe—A Systematic Review

    PubMed Central

    Wang, Li; Zhong, Buqing; Vardoulakis, Sotiris; Zhang, Fengying; Pilot, Eva; Li, Yonghua; Yang, Linsheng; Wang, Wuyi; Krafft, Thomas

    2016-01-01

    Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent

  12. The societal cost of Taenia solium cysticercosis in Tanzania.

    PubMed

    Trevisan, Chiara; Devleesschauwer, Brecht; Schmidt, Veronika; Winkler, Andrea Sylvia; Harrison, Wendy; Johansen, Maria Vang

    2017-01-01

    Taenia solium is a zoonotic parasite prevalent in many low income countries throughout Latin America, Asia and sub-Saharan Africa, including Tanzania. The parasite is recognized as a public health threat; however the burden it poses on populations of Tanzania is unknown. The aim of this study was to estimate the societal cost of T. solium cysticercosis in Tanzania, by assessing both the health and economic burden. The societal cost of T. solium cysticercosis was assessed in humans and pigs based on data obtained by a systematic review. Experts' opinion was sought in cases where data were not retrievable. The health burden was assessed in terms of annual number of neurocysticercosis (NCC) associated epilepsy incident cases, deaths and disability-adjusted life years (DALYs), while the economic burden was assessed in terms of direct and indirect costs imposed by NCC-associated epilepsy and potential losses due to porcine cysticercosis. Based on data retrieved from the systematic review and burden assessments, T. solium cysticercosis contributed to a significant societal cost for the population. The annual number of NCC-associated epilepsy incident cases and deaths were 17,853 (95% Uncertainty Interval (UI), 5666-36,227) and 212 (95% UI, 37-612), respectively. More than 11% (95% UI, 6.3-17) of the pig population was infected with the parasite when using tongue examination as diagnostic method. For the year 2012 the number of DALYs per thousand person-years for NCC-associated epilepsy was 0.7 (95% UI, 0.2-1.6). Around 5 million USD (95% UI, 797,535-16,933,477) were spent due to NCC-associated epilepsy and nearly 3 million USD (95% UI, 1,095,960-5,366,038) were potentially lost due to porcine cysticercosis. Our results show that T. solium imposes a serious public health, agricultural and economic threat for Tanzania. We urge that a One Health approach, which involves the joint collaboration and effort of veterinarians, medical doctors, agricultural extension officers

  13. Mental health and quality of life in deaf pupils.

    PubMed

    Fellinger, Johannes; Holzinger, Daniel; Sattel, Heribert; Laucht, Manfred

    2008-10-01

    In the past decade, the living conditions of hearing impaired children have been changing due to new technologies and mainstreaming in schools. The majority of population-based studies in deaf pupils were conducted before these changes started to take place. The present study aimed to evaluate the current situation regarding aspects of mental health and, for the first time, quality of life in a representative sample of deaf pupils. The sample stems from a population of 145,000 pupils attending the first to ninth grades during the school years 2003-2005 in Upper Austria. From 186 children with bilateral hearing impairment of at least 40 dB registered at the centre for special education for children with sensory impairments, 99 with a performance IQ above 70 were included in the present study. Parents and teachers completed the strengths and difficulties questionnaire (SDQ), while parents and children were administered the inventory for the assessment of the quality of life in children and adolescents (ILC). Results indicated that deaf children scored significantly higher on the SDQ than their counterparts from normative samples according to both parent and teacher ratings. Differences were most marked with regard to conduct problems, emotional problems, and peer problems, and less marked for hyperactivity/inattention. While parents of deaf children had a generally positive view of their children's quality of life, deaf children provided a more complex picture, stressing areas of dissatisfaction. Mental health and quality of life were found to be unrelated to the child's degree of deafness.

  14. Societal Literacy and the Status of the Aged.

    ERIC Educational Resources Information Center

    Lee, Gary R.; Kezis, Mindy

    1980-01-01

    The relationship of status of the aged to societal literacy in a sample of 122 cultures appears spurious because of effects of variables indexing societal complexity. Conclusions are: societal literacy has no independent effect on status of the aged; and the overall relationship between the two appears curvilinear. (Author)

  15. Assessing the Quality and Value of Psychological Health Care in Civilian Health Plans

    PubMed Central

    Martsolf, Grant R.; Osilla, Karen Chan; Mandel, Daniel; Hepner, Kimberly A.; Farmer, Carrie M.

    2016-01-01

    Abstract The Military Health System (MHS) strives to provide high-quality care and improve outcomes for individuals with psychological health conditions. Over the last decade, the MHS has provided care to a growing number of individuals with psychological health conditions, such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). However, little is known about the extent to which the MHS delivers care that is consistent with evidence-based clinical practice guidelines or if it is achieving positive outcomes for its service members. To better understand these issues, the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) asked the RAND Corporation to describe civilian health plansâ; approaches to systematically measuring the quality of psychological health care delivered by providers in their networks. This work was part of a larger effort by RAND to develop a framework and identify a set of measures for monitoring the quality of care provided by the MHS for psychological health conditions. PMID:28083426

  16. Universal health insurance in India: ensuring equity, efficiency, and quality.

    PubMed

    Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

    2012-07-01

    Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete.

  17. Universal Health Insurance in India: Ensuring Equity, Efficiency, and Quality

    PubMed Central

    Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

    2012-01-01

    Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete. PMID:23112438

  18. Forensic mental health assessment in France: recommendations for quality improvement.

    PubMed

    Combalbert, Nicolas; Andronikof, Anne; Armand, Marine; Robin, Cécile; Bazex, Hélène

    2014-01-01

    The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

  19. [Professional communication in long term health care quality].

    PubMed

    Martín Padilla, E; Sarmiento Medina, P; Ramírez Jaramillo, A

    2014-01-01

    To Identify aspects of professional communication that affect the quality of long-term care for patients with chronic illness or disabilities and their families, in the experience of health professionals, as input for the development of an assessment tool. Descriptive qualitative.The data was processed by performing an interpretative analysis from grounded theory. The participants included 12 health professionals (three doctors, three nurses, three therapists and three psychologists), who work at the Hospital of the Universidad de La Sabana, Chia, and other institutions in Bogota, Colombia,with more than five years experience in programs treating chronic disease or disability in hospital therapeutic contexts. Semi-structured interviews and a Delphi survey were used. Validation strategies included, theoretical sampling, script evaluation by judges, triangulation of data collection techniques, and interviewers. We defined specific aspects of professional communication that could optimize the quality of health care, in information management as well as in the relationships with patients and families. From these aspects, an explanatory matrix was designed with axes, categories, and codes as a support for the construction of tools. Health communication, in order to become a therapeutic support element, requires professional training in communication skills to give information in an understandable way, with emotional support and coping possibilities. It should include and involve the family in decision making. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  20. Health-Related Quality of Life Among Jordanian Adolescents.

    PubMed

    Hourani, Eman Mohammad; Hammad, Sawsan Mohammad; Shaheen, Abeer; Amre, Huda Musa

    2017-06-01

    Adolescence is an unpredictable stage of life with varied and rapid changes. In Jordan, health-related quality of life (HRQoL) has been examined among diabetic and obese children and adolescents. The purpose of this study was to assess the HRQoL of Jordanian healthy adolescents. Three hundred fifty-four male and female adolescents whose ages ranged from 12 to 19 participated in the study. A descriptive comparative design was employed to investigate adolescents' HRQoL. The results revealed statistically significant differences in physical well-being, psychosocial well-being, and autonomy in favor of male adolescents. In addition, statistically significant differences were observed in favor of nonsmoker adolescents in psychosocial well-being, self-perception, parent relations and home life, financial resources, social relations and peers and school environment. In conclusion, the creation of a school health nurse role in Jordanian schools is crucial for helping adolescents improve their health.

  1. Improving the quality of care for children in health systems.

    PubMed Central

    Homer, C J; Kleinman, L C; Goldman, D A

    1998-01-01

    OBJECTIVE: To summarize the state of the art in quality improvement, review its application to care for children, and define the information that will be needed so that care for children can be further improved. PRINCIPAL FINDINGS: Health services for children exhibit numerous deficiencies in quality of care. The deficiencies cross all major domains of pediatric care--preventive services, acute care, and chronic care--and provide the opportunity for creative application of improvement strategies with a potential to benefit the health and well-being of children. Approaches to quality improvement have changed over the past two decades from those emphasizing the inspection of structural aspects of care and the imposition of sanctions to more dynamic strategies that emphasize measurement and comparison to motivate change; the use of evidence to specify aims for improvement; and the adoption of a variety of management strategies adapted from business and the social sciences to achieve these aims. These modern approaches to quality improvement have rarely been subjected to rigorous testing of their effectiveness. Moreover, their application in pediatrics has been less widespread than in adult healthcare. For children, several aspects about health services, such as the relative rarity of chronic illness, the important effects of social factors on health, and the limited cost, make some of these approaches even more challenging and may require new approaches or meaningful modifications. RECOMMENDATIONS: Research to understand better the general process of improvement will benefit improvement efforts for children. Research that builds the base of knowledge about best practices for children--effectiveness research--will also result in an enhanced capacity for improvement of those systems that care for children's health. Quality of care for children would be enhanced by targeted research examining ways both to foster improvement across segments of society, and to make

  2. Health-Related Quality of Life and Quality of Sexual Life in Obese Subjects

    PubMed Central

    Di Lazzaro, Luca; Pinto, Alessandro; Migliaccio, Silvia; Lenzi, Andrea; Donini, Lorenzo M.

    2014-01-01

    The increased prevalence of obesity represents, currently, one of the major public health issues, due to its consequences on physical and psychological health status as well as on the psychosocial functioning. As defined by the World Health Organization, sexual health is “a state of physical, emotional, mental, and social well-being in relation to sexuality.” The aim of the present study was to explore the relationship between sexual life in obese subjects and quality of life, psychological status, and disability. Methods. 95 obese subjects were recruited from June 2012 to February 2013 and underwent physical examination and measures for the assessment of quality of life, sexual life, psychological status, and disability. Results. In obese subjects sexual life was related to gender, age, psychological status, disability, and quality of life. Conclusion. As obesity is a multifactorial disease, and is accompanied by multiple comorbidities, it is difficult to identify a single causative factor responsible for the impairment of sexual life in obese subjects; thus, a thorough, multidimensional evaluation including sexual function assessment should be performed in obese people. PMID:24707290

  3. Cost-Effectiveness of Treatments for Relapsing Remitting Multiple Sclerosis: A French Societal Perspective

    PubMed Central

    Chevalier, Julie; Chamoux, Catherine; Hammès, Florence; Chicoye, Annie

    2016-01-01

    Objectives The paper aimed to estimate the incremental cost-effectiveness ratio (ICER) at the public published price for delayed-release dimethyl fumarate versus relevant Multiple Sclerosis disease-modifying therapies available in France in June 2015. Methods The economic model was adapted to the French setting in accordance with the Haute Autorité de Santé guidelines using a model previously developed for NICE. A cohort of Relapsing Remitting Multiple Sclerosis patients was simulated over a 30-year time horizon. Twenty one health states were taken into account: Kurtzke Expanded Disability Status Scale (EDSS) 0–9 for Relapsing Remitting Multiple Sclerosis patients, EDSS 0–9 for Secondary Progressive Multiple Sclerosis patients, and death. Estimates of relative treatment efficacy were determined using a mixed-treatment comparison. Probabilities of events were derived from the dimethyl fumarate pivotal clinical trials and the London Ontario Dataset. Costs and utilities were extracted from the published literature from both the payer and societal perspectives. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the model results. Results From both perspectives, dimethyl fumarate and interferon beta-1a (IFN beta-1a) 44mcg were the two optimal treatments, as the other treatments (IFN beta-1a 30mcg, IFN beta-1b 250mcg, teriflunomide, glatiramer acetate, fingolimod) were dominated on the efficiency frontier. From the societal perspective, dimethyl fumarate versus IFN beta-1a 44mcg incurred an incremental cost of €3,684 and an incremental quality-adjusted life year (QALY) of 0.281, corresponding to an ICER of €13,110/QALY. Conclusions Despite no reference threshold for France, dimethyl fumarate can be considered as a cost-effective option as it is on the efficiency frontier. PMID:26987055

  4. The societal burden of blindness secondary to retinopathy of prematurity in Lima, Peru.

    PubMed

    Dave, Hreem B; Gordillo, Luz; Yang, Zhou; Zhang, Monica S; Hubbard, G Baker; Olsen, Timothy W

    2012-10-01

    To determine the cost-effectiveness of laser treatment for retinopathy of prematurity (ROP) in Lima, Peru. A cost-of-illness study (in US dollars) to determine the direct cost of treatment, the indirect lifetime cost of blindness, and the quality-adjusted life years. The direct cost of ROP-related treatment was determined by reviewing data retrospectively from a social security sector hospital. The indirect cost was determined using national economic data of Peru published by the Central Information Agency (CIA), including the per capita gross domestic product, the sex-adjusted income distribution, and years spent in the work force. Indirect costs per child that were avoided by treatment were calculated using the known natural history of ROP vs evidence-based treatment. For ROP-related neonatal blindness in Peru, we estimate the total indirect cost saving at $197,753 per child and the direct cost of laser treatment at $2496 per child. The societal lifetime cost saving per child is estimated at $195,257. The mean annual income per educated adult in Peru is $8000 and treating 1 child is equivalent to employing 24 educated Peruvians per year. The generational cost savings for society is approximately $516 million, or the equivalent of 64,500 educated Peruvian work years. The societal burden of blindness far exceeds the costs of treatment per child. Proper screening and treatment of ROP prevents blindness and leads to substantial cost savings for society. Public health policy in Peru and other middle-income countries should consider financial impact when allocating healthcare resources. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Partnering health disparities research with quality improvement science in pediatrics.

    PubMed

    Lion, K Casey; Raphael, Jean L

    2015-02-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. Copyright © 2015 by the American Academy of Pediatrics.

  6. The economics of health care quality and medical errors.

    PubMed

    Andel, Charles; Davidow, Stephen L; Hollander, Mark; Moreno, David A

    2012-01-01

    Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine's (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths--conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct-preventable death being ten times the IOM estimate-the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout U.S. hospitals. Whatever the measure, poor quality is costing payers and

  7. The effects of marital dissolution and marital quality on health and health service use among women.

    PubMed

    Prigerson, H G; Maciejewski, P K; Rosenheck, R A

    1999-09-01

    Little is known about the impact of marital dissolution and/or marital harmony on health service use. To examine the ways in which marital dissolution and/or marital quality influence health and health service use. The Americans' Changing Lives (ACL) survey was designed to provide a longitudinal study of successful aging. The ACL contains a nationally representative sample of people over age 24, with an oversampling of individuals age 60 and above. Nine hundred and twenty seven female subjects who were married at baseline (1986); 101 (10.9%) of those were no longer married at follow up (1989). Health status and health service use at follow up. Marital dissolution, alone and together with marital quality, was associated with worsened mental and physical health and increased mental health service use. Marital harmony was associated with better sleep and fewer depressive symptoms and physician visits. Widowhood was associated with worsened health, but not with greater health service use. Separated women and women divorced from a discordant marriage were not more depressed but used more mental health services. Women separated from a marriage they had rated as harmonious increased their alcohol consumption. Marital dissolution increases the risk for mental and physical health problems, some of which emerge only among women who had harmonious marriages. Marital harmony appears protective against physician visits. Widows should be encouraged to seek help for their health difficulties. Separated women should be counseled that they are at heightened risk for increased alcohol consumption. Divorced and separated women appear to seek help for emotional problems, over and above depressive symptoms.

  8. Health workers, quality of care, and child health: Simulating the relationships between increases in health staffing and child length

    PubMed Central

    Barber, Sarah L.; Gertler, Paul J.

    2010-01-01

    Objective One in three children globally is stunted in growth. Many of the conditions that promote child stunting are amenable to quality care provided by skilled health workers. Methods The study uses household and facility data from the Indonesian Family Life Surveys in 1993 and 1997. The first set of multivariate regression models evaluate whether the number of medical doctors (MDs), nurses, and midwives predict quality of care as measured by adherence to clinical guidelines. The second set explains the relationships between quality and length among children less than 36 months. Using the information generated from these two sets of regressions, we simulate the effect of increasing the number of MDs, nurses, and midwives on child length and stunting. Results Increases in the number of MDs and nurses predict increases in the quality of care. Higher quality care is associated with child length in centimeters and stunting. Simulations suggest that large health gains among children under 24 months of age result by placing MDs where none are available. Conclusions Improvements in child health could be made by increasing the number of qualified health staff. The returns to investing in improvements in human resources for health are high. PMID:19147250

  9. National Quality Measures for Child Mental Health Care: Background, Progress, and Next Steps

    PubMed Central

    Murphy, J. Michael; Scholle, Sarah Hudson; Hoagwood, Kimberly Eaton; Sachdeva, Ramesh C.; Mangione-Smith, Rita; Woods, Donna; Kamin, Hayley S.; Jellinek, Michael

    2013-01-01

    OBJECTIVE: To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. METHODS: Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. RESULTS: Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. CONCLUSIONS: The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace. PMID:23457148

  10. Societal Impacts of Solar Electromagnetic Radiation

    NASA Astrophysics Data System (ADS)

    Lean, J. L.

    2000-05-01

    Changes in solar electromagnetic radiation, which occur continuously and at all wavelengths of the spectrum, can have significant societal impacts on a wide range of time scales. Detection of climate change and ozone depletion requires reliable specification of solar-induced processes that mask or exacerbate anthropogenic effects. Living with, and mitigating, climate change and ozone depletion has significant economic, habitat and political impacts of international extent. As an example, taxes to restrict carbon emission may cause undue economic stress if the role of greenhouse gases in global warming is incorrectly diagnosed. Ignoring solar-induced ozone changes in the next century may lead to incorrect assessment of the success of the Montreal Protocol in protecting the ozone layer by limiting the use of ozone-destroying chlorofluorocarbons. Societal infrastructure depends in many ways on space-based technological assets. Communications and navigation for commerce, industry, science and defense rely on satellite signals transmitted through, and reflected by, electrons in the ionosphere. Electron densities change in response to solar flares, and by orders of magnitude in response to EUV and X-ray flux variations during the Sun's 11-year activity cycle. Spacecraft and space debris experience enhanced drag on their orbits when changing EUV radiation causes upper atmosphere densities to increase. Especially affected are spacecraft and debris in lower altitude orbits, such as Iridium-type communication satellites, and the International Space Station (ISS). Proper specification of solar-induced fluctuations in the neutral upper atmosphere can, for example, aid in tracking the ISS and surrounding space debris, reducing the chance of ISS damage from collisions, and maximizing its operations. Aspects of solar electromagnetic radiation variability will be briefly illustrated on a range of time scales, with specific identification of the societal impacts of different

  11. The Water Quality in Rio Highlights the Global Public Health ...

    EPA Pesticide Factsheets

    Water quality issues in Rio have been widely publicized because of the 2016 Olympics. Recent concerns about polluted waters that athletes may be exposed to highlights the conditions that more than a billion people globally are exposed to daily. Despite these unhealthy conditions, much is unknown about the risks and exposure pathways associated with bathing in or drinking untreated or partially treated sewage. Beyond acute illness, we are learning more about the chronic sequelae that arise from repeated exposure to pathogens found in sewage. Additionally, we do not know enough about how to measure water quality, especially in developing countries. A consequence of these knowledge gaps is that data from developed countries are used to guide public health approaches in low· and middle-income settings. More data that are locally specific are needed to inform guidelines for improving sanitation and water quality in Rio and other cities in developing countries. Recent media reports of high levels of sewage contamination have caused wide-ranging concerns about the safety of sailing, rowing, and other open water events at the upcoming Olympics. This commentary discusses the global public health problem of exposures to untreated sewage and describes the need for context specific solutions to monitoring and communication and risk assessment.

  12. Adolescent development in interpersonal and societal contexts.

    PubMed

    Smetana, Judith G; Campione-Barr, Nicole; Metzger, Aaron

    2006-01-01

    In this chapter we review theoretical and empirical advances in research on adolescent development in interpersonal and societal contexts. First, we identify several trends in current research, including the current emphasis on ecological models and the focus on diversity in and relational models of adolescent development. Next, we discuss recent research on interpersonal relationships, with an eye toward identifying major research themes and findings. Research on adolescents' relationships with parents, siblings, other relatives, peers, and romantic partners, and adolescents' involvement in community and society is reviewed. Future directions in research on adolescent development are discussed.

  13. Western Mineral and Environmental Resources Science Center--providing comprehensive earth science for complex societal issues

    USGS Publications Warehouse

    Frank, David G.; Wallace, Alan R.; Schneider, Jill L.

    2010-01-01

    Minerals in the environment and products manufactured from mineral materials are all around us and we use and come into contact with them every day. They impact our way of life and the health of all that lives. Minerals are critical to the Nation's economy and knowing where future mineral resources will come from is important for sustaining the Nation's economy and national security. The U.S. Geological Survey (USGS) Mineral Resources Program (MRP) provides scientific information for objective resource assessments and unbiased research results on mineral resource potential, production and consumption statistics, as well as environmental consequences of mining. The MRP conducts this research to provide information needed for land planners and decisionmakers about where mineral commodities are known and suspected in the earth's crust and about the environmental consequences of extracting those commodities. As part of the MRP scientists of the Western Mineral and Environmental Resources Science Center (WMERSC or 'Center' herein) coordinate the development of national, geologic, geochemical, geophysical, and mineral-resource databases and the migration of existing databases to standard models and formats that are available to both internal and external users. The unique expertise developed by Center scientists over many decades in response to mineral-resource-related issues is now in great demand to support applications such as public health research and remediation of environmental hazards that result from mining and mining-related activities. Western Mineral and Environmental Resources Science Center Results of WMERSC research provide timely and unbiased analyses of minerals and inorganic materials to (1) improve stewardship of public lands and resources; (2) support national and international economic and security policies; (3) sustain prosperity and improve our quality of life; and (4) protect and improve public health, safety, and environmental quality. The MRP

  14. China's human resources for health: quantity, quality, and distribution.

    PubMed

    Anand, Sudhir; Fan, Victoria Y; Zhang, Junhua; Zhang, Lingling; Ke, Yang; Dong, Zhe; Chen, Lincoln C

    2008-11-15

    In this paper, we analyse China's current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses-in 2005, there were 1.9 million licensed doctors and 1.4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold difference. Most of China's doctors (67.2%) and nurses (97.5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban-rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly significant in explaining infant mortality.

  15. Mitochondrial Protein Quality Control: The Mechanisms Guarding Mitochondrial Health

    PubMed Central

    Bohovych, Iryna; Chan, Sherine S.L.

    2015-01-01

    Abstract Significance: Mitochondria are complex dynamic organelles pivotal for cellular physiology and human health. Failure to maintain mitochondrial health leads to numerous maladies that include late-onset neurodegenerative diseases and cardiovascular disorders. Furthermore, a decline in mitochondrial health is prevalent with aging. A set of evolutionary conserved mechanisms known as mitochondrial quality control (MQC) is involved in recognition and correction of the mitochondrial proteome. Recent Advances: Here, we review current knowledge and latest developments in MQC. We particularly focus on the proteolytic aspect of MQC and its impact on health and aging. Critical Issues: While our knowledge about MQC is steadily growing, critical gaps remain in the mechanistic understanding of how MQC modules sense damage and preserve mitochondrial welfare, particularly in higher organisms. Future Directions: Delineating how coordinated action of the MQC modules orchestrates physiological responses on both organellar and cellular levels will further elucidate the current picture of MQC's role and function in health, cellular stress, and degenerative diseases. Antioxid. Redox Signal. 22, 977–994. PMID:25546710

  16. Health-Related Quality of Life Following Blind Rehabilitation

    PubMed Central

    Kuyk, Thomas; Liu, Lei; Elliott, Jeffry L.; Grubbs, Hartley E.; Owsley, Cynthia; McGwin, Gerald; Griffin, Russell L.; Fuhr, Patti S.

    2009-01-01

    Purpose The purpose of this study was to investigate the effect of residential blind rehabilitation on patients’ vision targeted health-related quality of life (HRQOL) and general physical and mental function. Methods The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ) plus appendix questions, the 12 item Short-Form Health Survey (SF-12), Hope Scale and Coopersmith self-esteem inventory were administered to 206 legally blind veterans prior to their entering a residential (in-patient) blind rehabilitation program and again to 185 and 176 of the original cohort at two and six months after completion of the rehabilitation program, respectively. Data on visual acuity, visual field extent, contrast sensitivity and scanning ability were also collected. The duration of the in-patient rehabilitation programs ranged from 11–109 days. Questionnaire scores were compared pre-rehabilitation and post-rehabilitation. Results Following rehabilitation there was a significant improvement in nine of eleven NEI VFQ subscales and in a composite score at both 2- and 6-month post-rehab intervals. Mental health (SF-12) and self esteem also improved significantly although physical health ratings declined over the course of the study (approximately 10 months). Conclusions Residential blind rehabilitation appears to improve patients’ self-reported vision-targeted HRQOL, self-esteem, and mental health aspects of generic HRQOL. PMID:18392688

  17. Applying total quality management concepts to public health organizations.

    PubMed

    Kaluzny, A D; McLaughlin, C P; Simpson, K

    1992-01-01

    Total quality management (TQM) is a participative, systematic approach to planning and implementing a continuous organizational improvement process. Its approach is focused on satisfying customers' expectations, identifying problems, building commitment, and promoting open decision-making among workers. TQM applies analytical tools, such as flow and statistical charts and check sheets, to gather data about activities within an organization. TQM uses process techniques, such as nominal groups, brainstorming, and consensus forming to facilitate communication and decision making. TQM applications in the public sector and particularly in public health agencies have been limited. The process of integrating TQM into public health agencies complements and enhances the Model Standards Program and assessment methodologies, such as the Assessment Protocol for Excellence in Public Health (APEX-PH), which are mechanisms for establishing strategic directions for public health. The authors examine the potential for using TQM as a method to achieve and exceed standards quickly and efficiently. They discuss the relationship of performance standards and assessment methodologies with TQM and provide guidelines for achieving the full potential of TQM in public health organizations. The guidelines include redefining the role of management, defining a common corporate culture, refining the role of citizen oversight functions, and setting realistic estimates of the time needed to complete a task or project.

  18. Applying total quality management concepts to public health organizations.

    PubMed Central

    Kaluzny, A D; McLaughlin, C P; Simpson, K

    1992-01-01

    Total quality management (TQM) is a participative, systematic approach to planning and implementing a continuous organizational improvement process. Its approach is focused on satisfying customers' expectations, identifying problems, building commitment, and promoting open decision-making among workers. TQM applies analytical tools, such as flow and statistical charts and check sheets, to gather data about activities within an organization. TQM uses process techniques, such as nominal groups, brainstorming, and consensus forming to facilitate communication and decision making. TQM applications in the public sector and particularly in public health agencies have been limited. The process of integrating TQM into public health agencies complements and enhances the Model Standards Program and assessment methodologies, such as the Assessment Protocol for Excellence in Public Health (APEX-PH), which are mechanisms for establishing strategic directions for public health. The authors examine the potential for using TQM as a method to achieve and exceed standards quickly and efficiently. They discuss the relationship of performance standards and assessment methodologies with TQM and provide guidelines for achieving the full potential of TQM in public health organizations. The guidelines include redefining the role of management, defining a common corporate culture, refining the role of citizen oversight functions, and setting realistic estimates of the time needed to complete a task or project. PMID:1594734

  19. Sleep quality, daytime sleepiness and health-related quality-of-life in maintenance haemodialysis patients.

    PubMed

    Shen, Quanquan; Huang, Xiaohong; Luo, Zhaofen; Xu, Xiujun; Zhao, Xiang; He, Qiang

    2016-06-01

    To assess the relationship between sleep quality, daytime sleepiness and health-related quality-of-life (HRQoL) in Chinese patients undergoing maintenance haemodialysis (MHD). This cross-sectional study enrolled patients undergoing MHD. Self-reported sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]) and HRQoL (36-item Short Form [SF-36]) were recorded for all patients. Sixty eight patients (mean ± SD age = 61.75 ± 16.56 years; 43 male/25 female) who regularly received MHD were included. The prevalence of poor sleepers was 69.1% (47/68) and daytime sleepiness was 11.8% (eight of 68). Poor sleepers had a significantly lower Physical Component Scale (PCS) score, Mental Component Scale (MCS) score and total SF-36 score than good sleepers. The PSQI score correlated inversely with both the PCS and MCS scores and correlated positively with age. Independent variables associated with total SF-36 score were duration of MHD, ESS score and PSQI score. Poor sleep quality is a common and severe issue for MHD patients in east China. Both sleep quality and daytime sleepiness were associated with lower HRQoL scores. © The Author(s) 2016.

  20. Quality and Safety in Health Care, Part I: Five Pioneers in Quality.

    PubMed

    Harolds, Jay

    2015-08-01

    Five pioneers had a huge impact on the quality movement in health care in the United States. Ernest Codman contributed in many ways, including his focus on outcome analysis. Avidis Donabedian is known for his focus on the 3 domains of structure, process, and outcome in health care. Walter Shewhart is known especially for the control chart and early work on what W. Edwards Deming made into the PDSA cycle. Deming is also known for other contributions, including his 14 points of management, correcting system problems rather than blaming the workers, and his System of Profound Knowledge. Juran is known for the Pareto principle and his emphasis on customer satisfaction and addressing the human, not just statistical side, of quality improvement.

  1. Breast Cancer Survivors’ Health-related Quality of Life

    PubMed Central

    Paskett, Electra D.; Alfano, Catherine M.; Davidson, Mario A.; Andersen, Barbara L.; Naughton, Michelle J.; Sherman, Aurora; McDonald, Paige; Hays, Jennifer

    2008-01-01

    Background Small samples with few minority women and/or the absence of comparisons to peers without cancer histories have limited previous research suggesting racial differences in breast cancer survivors’ health-related quality of life (HRQoL). The present study not only compares HRQoL of African American and white breast cancer survivors, but also compares the HRQoL of these women to that of same race women with no cancer history. Methods Data from the Women’s Health Initiative-Observational Study were used including 5,021 cancer survivors and 88,532 women without a history of cancer. Multivariable regression analyses estimated differences in breast cancer survivors’ baseline HRQoL (RAND36), depressive symptoms (CES-D short-form), and sleep quality (WHIIRS). Results African American breast cancer survivors reported worse physical functioning and general health compared to white survivors. Among African Americans, survivors reported worse role limitations due to physical health, pain, general health, and vitality than women without a history of cancer. This was most evident in those with more recent diagnoses. Most significant differences between groups were small in magnitude (Cohen’s d=.21-.36). Conclusions These results add to the increasing knowledge of cancer disparities by showing that African American women have small but clinically meaningful decrements in physical HRQoL compared to white survivors and to African American women without cancer. Since African American women also face diagnosis with higher grade tumors and higher breast cancer mortality, more research is needed to examine the physical and psychosocial experiences of African American breast cancer survivors to elucidate the mechanisms leading to poorer outcomes. PMID:18973178

  2. Integrating health promotion with quality improvement in a Swedish hospital.

    PubMed

    Astnell, Sandra; von Thiele Schwarz, Ulrica; Hasson, Henna; Augustsson, Hanna; Stenfors-Hayes, Terese

    2016-09-01

    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.

  3. [Dentistry and supplementary health: regulatory framework, health promotion policies and quality of care].

    PubMed

    Garbin, Daniela; Mattevi, Gianina Salton; Carcereri, Daniela Lemos; Caetano, João Carlos

    2013-02-01

    Based on the regulatory framework and an overview of dentistry in supplementary health, this paper discusses the specifics of the dental sector with respect to health promotion policies and quality of health care services proposed by the National Supplementary Health Agency (ANS). The State's activities in supplementary health are based on law 9.656/98, which defines the relations between operators, products and their beneficiaries, and law 9.961/2000, which created the ANS. Concomitantly there was a great increase in dentistry in the private health plan market, because of changes in the practices of the profession. This required the need to know the logic of the organization of the services regarding the assistance provided and the model of care. The ANS develops measures to encourage operators to implement health promotion programs, striving for an integral care model. At the same time, it promotes the qualification policy of supplementary health care, with emphasis on the scope of care, though in dentistry the focus of evaluation is still individual and fragmented care. Indeed, the great challenge of dentistry is making it a public health policy, accessible to all, and the qualification of dental care in supplementary health.

  4. [Evaluation auditing of the quality of health care in accreditation of health facilities].

    PubMed

    Paim, Chennyfer da Rosa Paino; Zucchi, Paola

    2011-01-01

    This article shows how many health insurance companies operating in the Greater São Paulo have been performing auditing of the quality of their health care services, professionals, and which criteria are being employed to do so. Because of the legislation decreeing that health insurance companies have legal co-responsibility for the health care services and National Health Agency control the health services National Health Agency, auditing evaluations have been implemented since then. The survey was based on electronic forms e-mailed to all health insurance companies operating in the Greater São Paulo. The sample consisted of 125 health insurance companies; 29 confirmed that had monitoring and evaluation processes; 26 performed auditing of their services regularly; from those, 20 used some type of form or protocol for technical visits; all evaluation physical and administrative structure and 22 included functional structure. Regarding the professionals audited 21 were nurses, 13 administrative assistants; 04 managers and 02 doctors. Regarding criteria for accreditation the following were highlighted: region analysis (96%), localization (88.88%) and cost (36%). We conclude that this type of auditing evaluation is rather innovative and is being gradually implemented by the health insurance companies, but is not a systematic process.

  5. Quality and Innovation: Redesigning a Coordinated and Connected Health System.

    PubMed

    Vaughan, Peter W

    2017-01-01

    Nova Scotia's consolidated health system was launched on April 1, 2015. This new approach to organizing health administration and services in the province arose out of necessity. When planning began, Nova Scotia was spending 41% of its annual budget on health services. In comparison to other provinces and territories, our per capita health-related spending was among the highest in the country, we had one of Canada's oldest populations and we had some of the worst health outcomes. Clearly, we could not continue to do the same things and expect different results. Both the life sciences and technology are changing at breakneck speed, while design of healthcare delivery has barely moved beyond a mid-twentieth century paternalistic provider-centric model. Nova Scotia's transformation journey was facilitated by a major policy effort 20 years earlier that had integrated emergency health services across the province. Our aim was to build on that foundation by integrating administration in order to build primary care networks with enhanced regional specialty services, with tertiary services located in Halifax. The goal of health system innovation in Nova Scotia was - and is - based firmly on the dimensions of quality: safe care that avoids harming patients; effective care that is based on levels of evidence to achieve scalability; access to care that is focused on individuals; efficient care that reduces waste, time, energy and supplies; and equitable care that ensures a system is in place that mitigates differences in geography and social economic status. The author offers a sketch of the principal initiatives, challenges, considerations, approaches and lessons involved in this multi-factorial, multi-stakeholder innovation process.

  6. [A quality evaluation tableau for health institutions: an educational tool].

    PubMed

    Moll, Marie Christine; Decavel, Frédérique; Merlet, Christine

    2009-09-01

    For a few years, health institutions have had to comply with the certification and the need to establish the new governance. Thanks to the accreditation version 2 (obtained in 2005), the elaboration of the hospital project (adopted in October, 2006) and the organization in poles since 2006, the quality oriented management became a priority axis at the University Hospital of Angers. The strategic adaptation to quality requirements leads to develop the hospital management, more especially at the level of the clinical, medico technical and administrative poles. The elements of the hospital project including the part about the quality, risk and evaluation aim at being adapted by every pole according to the level of its project. This adaptation which is imposed to each pole manager requires a practical and educational accompaniment allowing at the same time to realize a diagnosis of the progress of the quality approach, a measure of the impact of the global impregnation within the institution and a comparison between pole. A eight axis dashboard with criteria and a user guide were developed from certification ISO 9001, the EFQM manual and the certification manual version 2 of the Healthcare High Authorities. The criteria are transcribed in an EXCEL grid ready to use. Succeeding in estimating your own quality system means that you demonstrate the maturity of the quality approach. The results of this evaluation confirmed those of the certification. The dashboard is a management structuring tool at the service of the multidisciplinary team. Two considerations emerge from these results: First of all, for the hospital top management, the axes to be improved emerge as a priority to determine and target the next annual action plans. The results also allow to support the auto evaluation for the certification version 2010 planned in January of the same year. It is a pragmatic tool which allows auto evaluation and comparison to estimate the pole performances. It is a strategic

  7. Cultural orientation: an emerging dimension of quality in women's health services.

    PubMed

    Stone, C E

    2000-01-01

    There are many efforts underway to document the differences in health status and health services access of women in distinct cultural segments in the U.S. Along with the measurable aspects of health status and utilization, each cultural segment carries its unique perspective on what constitutes "quality" in women's health services. These definitions of quality may reflect access, interactions, process, and outcomes. Health care providers that aspire to provide quality women's health care need to identify the distinct cultural segments in their own communities; document the gaps in women's health services; and develop programs that are specific to clinical needs and quality criteria of these populations.

  8. Quality Implementation in Health Physics Unit, Cosenza Hospital. Accreditation Program as Quality Improvement instrument.

    PubMed

    Loizzo, M; Siciliano, R

    2016-01-01

    Achieving high levels of quality in healthcare, which could be measurable, is increasingly important at present and is dictated by the radical changes of the welfare system imposed today by the well known economic constraints. However, even in the ongoing legislation, the practices concerning the verification and review of the quality of health care has had a major impact in the galaxy of Health. On the one hand, the citizen is developing an awareness of the possibilities of choice (Empowerment) between a plurality of providers of healthcare services, on the other hand providers themselves are obliged, within the logic of a global market, to retrain their offers to respond satisfactorily to the needs of citizens. The purpose of this study was to demonstrate how the adoption of Operational Procedures, following the granting of a certificate of accreditation to the Unit of Medical Physics, has changed the approach to the work on the part of health workers, in the direction of a dynamic quality improvement.

  9. Technical Limitations of Electronic Health Records in Community Health Centers: Implications on Ambulatory Care Quality

    ERIC Educational Resources Information Center

    West, Christopher E.

    2010-01-01

    Research objectives: This dissertation examines the state of development of each of the eight core electronic health record (EHR) functionalities as described by the IOM and describes how the current state of these functionalities limit quality improvement efforts in ambulatory care settings. There is a great deal of literature describing both the…

  10. Technical Limitations of Electronic Health Records in Community Health Centers: Implications on Ambulatory Care Quality

    ERIC Educational Resources Information Center

    West, Christopher E.

    2010-01-01

    Research objectives: This dissertation examines the state of development of each of the eight core electronic health record (EHR) functionalities as described by the IOM and describes how the current state of these functionalities limit quality improvement efforts in ambulatory care settings. There is a great deal of literature describing both the…

  11. Leveraging Health-Related Quality of Life in Population Health Management: The Case for Healthy Days

    PubMed Central

    Slabaugh, S. Lane; Shah, Mona; Zack, Matthew; Cordier, Tristan; Havens, Eric; Davidson, Evan; Miao, Michael; Prewitt, Todd; Jia, Haomiao

    2017-01-01

    Abstract Measuring population health with morbidity and mortality data, often collected at the site of care, fails to capture the individual's perspective on health and well-being. Because health happens outside the walls of medical facilities, a holistic and singular measure of health that can easily be captured for an entire population could aid in understanding the well-being of communities. This paper postulates that Healthy Days, a health-related quality of life measure developed and validated by the Centers for Disease Control and Prevention, is an ideal survey instrument to advance population health. A systematic literature review was conducted and revealed a strong evidence base using Healthy Days with significant correlations to chronic disease conditions. Building on the literature base and experience, methods for analyzing Healthy Days data are discussed, including stratified sampling techniques, statistical measures to account for variance, and modeling techniques for skewed distributions. Using such analytic techniques, Healthy Days has been used extensively in national health surveillance. As the health care system faces increasing costs and constrained resources, the Healthy Days survey instrument can be used to inform public policies and allocate health service resources. Because Healthy Days captures broad dimensions of health from the individual's perspective, it is a simple way to holistically measure the health and well-being of a population and its trend over time. Expanded use of Healthy Days can aid population health managers and contribute to the understanding of the broader determinants of the nation's and individual community's health and aid in evaluating progress toward health goals. PMID:27031869

  12. Process quality indicators for general clinical occupational health practice.

    PubMed

    Baker, A; Madan, I

    2013-03-01

    The development and use of occupational health (OH) clinical process quality indicators are an essential component of a quality improvement programme in OH practice. To develop generic quality indicators (QI) in order to improve the quality of OH practice in rehabilitating sick-listed individuals back to work. A systematic search of literature on relevant governmental and academic websites was undertaken. Studies were analysed for evidence of interventions that led to a reduction of incidence or duration of sickness absence, or return-to-work rates. The studies were categorized thematically and reviewed by a small expert group who produced four draft QI. The draft QI were piloted in six OH departments to determine whether the indicators were clear, whether the data were feasible to collect and whether any changes to the indicators were recommended. 1605 reports or papers were retrieved and six met the criteria for inclusion as evidence for the development of QI. Four QI were developed based on temporary modification for work for those off sick for >4 weeks; timeliness of appointment and advice to manager; high level of patient satisfaction and the production of informative reports. The pilot indicated that the QI were feasible to use in practice and easy to implement in a busy OH clinical environment. Four QI have been developed for use in general OH practice. The pilot study demonstrated that the indicators are both feasible to use and easy to implement by clinical OH departments.

  13. Quality of health care: an absolute necessity for public satisfaction.

    PubMed

    Sajid, M S; Baig, M K

    2007-01-01

    The purpose of this paper is to discuss the value of consumers (patients) to assess the success or failure of a healthcare system. An evaluation of current healthcare in the NHS from a patient perspective culminating in suggestions and methods to achieve a patient responsive system. The provision of best quality health services to patients is a difficult task especially when NHS budgets are being cut and jobs are being lost. NHS executives and managers claim that these redundancies will improve the quality of healthcare for the patient. However, running the NHS like a corporate organization is questionable as the way forward. There is no question of making profit (as is the norm in any corporate organization) and saving money at the expense of patient care. In order to find out the real performance of a healthcare system like the NHS, the satisfaction of the public should be the sole criteria for judgement.

  14. Service quality in public health clinics: perceptions of users and health professionals.

    PubMed

    Campos, Domingos Fernandes; Negromonte Filho, Rinaldo Bezerra; Castro, Felipe Nalon

    2017-10-09

    Purpose The purpose of this paper is to investigate the expectations and quality gaps in services provided at city public health clinics in the city of Natal, Brazil, from the perspective of patients and healthcare service providers. Design/methodology/approach The research sample consisted of 1,200 patients who used public health services and 265 providers - doctors, nutritionists, physiotherapists, psychologists, pharmacists and managers at three health clinics in the city of Natal, Brazil. A scale with 25 health service attributes was used in data collection. Summary statistics and t-test were used to analyze the data. Findings The results show that the providers think that users have lower levels of expectations than those indicated by the users in all attributes. Providers and users have the most approximate insights into what attributes are considered most important: explanations, level of knowledge and attention dispensed by health professionals. Users and providers perceived similar quality gaps for most of the attributes. The gaps were statistically the same, when comparing the mean quality shortcomings by means of a Student's test, considering a significance level of 5 percent, obtained independently by the manifestation of users and providers. Research limitations/implications The results reveal only a photograph of the moment. The study did not consider the differences that may exist between groups with different income levels, genders or age groups. A qualitative study could improve the understanding of the differences and coincidences of the diverse points of views. A more advanced research could even study possibilities so that health managers could promote changes in the service, some of them low cost, as the health professionals training for contact with patients. Practical implications The evaluation of the service quality complemented by the matrix of opportunities, importance × quality gaps generates information to help make decisions in the

  15. How to evaluate the quality of health related websites.

    PubMed

    Gattoni, Filippo; Sicola, Chiara

    2005-03-01

    To establish reliable quality criteria for medical websites is of foremost importance in relation to the increasing number of Internet users, both health professionals and lay people, searching for medical information in the mass of these sites. Quality in general refers to a set of features that distinguish one person or thing from others of the same type. The quality of a website is usually related to its content and usability. The first criteria we considered are contents and readability, which must be targeted to the intended type of user. Other important criteria include: transparency, consistency, honesty, references to sources, accountability, respect of privacy, currency of content material, responsibility, and accessibility. Technical criteria are the use of consolidated and standard technologies, soft colours, short page download time. Good medical websites should also follow the suggestions of organizations such as the World Health Organization, the Food and Drug Administration, the European Communities. Another organization, Health On Net Foundation, has issued some guidelines for medical websites, summarized in eight points, fundamental to assign real scientific value to a site. We believe, in agreement with the literature, that it is unnecessary to apply strict rules to medical website developers. We want to stress the importance of guidelines and recommendations to be modified with the development of web technology and the cultural evolution of patient and physicians. In the near future the presence on the Internet of websites certified by national or international medical web authorities will lead users to trust and give their preference to such sites, leading to the self-regulation of website developers and users.

  16. Evaluating the quality of Internet health resources in pediatric urology.

    PubMed

    Fast, Angela M; Deibert, Christopher M; Hruby, Gregory W; Glassberg, Kenneth I

    2013-04-01

    Many patients and their parents utilize the Internet for health-related information, but quality is largely uncontrolled and unregulated. The Health on the Net Foundation Code (HONcode) and DISCERN Plus were used to evaluate the pediatric urological search terms 'circumcision,' 'vesicoureteral reflux' and 'posterior urethral valves'. A google.com search was performed to identify the top 20 websites for each term. The HONcode toolbar was utilized to determine whether each website was HONcode accredited and report the overall frequency of accreditation for each term. The DISCERN Plus instrument was used to score each website in accordance with the DISCERN Handbook. High and low scoring criteria were then compared. A total of 60 websites were identified. For the search terms 'circumcision', 'posterior urethral valves' and 'vesicoureteral reflux', 25-30% of the websites were HONcode certified. Out of the maximum score of 80, the average DISCERN Plus score was 60 (SD = 12, range 38-78), 40 (SD = 12, range 22-69) and 45 (SD = 19, range 16-78), respectively. The lowest scoring DISCERN criteria included: 'Does it describe how the treatment choices affect overall quality of life?', 'Does it describe the risks of each treatment?' and 'Does it provide details of additional sources of support and information?' (1.35, 1.83 and 1.95 out of 5, respectively). These findings demonstrate the poor quality of information that patients and their parents may use in decision-making and treatment choices. The two lowest scoring DISCERN Plus criteria involved education on quality of life issues and risks of treatment. Physicians should know how to best use these tools to help guide patients and their parents to websites with valid information. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  17. Interactions of water quality and integrated groundwater management: exampled from the United States

    USDA-ARS?s Scientific Manuscript database

    Groundwater is available in many parts of the world, but the quality of the water may limit its use. Contaminants can limit the use of groundwater through concerns associated with human health, aquatic health, economic costs, or even societal perception. Given this broad range of concerns, this chap...

  18. Multinational investigation of cross-societal cooperation.

    PubMed

    Dorrough, Angela Rachael; Glöckner, Andreas

    2016-09-27

    In a globalized world, establishing successful cooperation between people from different nations is becoming increasingly important. We present results from a comprehensive investigation of cross-societal cooperation in one-shot prisoner's dilemmas involving population-representative samples from six countries and identify crucial facilitators of and obstacles to cooperation. In interactions involving mutual knowledge about only the other players' nationalities, we demonstrate that people hold strong and transnationally shared expectations (i.e., stereotypes) concerning the cooperation level of interaction partners from other countries. These expectations are the strongest determinants of participant cooperation. Paradoxically, however, they turn out to be incorrect stereotypes that even correlate negatively with reality. In addition to erroneous expectations, participants' cooperation behavior is driven by (shared) social preferences that vary according to the interaction partner's nationality. In the cross-societal context, these social preferences are influenced by differences in wealth and ingroup favoritism, as well as effects of specific country combinations but not by spatial distance between nations.

  19. Multinational investigation of cross-societal cooperation

    PubMed Central

    Dorrough, Angela Rachael

    2016-01-01

    In a globalized world, establishing successful cooperation between people from different nations is becoming increasingly important. We present results from a comprehensive investigation of cross-societal cooperation in one-shot prisoner’s dilemmas involving population-representative samples from six countries and identify crucial facilitators of and obstacles to cooperation. In interactions involving mutual knowledge about only the other players’ nationalities, we demonstrate that people hold strong and transnationally shared expectations (i.e., stereotypes) concerning the cooperation level of interaction partners from other countries. These expectations are the strongest determinants of participant cooperation. Paradoxically, however, they turn out to be incorrect stereotypes that even correlate negatively with reality. In addition to erroneous expectations, participants’ cooperation behavior is driven by (shared) social preferences that vary according to the interaction partner’s nationality. In the cross-societal context, these social preferences are influenced by differences in wealth and ingroup favoritism, as well as effects of specific country combinations but not by spatial distance between nations. PMID:27621437

  20. Genetic Diversity and Societally Important Disparities

    PubMed Central

    Rosenberg, Noah A.; Kang, Jonathan T. L.

    2015-01-01

    The magnitude of genetic diversity within human populations varies in a way that reflects the sequence of migrations by which people spread throughout the world. Beyond its use in human evolutionary genetics, worldwide variation in genetic diversity sometimes can interact with social processes to produce differences among populations in their relationship to modern societal problems. We review the consequences of genetic diversity differences in the settings of familial identification in forensic genetic testing, match probabilities in bone marrow transplantation, and representation in genome-wide association studies of disease. In each of these three cases, the contribution of genetic diversity to social differences follows from population-genetic principles. For a fourth setting that is not similarly grounded, we reanalyze with expanded genetic data a report that genetic diversity differences influence global patterns of human economic development, finding no support for the claim. The four examples describe a limit to the importance of genetic diversity for explaining societal differences while illustrating a distinction that certain biologically based scenarios do require consideration of genetic diversity for solving problems to which populations have been differentially predisposed by the unique history of human migrations. PMID:26354973

  1. Societal reintegration following cadaveric orthotopic liver transplantation

    PubMed Central

    Kelly, Ryan; Hurton, Scott; Ayloo, Subhashini; Cwinn, Mathew; De Coutere-Bosse, Sarah

    2016-01-01

    Background Studies on patients’ societal reintegration following orthotopic liver transplantation (OLT) are scarce. Methods Between September 2006 and January 2008, all adults who were alive after 3 years post OLT were included in this prospective cohort study. Validated questionnaires were administered to all candidates with the primary aim of investigating the rate of their social re-integration following OLT and potential barriers they might have encountered. Results Among 157 eligible patients 110 (70%) participated. Mean participants’ age was 57 years (SD 11.4) and 43% were females. Prior to OLT, 75% of patients were married and 6% were divorced. Following OLT there was no significant difference in marital status. Employment rate fell from 72% to 30% post-OLT. Patients who had been employed in either low-skill or advanced-skill jobs were less likely to return to work. After OLT, personal income fell an average of 4,363 Canadian dollars (CAN$) (SD 20,733) (P=0.03) but the majority of recipients (80%) reported high levels of satisfaction for their role in society. Conclusions Although patients’ satisfaction post-OLT is high, employment status is likely to be negatively affected for individuals who are not self-employed. Strategies to assist recipients in returning to their pre-OLT jobs should be developed to improve patients’ economical status and societal ability to recoup resources committed for OLT. PMID:27275465

  2. Societal reintegration following cadaveric orthotopic liver transplantation.

    PubMed

    Kelly, Ryan; Hurton, Scott; Ayloo, Subhashini; Cwinn, Mathew; De Coutere-Bosse, Sarah; Molinari, Michele

    2016-06-01

    Studies on patients' societal reintegration following orthotopic liver transplantation (OLT) are scarce. Between September 2006 and January 2008, all adults who were alive after 3 years post OLT were included in this prospective cohort study. Validated questionnaires were administered to all candidates with the primary aim of investigating the rate of their social re-integration following OLT and potential barriers they might have encountered. Among 157 eligible patients 110 (70%) participated. Mean participants' age was 57 years (SD 11.4) and 43% were females. Prior to OLT, 75% of patients were married and 6% were divorced. Following OLT there was no significant difference in marital status. Employment rate fell from 72% to 30% post-OLT. Patients who had been employed in either low-skill or advanced-skill jobs were less likely to return to work. After OLT, personal income fell an average of 4,363 Canadian dollars (CAN$) (SD 20,733) (P=0.03) but the majority of recipients (80%) reported high levels of satisfaction for their role in society. Although patients' satisfaction post-OLT is high, employment status is likely to be negatively affected for individuals who are not self-employed. Strategies to assist recipients in returning to their pre-OLT jobs should be developed to improve patients' economical status and societal ability to recoup resources committed for OLT.

  3. Ecological network analysis of China's societal metabolism.

    PubMed

    Zhang, Yan; Liu, Hong; Li, Yating; Yang, Zhifeng; Li, Shengsheng; Yang, Naijin

    2012-01-01

    Uncontrolled socioeconomic development has strong negative effects on the ecological environment, including pollution and the depletion and waste of natural resources. These serious consequences result from the high flows of materials and energy through a socioeconomic system produced by exchanges between the system and its surroundings, causing the disturbance of metabolic processes. In this paper, we developed an ecological network model for a societal system, and used China in 2006 as a case study to illustrate application of the model. We analyzed China's basic metabolic processes and used ecological network analysis to study the network relationships within the system. Basic components comprised the internal environment, five sectors (agriculture, exploitation, manufacturing, domestic, and recycling), and the external environment. We defined 21 pairs of ecological relationships in China's societal metabolic system (excluding self-mutualism within a component). Using utility and throughflow analysis, we found that exploitation, mutualism, and competition relationships accounted for 76.2, 14.3, and 9.5% of the total relationships, respectively. In our trophic level analysis, the components were divided into producers, consumers, and decomposers according to their positions in the system. Our analyses revealed ways to optimize the system's structure and adjust its functions, thereby promoting healthier socioeconomic development, and suggested ways to apply ecological network analysis in future socioeconomic research.

  4. Genetic Diversity and Societally Important Disparities.

    PubMed

    Rosenberg, Noah A; Kang, Jonathan T L

    2015-09-01

    The magnitude of genetic diversity within human populations varies in a way that reflects the sequence of migrations by which people spread throughout the world. Beyond its use in human evolutionary genetics, worldwide variation in genetic diversity sometimes can interact with social processes to produce differences among populations in their relationship to modern societal problems. We review the consequences of genetic diversity differences in the settings of familial identification in forensic genetic testing, match probabilities in bone marrow transplantation, and representation in genome-wide association studies of disease. In each of these three cases, the contribution of genetic diversity to social differences follows from population-genetic principles. For a fourth setting that is not similarly grounded, we reanalyze with expanded genetic data a report that genetic diversity differences influence global patterns of human economic development, finding no support for the claim. The four examples describe a limit to the importance of genetic diversity for explaining societal differences while illustrating a distinction that certain biologically based scenarios do require consideration of genetic diversity for solving problems to which populations have been differentially predisposed by the unique history of human migrations. Copyright © 2015 by the Genetics Society of America.

  5. Drivers of cost and health-related quality of life in patients with systemic lupus erythematosus (SLE): a Swedish nationwide study based on patient reports.

    PubMed

    Bexelius, C; Wachtmeister, K; Skare, P; Jönsson, L; Vollenhoven, R van

    2013-07-01

    The objective of this paper is to investigate drivers of cost and health-related quality of life (HRQoL) related to disease activity and fatigue among patients with systemic lupus erythematous (SLE). A questionnaire was sent to members of a patient organization with a self-reported diagnosis of SLE, requesting information on demographics and disease characteristics, medications, resource utilization, informal care, loss of productivity, fatigue and HRQoL in relation to SLE. Mean annual costs per patient were estimated from a societal perspective. HRQoL was measured through EQ-5D and fatigue was measured through a 10 cm VAS scale. Patient-reported disease activity was measured through the Systemic Lupus Activity Questionnaire (SLAQ) and corticosteroid dose. Drivers of costs and HRQoL were analyzed through regression analysis. A total of 339 patients out of 737 returned the questionnaire. Mean age was 55; 94% were female. The mean HRQoL measured through the five-item EQ-5D instrument was 0.64 and total costs were estimated at €22,594 (direct costs €7818; indirect costs €14,776). Disease activity, fatigue and corticosteroid doses had a statistically significant impact on costs and HRQoL. This study demonstrates that Swedish patients with SLE have low HRQoL and incur high societal costs and that are both associated with and most likely driven by disease activity, fatigue and corticosteroid use.

  6. Quality assessment of published health economic analyses from South America.

    PubMed

    Machado, Márcio; Iskedjian, Michael; Einarson, Thomas R

    2006-05-01

    Health economic analyses have become important to healthcare systems worldwide. No studies have previously examined South America's contribution in this area. To survey the literature with the purpose of reviewing, quantifying, and assessing the quality of published South American health economic analyses. A search of MEDLINE (1990-December 2004), EMBASE (1990-December 2004), International Pharmaceutical Abstracts (1990-December 2004), Literatura Latino-Americana e do Caribe em Ciências da Saúde (1982-December 2004), and Sistema de Informacion Esencial en Terapéutica y Salud (1980-December 2004) was completed using the key words cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-minimization analysis (CMA), and cost-benefit analysis (CBA); abbreviations CEA, CUA, CMA, and CBA; and all South American country names. Papers were categorized by type and country by 2 independent reviewers. Quality was assessed using a 12 item checklist, characterizing scores as 4 (good), 3 (acceptable), 2 (poor), 1 (unable to judge), and 0 (unacceptable). To be included in our investigation, studies needed to have simultaneously examined costs and outcomes. We retrieved 25 articles; one duplicate article was rejected, leaving 24 (CEA = 15, CBA = 6, CMA = 3; Brazil = 9, Argentina = 5, Colombia = 3, Chile = 2, Ecuador = 2, 1 each from Peru, Uruguay, Venezuela). Variability between raters was less than 0.5 point on overall scores (OS) and less than 1 point on all individual items. Mean OS was 2.6 (SD 1.0, range 1.4-3.8). CBAs scored highest (OS 2.8, SD 0.8), CEAs next (OS 2.7, SD 0.7), and CMAs lowest (OS 2.0, SD 0.5). When scored by type of question, definition of study aim scored highest (OS 3.0, SD 0.8), while ethical issues scored lowest (OS 1.5, SD 0.9). By country, Peru scored highest (mean OS 3.8) and Uruguay had the lowest scores (mean OS 2.2). A nonsignificant time trend was noted for OS (R2 = 0.12; p = 0.104). Quality scores of health economic analyses

  7. Emergent Societal Effects of Crimino-Social Forces in an Animat Agent Model

    NASA Astrophysics Data System (ADS)

    Scogings, Chris J.; Hawick, Ken A.

    Societal behaviour can be studied at a causal level by perturbing a stable multi-agent model with new microscopic behaviours and observing the statistical response over an ensemble of simulated model systems. We report on the effects of introducing criminal and law-enforcing behaviours into a large scale animat agent model and describe the complex spatial agent patterns and population changes that result. Our well-established predator-prey substrate model provides a background framework against which these new microscopic behaviours can be trialled and investigated. We describe some quantitative results and some surprising conclusions concerning the overall societal health when individually anti-social behaviour is introduced.

  8. Canadian soil quality guidelines for copper: Environmental and human health

    SciTech Connect

    1997-12-31

    This report begins with background information on the physical and chemical properties of copper, the production and use of copper in Canada, its levels in the Canadian environment, and existing guidelines and criteria regarding copper concentrations in various media. It then reviews the environmental fate and behaviour of copper, notably in the soil; the behavior and effects of copper in biota, including soil microbial processes, terrestrial plants and invertebrates, livestock and wildlife, and bioaccumulation; and the pharmacokinetics and toxicology of copper in mammals and humans, concluding with an overall toxicological evaluation and human exposure estimates. This information is used to derive environmental and human health soil quality guidelines for copper to protect environmental and human health receptors, for agricultural, residential/parkland, commercial, and industrial land uses.

  9. Indoor air quality. [Health hazards due to energy conservation measures

    SciTech Connect

    Hollowell, C.D.

    1981-06-01

    Rising energy prices, among other factors, have generated an incentive to reduce ventilation rates and thereby reduce the cost of heating and cooling buildings. Reduced ventilation in buildings may significantly increase exposure to indoor air pollution and perhaps have adverse effects on occupant health and comfort. Preliminary findings suggest that reduced ventilation may adversely affect indoor air quality unless appropriate control strategies are undertaken. The strategies used to control indoor air pollution depend on the specific pollutant or class of pollutants encountered, and differ somewhat depending on whether the application is to an existing building or a new building under design and construction. Whenever possible, the first course of action is prevention or reduction of pollutant emissions at the source. In most buildings, control measures involve a combination of prevention, removal, and suppression. Common sources of indoor air pollution in buildings, the specific pollutants emitted by each source, the potential health effects, and possible control techniques are discussed.

  10. Functional health outcomes as a measure of health care quality for Medicare beneficiaries.

    PubMed Central

    Bierman, A S; Lawrence, W F; Haffer, S C; Clancy, C M

    2001-01-01

    OBJECTIVE: the Medicare Health Outcomes Survey (HOS), a new quality measure in the Health Plan Employer Data and Information Set, is designed to assess physical and mental functional health outcomes of Medicare beneficiaries enrolled in Medicare+Choice organizations. We discuss the rationale for the HOS measure together with methodologic challenges in its use and interpretation, using descriptive data from the baseline Medicare HOS to illustrate some of these challenges. DATA SOURCES/STUDY DESIGN: The 1999 Cohort 2 Medicare HOS baseline data were used for a cross-sectional descriptive analysis. A random sample of 1,000 beneficiaries from each health plan with a Medicare+Choice contract was surveyed (N = 156,842; 282 organizations included in these analyses) . PRINCIPAL FINDINGS: The HOS measure is designed to assess a previously unmeasured dimension of quality. Plan-level variation was seen across all baseline measures of sociodemographic characteristics and illness burden. At the individual level socioeconomic position as measured by educational attainment was strongly associated with functional status. The least educated beneficiaries had the highest burden of illness on all measures examined, and there was a consistent and significant gradient in health and functional status across all levels of education. In analyses stratified by race and ethnicity, socioeconomic gradients in f un ct ion persist ed. CONCLUSIONS Despite limitations, by focusing at t en t ion on the need to improve functional health out comes among elderly Medicare beneficiaries enrolled in Medicare+Choice, the HOS can serve as an important new tool to support efforts to improve health care quality. The HOS provides valuable information at the federal, state, and health plan levels that can be used to identify, prioritize, and evaluate quality improvement interventions and monitor progress for the program overall as well as for vulnerable subgroups. To interpret the HOS as a quality measure

  11. The health mediators-qualified interpreters contributing to health care quality among Romanian Roma patients.

    PubMed

    Roman, Gabriel; Gramma, Rodica; Enache, Angela; Pârvu, Andrada; Moisa, Ştefana Maria; Dumitraş, Silvia; Ioan, Beatrice

    2013-11-01

    In order to assure optimal care of patients with chronic illnesses, it is necessary to take into account the cultural factors that may influence health-related behaviors, health practices, and health-seeking behavior. Despite the increasing number of Romanian Roma, research regarding their beliefs and practices related to healthcare is rather poor. The aim of this paper is to present empirical evidence of specificities in the practice of healthcare among Romanian Roma patients and their caregivers. Using a qualitative exploratory descriptive design, this study is based on data gathered through three focus groups with 30 health mediators in the counties of Iasi and Cluj (Romania). We identified various barriers to access to healthcare for Roma patients: lack of financial resources and health insurance coverage, lack of cognitive resources or lack of personal hygiene, but also important cultural issues, such as the shame of being ill, family function, disclosure of disease-related information, patient's autonomy, attitudes towards illness and health practices, that should be considered in order to create a culturally sensitive environment in Romanian medical facilities:… The role of the health mediators within the context of cultural diversity is also discussed, as cultural brokers contributing to health care quality among Romanian Roma patients Bridging cultural differences may improve patient-healthcare provider relationships, but may have limited impact in reducing ethnic disparities, unless coupled with efforts of Roma communities to get involved in creating and implementing health policies.

  12. Health-related quality of life among online university students.

    PubMed

    Maynard, Pamela L; Rohrer, James E; Fulton, Lawrence

    2015-01-01

    Online university students are a growing population whose health has received minimal attention. The purpose of this cross-sectional Internet survey was to identify risk factors for the health status among online university students. This online survey collected data from 301 online university students through a large, US-based participant pool and LinkedIn. Health status was measured using 3 elements of health-related quality of life (HRQOL): self-rated overall health (SRH), unhealthy days, and recent activity limitation days. All 3 measures were dichotomized. The odds of poor SRH were higher for people who reported a body mass index in the overweight and obese categories (odds ratio [OR] = 2.99, P < .05) and for those who reported being smokers (OR = 2.52, P = .03). The odds of frequent unhealthy days were lower for those who made more than $35 000 compared with those who reported making less (OR = 0.50, P = .03) and those who exercised 4 or more times a week compared with those who exercised less (OR = 0.28, P < .05). The odds of frequent activity limitation were lower for those who reported an income of more than $35 000 (OR = 0.29, P = .04) and higher for persons who reported belonging to "other" race (OR = 14.75, P = .00). Universities might fruitfully target health promotion programs for online students who are low income, in disadvantaged racial groups, who are overweight, smoke, and who do not exercise. © The Author(s) 2014.

  13. Water quality associated public health risk in Bo, Sierra Leone.

    PubMed

    Jimmy, David H; Sundufu, Abu J; Malanoski, Anthony P; Jacobsen, Kathryn H; Ansumana, Rashid; Leski, Tomasz A; Bangura, Umaru; Bockarie, Alfred S; Tejan, Edries; Lin, Baochuan; Stenger, David A

    2013-01-01

    Human health depends on reliable access to safe drinking water, but in many developing countries only a limited number of wells and boreholes are available. Many of these water resources are contaminated with biological or chemical pollutants. The goal of this study was to examine water access and quality in urban Bo, Sierra Leone. A health census and community mapping project in one neighborhood in Bo identified the 36 water sources used by the community. A water sample was taken from each water source and tested for a variety of microbiological and physicochemical substances. Only 38.9% of the water sources met World Health Organization (WHO) microbial safety requirements based on fecal coliform levels. Physiochemical analysis indicated that the majority (91.7%) of the water sources met the requirements set by the WHO. In combination, 25% of these water resources met safe drinking water criteria. No variables associated with wells were statistically significant predictors of contamination. This study indicated that fecal contamination is the greatest health risk associated with drinking water. There is a need to raise hygiene awareness and implement inexpensive methods to reduce fecal contamination and improve drinking water safety in Bo, Sierra Leone.

  14. Differences in Preventive Health Quality by Residency Year

    PubMed Central

    Willett, Lisa L; Palonen, Katri; Allison, Jeroan J; Heudebert, Gustavo R; Kiefe, Catarina I; Stanford Massie, F; Wall, Terry C; Houston, Thomas K

    2005-01-01

    Background It is assumed that the performance of more senior residents is superior to that of interns, but this has not been assessed objectively. Objective To determine whether adherence to national guidelines for outpatient preventive health services differs by year of residency training. Design Cross-sectional study. Participants One hundred twenty Internal Medicine residents, postgraduate year (PGY)- 1 and PGY -2, attending a University Internal Medicine teaching clinic between June 2000 and May 2003. Measurements We studied 6 preventive health care services offered or received by patients by abstracting data from 1,017 patient records. We examined the differences in performance between PGY-1 and PGY-2 residents. Results Postgraduaute year-2 residents did not statistically outperform PGY-1 residents on any measure. The overall proportion of patients receiving appropriate preventive health services for pneumococcal vaccination, advising tobacco cessation, breast and colon cancer screening, and lipid screening was similar across levels of training. PGY-1s outperformed PGY-2s for tobacco use screening (58%, 51%, P=.03). These results were consistent after accounting for clustering of patients within provider and adjusting for patient age, gender, race and insurance, resident gender, and number of visits during the measurement year. Conclusions Overall, patients cared for by PGY-2 residents did not receive more outpatient preventive health services than those cared for by PGY-1 residents. Efforts should be made to ensure quality patient care in the outpatient setting for all levels of training. PMID:16117750

  15. The how and why of societal publications for citizen science projects and scientists

    NASA Astrophysics Data System (ADS)

    van Vliet, Arnold J. H.; Bron, Wichertje A.; Mulder, Sara

    2014-05-01

    In the scientific community, the importance of communication to society is often underestimated. Scientists and scientific organisations often lack the skills to organise such communication effectively. The Dutch citizen science phenology network Nature's Calendar has been successful in communicating to the general public via numerous newspaper articles, television appearances, presentations, websites and social media. We refer to these publications as societal publications. Due to active communication to mass media, we frequently reach millions of people. This communication helped us to involve thousands of volunteers in recording the timing of phenological events like the start of flowering, leaf unfolding and bird migration, but also several health-related events like hay fever symptoms and tick bites. In this paper, we analyse and present our experiences with the Nature's Calendar project regarding societal publications. Based on this analysis, we explain the importance of societal publications for citizen science projects and scientists in general, and we show how scientists can increase the newsworthiness of scientific information and what factors and activities can increase the chances of media paying attention to this news. We show that societal publications help phenological networks by facilitating the recruitment, retention and instruction of observers. Furthermore, they stimulate the generation of new ideas and partners that lead to an increase in knowledge, awareness and behavioural change of the general public or specific stakeholders. They make projects, and scientists involved, better known to the public and increase their credibility and authority. Societal publications can catalyse the production of new publications, thereby enforcing the previous mentioned points.

  16. Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

    ERIC Educational Resources Information Center

    Nesbitt, Thomas S.; Marcin, James P.; Daschbach, Martha M.; Cole, Stacey L.

    2005-01-01

    Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7…

  17. Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine

    ERIC Educational Resources Information Center

    Nesbitt, Thomas S.; Marcin, James P.; Daschbach, Martha M.; Cole, Stacey L.

    2005-01-01

    Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services. This study examines perceptions of local health care quality in 7…

  18. 42 CFR 422.2430 - Activities that improve health care quality.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Activities that improve health care quality. 422... Minimum Medical Loss Ratio § 422.2430 Activities that improve health care quality. (a) Activity... discharge planning, and post-discharge reinforcement by an appropriate health care professional. (iii) To...

  19. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... QIO interpretations on the quality of health care. Subject to the procedures for disclosure and notice... interpretations and generalizations on the quality of health care that identify a particular institution. ...

  20. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... interpretations on the quality of health care. Subject to the procedures for disclosure and notice of disclosure... generalizations on the quality of health care that identify a particular institution. ...

  1. 42 CFR 422.2430 - Activities that improve health care quality.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Activities that improve health care quality. 422... Minimum Medical Loss Ratio § 422.2430 Activities that improve health care quality. (a) Activity... discharge planning, and post-discharge reinforcement by an appropriate health care professional. (iii) To...

  2. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... interpretations on the quality of health care. Subject to the procedures for disclosure and notice of disclosure... generalizations on the quality of health care that identify a particular institution. ...

  3. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... QIO interpretations on the quality of health care. Subject to the procedures for disclosure and notice... interpretations and generalizations on the quality of health care that identify a particular institution. ...

  4. 42 CFR 480.141 - Disclosure of QIO interpretations on the quality of health care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... health care. 480.141 Section 480.141 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... interpretations on the quality of health care. Subject to the procedures for disclosure and notice of disclosure... generalizations on the quality of health care that identify a particular institution. ...

  5. Quality Improvement: Indigenous Influence in Oral Health Policy, Process, and Practice.

    PubMed

    Makowharemahihi, Charrissa; Wall, Justin; Keay, Greg; Britton, Cheryl; McGibbon, Minnie; LeGeyt, Patrick; Maipi, Joyce; Signal, Virginia

    2016-02-01

    A Quality Improvement Group for Māori oral health providers [Indigenous New Zealand oral health services] has been an effective and necessary mechanism for engaging Indigenous oral health expertise in decision-making for Indigenous oral health policy and sector developments to reduce oral health inequalities and improve Indigenous oral health outcomes.

  6. Heat stress and societal impacts in the 21st century

    NASA Astrophysics Data System (ADS)

    Coffel, E.; Horton, R. M.; de Sherbinin, A. M.

    2015-12-01

    Heat is the number-one weather related killer in the US and around the world. As a result of rising temperatures and steady or slightly rising levels of specific humidity, heat stress is projected to become increasingly severe. Here we show that heat stress as measured by two common indices -- the heat index and the wet-bulb temperature -- is projected to rapidly and dramatically increase, and that by mid-century crippling summertime conditions ar