45 CFR 162.412 - Implementation specifications: Health plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Implementation specifications: Health plans. 162.412 Section 162.412 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health...

45 CFR 162.512 - Implementation specifications: Health plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Implementation specifications: Health plans. 162.512 Section 162.512 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health...

45 CFR 162.512 - Implementation specifications: Health plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Implementation specifications: Health plans. 162.512 Section 162.512 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health...

Provision of Patient-Centered Transgender Care.

PubMed

Selix, Nancy W; Rowniak, Stefan

2016-11-01

Transgender individuals have unique health care needs and experience health disparities. There is an increased need for transgender health care services and primary care for this underserved population. However, provision of appropriate health care services for transgender persons requires cultural competency and skill on the part of the health care provider, and providers need specific skills to address the needs of this population. A review of the literature was performed by accessing CINAHL, PsycINFO, and PubMed databases. Pertinent research was extracted and reviewed for relevance. References in these publications were reviewed to identify additional publications that address primary prevention, secondary prevention, and tertiary care of transgender individuals. Articles that include prevention, screening, and treatment of health problems of transgender persons were identified. Research on the health needs of the transgender population is limited. Whenever available, research findings that address this unique population should be incorporated into clinical practice. When research evidence is not available to address the unique needs of transgender individuals, research and clinical care guidelines from the general population may be applied for health screening and maintenance. This article provides information about primary care services for transgender individuals and seeks to improve awareness of the health disparities this underserved population experiences. Simple solutions to modify clinical settings to enhance care are provided. © 2016 by the American College of Nurse-Midwives.

45 CFR 162.414 - Implementation specifications: Health care clearinghouses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Implementation specifications: Health care clearinghouses. 162.414 Section 162.414 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier...

45 CFR 162.410 - Implementation specifications: Health care providers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Implementation specifications: Health care providers. 162.410 Section 162.410 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier...

45 CFR 162.410 - Implementation specifications: Health care providers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Implementation specifications: Health care providers. 162.410 Section 162.410 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier...

45 CFR 162.414 - Implementation specifications: Health care clearinghouses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Implementation specifications: Health care clearinghouses. 162.414 Section 162.414 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier...

Low- and middle-income countries face many common barriers to implementation of maternal health evidence products.

PubMed

Puchalski Ritchie, Lisa M; Khan, Sobia; Moore, Julia E; Timmings, Caitlyn; van Lettow, Monique; Vogel, Joshua P; Khan, Dina N; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza; Uka, Sami; Gülmezoglu, A Metin; Straus, Sharon E

2016-08-01

To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC health care settings. Secondary analysis of qualitative data. Meeting reports and articles describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis. Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products. By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

A Needs Assessment: A Study of Perceived Need for Student Health Services by Chinese International Students

ERIC Educational Resources Information Center

Ellis-Bosold, Carey; Thornton-Orr, Denise

2013-01-01

The purpose of this study was to identify the unique health related needs of the Chinese international student (N = 91) and identify barriers to utilization of the available health care services on the university campus. The setting was a university campus in Arkansas which had an overall enrollment of 8864 students on the main campus during the…

A Latent Class Analysis of Weight-Related Health Behaviors among 2-and 4-Year College Students and Associated Risk of Obesity

ERIC Educational Resources Information Center

Mathur, Charu; Stigler, Melissa; Lust, Katherine; Laska, Melissa

2014-01-01

Little is known about the complex patterning of weight-related health behaviors in 2-and 4-year college students. The objective of this study was to identify and describe unique classes of weight-related health behaviors among college students. Latent class analysis was used to identify homogenous, mutually exclusive classes of nine health…

An innovative Oklahoma program to coordinate interdisciplinary and interagency services for children with special healthcare needs at a county level.

PubMed

Wolraich, Mark; Lockhart, Jennifer; Worley, Louis

2013-03-01

Children and youth with special health care needs (CYSHCN) and their families often require multiple services from multiple providers in order to meet their needs. The Sooner SUCCESS (State Unified Children's Comprehensive Exemplary Services for Special Needs), was developed based on a complex adaptive systems approach allowing local coalitions to address their unique needs. Sooner SUCCESS provides support to families and service providers at the community level including a broad range of supports from simply helping a family identify and access a service that already exists to innovatively marshaling generic resources to meet a unique need. The program uses these family support activities coupled with the Community Needs Assessment to identify local service needs encouraging community capacity building by coordinating the efforts of the health, mental health, social and education systems to identify service gaps and develop community-based strategies to fill those gaps.

An Australian case study of patient attitudes towards the use of computerised medical records and unique identifiers.

PubMed

Bomba, D; de Silva, A

2001-01-01

Research into patient attitudes towards the use of technology in health care needs to be given much greater attention within health informatics. Past research has often focused more on the needs of health care providers rather than the end users. This article attempts to redress this knowledge bias by reporting on a case study of the responses gained from patients in a selected Australian medical practice towards the use of computerised medical records and unique identifiers. The responses (n=138) were gained from a survey of patients over a 13 day period of practice operation. This case study serves as an example of the type of future consumer health informatics research which can be undertaken not just in Australia but also in other countries, both at local regional levels and at a national level.

Using the Theory of Planned Behavior to Identify Predictors of Oral Hygiene: A Collection of Unique Behaviors.

PubMed

Brein, Daniel J; Fleenor, Thomas J; Kim, Soo-Woo; Krupat, Edward

2016-03-01

This study aims to identify predictors of performed oral hygiene behaviors (OHBs) based on the Theory of Planned Behavior (TPB), oral health knowledge, and demographic factors. Using a questionnaire, 381 participants in three general dental offices and one hospital dental department in York, Pennsylvania, were surveyed regarding performed OHB, attitudes, subjective norms, perceived behavioral control, oral health knowledge, income, age, and sex. Three unique elements of OHB were identified for analysis: brushing, interdental cleaning, and tongue cleaning. Regression analysis revealed that attitude was the strongest predictor of brushing behavior, followed by oral health knowledge, perceived behavior control, subjective norms, and income. Perceived behavior control was the strongest predictor of interdental cleaning, followed by increased age and attitude. Female sex was the strongest predictor of tongue cleaning, followed by subjective norms, decreased age, and perceived behavior control. Respectively, these three groups of predictive variables explained 22.5% of brushing behavior, 22.7% of interdental cleaning behavior, and 9.5% of tongue cleaning behavior. The present findings highlight the utility of viewing OHB as a set of unique behaviors with unique predictive variables and provide additional support for use of TPB in predicting OHB. Periodontal practitioners should consider the strong associations of attitude and perceived behavioral control with brushing and interdental cleaning behaviors when designing interventional efforts to improve patient home care.

Leveraging Administrative Data for Program Evaluations: A Method for Linking Data Sets Without Unique Identifiers.

PubMed

Lorden, Andrea L; Radcliff, Tiffany A; Jiang, Luohua; Horel, Scott A; Smith, Matthew L; Lorig, Kate; Howell, Benjamin L; Whitelaw, Nancy; Ory, Marcia

2016-06-01

In community-based wellness programs, Social Security Numbers (SSNs) are rarely collected to encourage participation and protect participant privacy. One measure of program effectiveness includes changes in health care utilization. For the 65 and over population, health care utilization is captured in Medicare administrative claims data. Therefore, methods as described in this article for linking participant information to administrative data are useful for program evaluations where unique identifiers such as SSN are not available. Following fuzzy matching methodologies, participant information from the National Study of the Chronic Disease Self-Management Program was linked to Medicare administrative data. Linking variables included participant name, date of birth, gender, address, and ZIP code. Seventy-eight percent of participants were linked to their Medicare claims data. Linking program participant information to Medicare administrative data where unique identifiers are not available provides researchers with the ability to leverage claims data to better understand program effects. © The Author(s) 2014.

Unique agricultural safety and health issues of migrant and immigrant children.

PubMed

McLaurin, Jennie A; Liebman, Amy K

2012-01-01

Immigrant and migrant youth who live and work in agricultural settings experience unique agricultural safety and health issues. Mobility, poverty, cultural differences, immigration status, language, education, housing, food security, regulatory standards and enforcement, and access to childcare and health care influence exposure risk and the well-being of this population. Approximately 10% of the migrant agricultural labor force is composed of unaccompanied minors, whose safety and health is further compounded by lack of social supports and additional stresses associated with economic independence. This paper examines the current demographic and health data, regulatory protections, and programs and practices addressing safety and health in this sector of youth in agriculture. Gaps in knowledge and practice are identified, with emphasis on data collection and regulatory limitations. Best practices in programs addressing the special needs of this population are highlighted. Recommendations identify seven priority areas for impact to promote transformative change in the agricultural health and safety concerns of unaccompanied minors and children of immigrant, migrant and seasonal farmworkers. This framework may be used to examine similar needs in other identified subpopulations of children as they merit attention, whether now or in the future.

78 FR 5565 - Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-25

... certain health information, such as standards for certain health care transactions conducted electronically and code sets and unique identifiers for health care providers and employers. The HIPAA... HIPAA apply to three types of entities, which are known as ``covered entities'': health care providers...

Facilitators and barriers experienced by federal cross-sector partners during the implementation of a healthy eating campaign.

PubMed

Fernandez, Melissa Anne; Desroches, Sophie; Marquis, Marie; Turcotte, Mylène; Provencher, Véronique

2017-09-01

To identify facilitators and barriers that Health Canada's (HC) cross-sector partners experienced while implementing the Eat Well Campaign: Food Skills (EWC; 2013-2014) and describe how these experiences might differ according to distinct partner types. A qualitative study using hour-long semi-structured telephone interviews conducted with HC partners that were transcribed verbatim. Facilitators and barriers were identified inductively and analysed according partner types. Implementation of a national mass-media health education campaign. Twenty-one of HC's cross-sector partners (food retailers, media and health organizations) engaged in the EWC. Facilitators and barriers were grouped into seven major themes: operational elements, intervention factors, resources, collaborator traits, developer traits, partnership factors and target population factors. Four of these themes had dual roles as both facilitators and barriers (intervention factors, resources, collaborator traits and developer traits). Sub-themes identified as both facilitators and barriers illustrate the extent to which a facilitator can easily become a barrier. Partnership factors were unique facilitators, while operational and target population factors were unique barriers. Time was a barrier that was common to almost all partners regardless of partnership type. There appeared to be a greater degree of uniformity among facilitators, whereas barriers were more diverse and unique to the realities of specific types of partner. Collaborative planning will help public health organizations anticipate barriers unique to the realities of specific types of organizations. It will also prevent facilitators from becoming barriers. Advanced planning will help organizations manage time constraints and integrate activities, facilitating implementation.

Games for health conference 2004: issues, trends, and needs unique to games for health.

PubMed

Howell, Kay

2005-04-01

The first-ever Games for Health Conference (Madison, WI, September 16-17, 2004) identified issues, trends, and needs unique to games for healthcare. More than 130 doctors, educators, therapists, and game makers gathered to share experiences particular to the health industry, health practitioners, and patient treatment. Co-sponsored by Games for Health, Project of the Serious Games Initiative, the Academic ADL Co-Lab, and the Federation of American Scientists, the conference highlighted applications for direct patient care and therapy, as well as health education, policy, and management ideas. This paper presents key concepts from the conference's panel discussions and summarizes successful projects demonstrated at the conference that can serve as models for the field.

The Future LGBT Health Professional: Perspectives on Career and Personal Mentorship.

PubMed

Sánchez, Nelson F; Callahan, Edward; Brewster, Cheryl; Poll-Hunter, Norma; Sánchez, John Paul

2018-04-01

Mentorship is a critical factor contributing to career success. There is limited research on the quality of mentoring relationships for LGBT health professionals. This study explores facilitators of, obstacles to, and strategies for successful mentorship for LGBT health professional trainees. We applied a convenience sampling strategy to collect quantitative and qualitative data among LGBT health professional trainees. The authors identified trends in data using bivariate analyses and Consensual Qualitative Research methods. Seventy-five LGBT trainees completed surveys and a subset of 23 survey respondents also participated in three focus groups. Among survey participants, 100% identified along the queer spectrum; 10.7% identified along the trans spectrum; 36.0% identified as a racial or ethnic minority; and 61.3% were in MD/DO-granting programs. Eighty-eight percent of trainees reported working with at least one mentor and 48.5% of trainees had at least one mentor of the same sexual orientation. Seventy-two percent of trainees endorsed the importance of having an LGBT-identified mentor for personal development. Qualitative data showed that trainees valued such a mentor for positive role modeling and shared understanding of experiences. Fifty-nine percent of trainees felt it was important to have an LGBT-identified mentor for career development. LGBT peer networking and LGBT-related professional advice were cited as unique benefits in the qualitative findings. LGBT health professional trainees have unique personal and career development needs that may benefit from LGBT mentorship. Academic health centers that facilitate LGBT mentorship could enhance LGBT health trainees' academic productivity and personal development.

Employing immersive virtual environments for innovative experiments in health care communication.

PubMed

Persky, Susan

2011-03-01

This report reviews the literature for studies that employ immersive virtual environment technology methods to conduct experimental studies in health care communication. Advantages and challenges of using these tools for research in this area are also discussed. A literature search was conducted using the Scopus database. Results were hand searched to identify the body of studies, conducted since 1995, that are related to the report objective. The review identified four relevant studies that stem from two unique projects. One project focused on the impact of a clinician's characteristics and behavior on health care communication, the other focused on the characteristics of the patient. Both projects illustrate key methodological advantages conferred by immersive virtual environments, including, ability to maintain simultaneously high experimental control and realism, ability to manipulate variables in new ways, and unique behavioral measurement opportunities. Though implementation challenges exist for immersive virtual environment-based research methods, given the technology's unique capabilities, benefits can outweigh the costs in many instances. Immersive virtual environments may therefore prove an important addition to the array of tools available for advancing our understanding of communication in health care. Published by Elsevier Ireland Ltd.

Averting Uncertainty: A Practical Guide to Physical Activity Research in Australian Schools

ERIC Educational Resources Information Center

Rachele, Jerome N.; Cuddihy, Thomas F.; Washington, Tracy L.; McPhail, Steven M.

2013-01-01

Preventative health has become central to contemporary health care, identifying youth physical activity as a key factor in determining health and functioning. Schools offer a unique research setting due to distinctive methodological circumstances. However, school-based researchers face several obstacles in their endeavour to complete successful…

45 CFR 162.508 - Enumeration System.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Enumeration System. 162.508 Section 162.508 Public... ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health Plans § 162.508 Enumeration System. The Enumeration System must do all of the following: (a) Assign a single, unique— (1) HPID to a health plan...

45 CFR 162.508 - Enumeration System.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Enumeration System. 162.508 Section 162.508 Public... ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health Plans § 162.508 Enumeration System. The Enumeration System must do all of the following: (a) Assign a single, unique— (1) HPID to a health plan...

45 CFR 162.508 - Enumeration System.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Enumeration System. 162.508 Section 162.508 Public... ADMINISTRATIVE REQUIREMENTS Standard Unique Health Identifier for Health Plans § 162.508 Enumeration System. The Enumeration System must do all of the following: (a) Assign a single, unique— (1) HPID to a health plan...

Privacy and ethics in pediatric environmental health research-part II: protecting families and communities.

PubMed

Fisher, Celia B

2006-10-01

In pediatric environmental health research, information about family members is often directly sought or indirectly obtained in the process of identifying child risk factors and helping to tease apart and identify interactions between genetic and environmental factors. However, federal regulations governing human subjects research do not directly address ethical issues associated with protections for family members who are not identified as the primary "research participant." Ethical concerns related to family consent and privacy become paramount as pediatric environmental health research increasingly turns to questions of gene-environment interactions. In this article I identify issues arising from and potential solutions for the privacy and informed consent challenges of pediatric environmental health research intended to adequately protect the rights and welfare of children, family members, and communities. I first discuss family members as secondary research participants and then the specific ethical challenges of longitudinal research on late-onset environmental effects and gene-environment interactions. I conclude with a discussion of the confidentiality and social risks of recruitment and data collection of research conducted within small or unique communities, ethnic minority populations, and low-income families. The responsible conduct of pediatric environmental health research must be conceptualized as a goodness of fit between the specific research context and the unique characteristics of subjects and other family stakeholders.

Lay Worker Health Literacy: A Concept Analysis and Operational Definition.

PubMed

Cadman, Kathleen Paco

2017-10-01

The concept of lay worker health literacy is created by concurrently analyzing and synthesizing two intersecting concepts, lay workers and health literacy. Articulation of this unique intersection is the result of implementing a simplified Wilson's Concept Analysis Procedure. This process incorporates the following components: a) selecting a concept, b) determining the aims/purposes of analysis, c) identifying all uses of the concept, d) determining defining attributes, e) identifying a model case, f) identifying borderline, related, contrary, and illegitimate cases, g) identifying antecedents and consequences, and h) defining empirical referents. Furthermore, as current literature provides no operational definition for lay worker health literacy, one is created to contribute cohesion to the concept. © 2017 Wiley Periodicals, Inc.

Mental Health and Social Services: Results from the School Health Policies and Programs Study 2006

ERIC Educational Resources Information Center

Brener, Nancy D.; Weist, Mark; Adelman, Howard; Taylor, Linda; Vernon-Smiley, Mary

2007-01-01

Background: Schools are in a unique position not only to identify mental health problems among children and adolescents but also to provide links to appropriate services. This article describes the characteristics of school mental health and social services in the United States, including state- and district-level policies and school practices.…

Searching for religion and mental health studies required health, social science, and grey literature databases.

PubMed

Wright, Judy M; Cottrell, David J; Mir, Ghazala

2014-07-01

To determine the optimal databases to search for studies of faith-sensitive interventions for treating depression. We examined 23 health, social science, religious, and grey literature databases searched for an evidence synthesis. Databases were prioritized by yield of (1) search results, (2) potentially relevant references identified during screening, (3) included references contained in the synthesis, and (4) included references that were available in the database. We assessed the impact of databases beyond MEDLINE, EMBASE, and PsycINFO by their ability to supply studies identifying new themes and issues. We identified pragmatic workload factors that influence database selection. PsycINFO was the best performing database within all priority lists. ArabPsyNet, CINAHL, Dissertations and Theses, EMBASE, Global Health, Health Management Information Consortium, MEDLINE, PsycINFO, and Sociological Abstracts were essential for our searches to retrieve the included references. Citation tracking activities and the personal library of one of the research teams made significant contributions of unique, relevant references. Religion studies databases (Am Theo Lib Assoc, FRANCIS) did not provide unique, relevant references. Literature searches for reviews and evidence syntheses of religion and health studies should include social science, grey literature, non-Western databases, personal libraries, and citation tracking activities. Copyright © 2014 Elsevier Inc. All rights reserved.

Privacy and Ethics in Pediatric Environmental Health Research—Part II: Protecting Families and Communities

PubMed Central

Fisher, Celia B.

2006-01-01

Background In pediatric environmental health research, information about family members is often directly sought or indirectly obtained in the process of identifying child risk factors and helping to tease apart and identify interactions between genetic and environmental factors. However, federal regulations governing human subjects research do not directly address ethical issues associated with protections for family members who are not identified as the primary “research participant.” Ethical concerns related to family consent and privacy become paramount as pediatric environmental health research increasingly turns to questions of gene–environment interactions. Objectives In this article I identify issues arising from and potential solutions for the privacy and informed consent challenges of pediatric environmental health research intended to adequately protect the rights and welfare of children, family members, and communities. Discussion I first discuss family members as secondary research participants and then the specific ethical challenges of longitudinal research on late-onset environmental effects and gene–environment interactions. I conclude with a discussion of the confidentiality and social risks of recruitment and data collection of research conducted within small or unique communities, ethnic minority populations, and low-income families. Conclusions The responsible conduct of pediatric environmental health research must be conceptualized as a goodness of fit between the specific research context and the unique characteristics of subjects and other family stakeholders. PMID:17035154

The Quality Control of Data in a Clinical Database System—The Patient Identification Problem *

PubMed Central

Lai, J. Chi-Sang; Covvey, H.D.; Sevcik, K.C.; Wigle, E.D.

1981-01-01

Ensuring the accuracy of patient identification and the linkage of records with the appropriate patient owner is the first level of quality control of data in a clinical database system. Without a unique patient identifier, the fact that patient identity may be recorded at different places and times means that multiple identities may be associated with a given patient and new records associated with any of these identities. Even when a unique patient identifier is utilized, errors introduced in the data handling process can result in the same problems. The outcome is that the retrieval request for a given record may fail, or an erroneously identified record may be retrieved. We have studied each of the ways this fundamental problem occurs and propose a solution based on record linkage techniques to detect errors of this type. Specifically, we propose a patient identification scheme for the situation where no unique health identifier is available and detail a method to find patient records with erroneous identifiers.

Methodological and clinical implications of a three-in-one Russian doll design for tracking health trajectories and improving health and function through innovative exercise treatments in adults with disability.

PubMed

Rimmer, James H; Herman, Cassandra; Wingo, Brooks; Fontaine, Kevin; Mehta, Tapan

2018-03-14

Hybrid research designs targeting adults with neurologic disability are critical for improving the efficiency of models that can identify, track and intervene on identified health issues. Our Russian doll framework encompasses three study phases. Phase 1 involves prospectively following a cohort of participants with disability to examine the relationships between rates of health and functional deficits (e.g., pain, fatigue, deconditioning), functional measures (e.g., cardiorespiratory endurance, strength, balance), and environmental and sociocultural factors. In Phase 2, eligible participants with neurologic disability from Phase 1 (in our example, individuals with multiple sclerosis) are screened and randomized to a clinical exercise efficacy trial. In Phase 3, study participants are enrolled in a home-based teleexercise trial to test the feasibility and replicability of delivering the clinical exercise study in the home. This unique three-in-one Russian doll framework serves as a foundation for informing and guiding researchers and clinicians in treating certain health and functional deficits in people with neurologic disability using exercise as a primary treatment modality in both the clinical and home settings. It offers a unique perspective for understanding the critical issues of functioning, health maintenance and quality of life for people with neurologic disability across a longitudinal framework. Study 2 ClinicalTrials.gov identifier NCT02533882 (retroactively registered 03/06/2015). Study 3 ClinicalTrials.gov identifier NCT03108950 (retroactively registered 04/05/2017).

Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance

PubMed Central

Long, Judith A.; Wall, Stephen P.; Carr, Brendan G.; Satchell, Samantha N.; Braithwaite, R. Scott; Elbel, Brian

2015-01-01

Objectives. We sought to improve public health surveillance by using a geographic analysis of emergency department (ED) visits to determine local chronic disease prevalence. Methods. Using an all-payer administrative database, we determined the proportion of unique ED patients with diabetes, hypertension, or asthma. We compared these rates to those determined by the New York City Community Health Survey. For diabetes prevalence, we also analyzed the fidelity of longitudinal estimates using logistic regression and determined disease burden within census tracts using geocoded addresses. Results. We identified 4.4 million unique New York City adults visiting an ED between 2009 and 2012. When we compared our emergency sample to survey data, rates of neighborhood diabetes, hypertension, and asthma prevalence were similar (correlation coefficient = 0.86, 0.88, and 0.77, respectively). In addition, our method demonstrated less year-to-year scatter and identified significant variation of disease burden within neighborhoods among census tracts. Conclusions. Our method for determining chronic disease prevalence correlates with a validated health survey and may have higher reliability over time and greater granularity at a local level. Our findings can improve public health surveillance by identifying local variation of disease prevalence. PMID:26180983

Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance.

PubMed

Lee, David C; Long, Judith A; Wall, Stephen P; Carr, Brendan G; Satchell, Samantha N; Braithwaite, R Scott; Elbel, Brian

2015-09-01

We sought to improve public health surveillance by using a geographic analysis of emergency department (ED) visits to determine local chronic disease prevalence. Using an all-payer administrative database, we determined the proportion of unique ED patients with diabetes, hypertension, or asthma. We compared these rates to those determined by the New York City Community Health Survey. For diabetes prevalence, we also analyzed the fidelity of longitudinal estimates using logistic regression and determined disease burden within census tracts using geocoded addresses. We identified 4.4 million unique New York City adults visiting an ED between 2009 and 2012. When we compared our emergency sample to survey data, rates of neighborhood diabetes, hypertension, and asthma prevalence were similar (correlation coefficient = 0.86, 0.88, and 0.77, respectively). In addition, our method demonstrated less year-to-year scatter and identified significant variation of disease burden within neighborhoods among census tracts. Our method for determining chronic disease prevalence correlates with a validated health survey and may have higher reliability over time and greater granularity at a local level. Our findings can improve public health surveillance by identifying local variation of disease prevalence.

Challenges in Identifying Refugees in National Health Data Sets.

PubMed

Semere, Wagahta; Yun, Katherine; Ahalt, Cyrus; Williams, Brie; Wang, Emily A

2016-07-01

To evaluate publicly available data sets to determine their utility for studying refugee health. We searched for keywords describing refugees in data sets within the Society of General Internal Medicine Dataset Compendium and the Inter-University Consortium for Political and Social Research database. We included in our analysis US-based data sets with publicly available documentation and a self-defined, health-related focus that allowed for an examination of patient-level factors. Of the 68 data sets that met the study criteria, 37 (54%) registered keyword matches related to refugees, but only 2 uniquely identified refugees. Few health data sets identify refugee status among participants, presenting barriers to understanding refugees' health and health care needs. Information about refugee status in national health surveys should include expanded demographic questions and focus on mental health and chronic disease.

Sámi youth health, the role of climate change, and unique health-seeking behaviour.

PubMed

Kowalczewski, Emilie; Klein, Joern

2018-12-01

The goal of this cross-sectional qualitative study was to assess the impact of climate change on Sámi youth health, health care access, and health-seeking behaviour. Indigenous research methodology served as the basis of the investigation which utilised focus groups of youths and one-on-one interviews of adult community leaders using a semi-structured, open-ended questions. The results of the focus groups and interviews were then analysed to identify trends. We found that Sámi youth mostly associate the implications of climate change to their culture andcultural practices rather than the historical influence the environment had on Sámi health. They also take part in unique health-seeking behaviour by utilising both traditional and Western medicine simultaneously but without interaction due to social and structural factors. Our findings suggest that the health of Sámi teens is not tied to the environment directly, but through cultural activities.

A latent class analysis of weight-related health behaviors among 2- and 4-year college students and associated risk of obesity.

PubMed

Mathur, Charu; Stigler, Melissa; Lust, Katherine; Laska, Melissa

2014-12-01

Little is known about the complex patterning of weight-related health behaviors in 2- and 4-year college students. The objective of this study was to identify and describe unique classes of weight-related health behaviors among college students. Latent class analysis was used to identify homogenous, mutually exclusive classes of nine health behaviors that represent multiple theoretically/clinically relevant dimensions of obesity risk among 2- versus 4-year college students using cross-sectional statewide surveillance data (N = 17,584). Additionally, differences in class membership on selected sociodemographic characteristics were examined using a model-based approach. Analysis was conducted separately for both college groups, and five and four classes were identified for 2- and 4-year college students, respectively. Four classes were similar across 2- and 4-year college groups and were characterized as "mostly healthy dietary habits, active"; "moderately high screen time, active"; "moderately healthy dietary habits, inactive"; and "moderately high screen time, inactive." "Moderately healthy dietary habits, high screen time" was the additional class unique to 2-year college students. These classes differed on a number of sociodemographic characteristics, including the proportion in each class who were classified as obese. Implications for prevention scientists and future intervention programs are considered. © 2014 Society for Public Health Education.

Adolescent Depression in the Arab Region: A Systematic Literature Review.

PubMed

Dardas, Latefa A; Bailey, Donald E; Simmons, Leigh Ann

2016-08-01

Adolescent depression is a primary cause of global disability and burden with considerable variability across countries in its prevalence, diagnosis, management, and prognosis. No systematic reviews have been published on adolescent depression in Arab countries despite the unique sociocultural background that can play a major role in shaping Arab depressed adolescents' prognosis and response to treatment. The purpose of this study was to provide such a review with the goal of identifying the necessary foundations for culturally competent mental health care practices to address the unique needs of Arab adolescents and their families. We systematically reviewed PubMed, CINAHL, PsycINFO, and available Arabic databases. We adhered to the PRISMA statement to guide the process of identification, selection, and appraisal of the reviewed articles. No restrictions were applied on publication date. The search was completed in December 2015. A total of 199 unique articles met criteria for screening at the abstract level; 47 articles were selected for review in full text; and 27 articles were included in the final analysis. Four emerging themes were identified: (1) few robust prevalence estimates of adolescent depression are available in Arab countries; (2) depression varies based on the individual characteristics of Arab adolescents; (3) context influences Arab adolescents' risk of experiencing depression; and (4) the stigma of depression negatively impacts help-seeking process among Arab adolescents. This review highlights the need for more community-based detection efforts that employ developmentally and culturally appropriate measurement instruments for adolescent depression. Furthermore, findings suggest the need for culturally competent care that integrates indigenous health practices into modern mental health systems. Nurses, who form the greatest proportion of health personnel in all Arab countries, are uniquely situated to help Arab adolescents experiencing depression restore, maintain, and/or promote their mental health and wellbeing.

Health and safety needs in early care and education programs: what do directors, child health records, and national standards tell us?

PubMed

Alkon, Abbey; To, Kim; Mackie, Joanna F; Wolff, Mimi; Bernzweig, Jane

2010-01-01

To identify the overlapping and unique health and safety needs and concerns identified by early care and education (ECE) directors, health records, and observed compliance with national health and safety (NHS) standards. Cross-sectional study. 127 ECE programs from 5 California counties participated in the study, including 118 directors and 2,498 children's health records. Qualitative data were collected using standardized ECE directors' interviews to identify their health and safety concerns; and objective, quantitative data were collected using child health record reviews to assess regular health care, immunizations, health insurance, special health care needs, and screening tests and an observation Checklist of 66 key NHS standards collected by research assistants. The overlapping health and safety needs and concerns identified by the directors and through observations were hygiene and handwashing, sanitation and disinfection, supervision, and the safety of indoor and outdoor equipment. Some of the health and safety needs identified by only one assessment method were health and safety staff training, medical plans for children with special health care needs and follow-up on positive screening tests. Comprehensive, multimethod assessments are useful to identify health and safety needs and develop public health nursing interventions for ECE programs.

Use of OSHA inspections data for fatal occupational injury surveillance in New Jersey.

PubMed

Stanbury, M; Goldoft, M

1990-02-01

Occupational Safety and Health Administration (OSHA) computerized inspections data, death certificates, and medical examiner records identified 204 fatal occupational injuries in New Jersey, 1984-85. OSHA computerized data uniquely identified seven cases. They did not identify 35 fatalities under OSHA's jurisdiction, of which 24 were investigated by OSHA but not recorded, four were not considered work-related, and seven were not known to OSHA. Eighty-seven were outside OSHA's jurisdiction; 28 were among the self-employed who are not under the health and safety protection of any governmental agency.

Facilitators, challenges, and collaborative activities in faith and health partnerships to address health disparities.

PubMed

Kegler, Michelle C; Hall, Sarah M; Kiser, Mimi

2010-10-01

Interest in partnering with faith-based organizations (FBOs) to address health disparities has grown in recent years. Yet relatively little is known about these types of partnerships. As part of an evaluation of the Institute for Faith and Public Health Collaborations, representatives of 34 faith-health teams (n = 61) completed semi-structured interviews. Interviews were tape recorded, transcribed, and coded by two members of the evaluation team to identify themes. Major facilitators to faith-health collaborative work were passion and commitment, importance of FBOs in communities, favorable political climate, support from community and faith leaders, diversity of teams, and mutual trust and respect. Barriers unique to faith and health collaboration included discomfort with FBOs, distrust of either health agencies or FBOs, diversity within faith communities, different agendas, separation of church and state, and the lack of a common language. Findings suggest that faith-health partnerships face unique challenges but are capable of aligning resources to address health disparities.

Resilience in Rural Community-Dwelling Older Adults

ERIC Educational Resources Information Center

Wells, Margaret

2009-01-01

Context: Identifying ways to meet the health care needs of older adults is important because their numbers are increasing and they often have more health care issues. High resilience level may be one factor that helps older adults adjust to the hardships associated with aging. Rural community-dwelling older adults often face unique challenges such…

Organized Sport Trajectories from Childhood to Adolescence and Health Associations.

PubMed

Howie, Erin K; McVeigh, Joanne A; Smith, Anne J; Straker, Leon M

2016-07-01

The purpose of this study was to identify unique organized sport trajectories from early childhood to late adolescence in an Australian pregnancy cohort, the Raine Study. Participation in organized sport was assessed at ages 5, 8, 10, 14, and 17 yr. Physical activity, body composition, and self-rated physical and mental health were assessed at the age of 20 yr. Latent class analysis was used to identify patterns of sport participation. To assess the internal validity of the trajectory classes, differences in health characteristics between trajectories were analyzed using generalized linear models. For girls, three trajectory classes were identified: consistent sport participators (47.5%), sport dropouts (34.3%), and sport nonparticipators (18.1%). For boys, three trajectory classes were identified: consistent sport participators (55.2%), sport dropouts (36.9%), and sport joiners (8.1%). For girls, there were overall differences across trajectory classes in lean body mass (P = 0.003), lean mass index (P = 0.06), and physical health (P = 0.004). For boys, there were differences across classes in physical activity (P = 0.018), percent body fat (P = 0.002), lean body mass (P < 0.001), lean mass index (P < 0.001), physical health (P = 0.06), and depression scores (P = 0.27). This study identified unique, sex-specific trajectories of organized sport participation. The differences in health outcomes between trajectory classes, such as participants with consistent sport participation having more preferable health outcomes at the age of 20 yr, support the internal validity of the trajectories. Strategies are needed to identify and encourage those in the dropout trajectory to maintain their participation and those in the nonparticipator or joiner trajectories to join sport earlier. Specifically, interventions to encourage early sport participation in girls and help nonparticipating boys to join sport during adolescence may help more children receive the benefits of sport participation.

77 FR 60629 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-04

... International Organization for Standardization (ISO) Standard, we inadvertently mischaracterized a public... Secretary finds, for good cause, that the notice and comment process is impracticable, unnecessary, or...

Mobile Smog Simulator: New Capabilities to Study Urban Mixtures

EPA Pesticide Factsheets

A smog simulator developed by EPA scientists and engineers has unique capabilities that will provide information for assessing the health impacts of relevant multipollutant atmospheres and identify contributions of specific sources.

The health care professional as a modern abolitionist.

PubMed

O'Callaghan, Michael G

2012-01-01

Health care professionals are in a unique position to identify and to assist victims of human trafficking. Human trafficking today occurs both domestically and globally. It manifests in many forms, including adult and child forced labor, involuntary domestic servitude, adult and child sexual slavery, involuntary servitude, debt bondage, and child soldiers. This article offers insight into modern human trafficking and ways health care professionals can be activists.

Optimising the benefits of community health workers' unique position between communities and the health sector: A comparative analysis of factors shaping relationships in four countries.

PubMed

Kok, Maryse C; Ormel, Hermen; Broerse, Jacqueline E W; Kane, Sumit; Namakhoma, Ireen; Otiso, Lilian; Sidat, Moshin; Kea, Aschenaki Z; Taegtmeyer, Miriam; Theobald, Sally; Dieleman, Marjolein

2017-11-01

Community health workers (CHWs) have a unique position between communities and the health sector. The strength of CHWs' relationships with both sides influences their motivation and performance. This qualitative comparative study aimed at understanding similarities and differences in how relationships between CHWs, communities and the health sector were shaped in different Sub-Saharan African settings. The study demonstrates a complex interplay of influences on trust and CHWs' relationships with their communities and actors in the health sector. Mechanisms influencing relationships were feelings of (dis)connectedness, (un)familiarity and serving the same goals, and perceptions of received support, respect, competence, honesty, fairness and recognition. Sometimes, constrained relationships between CHWs and the health sector resulted in weaker relationships between CHWs and communities. The broader context (such as the socio-economic situation) and programme context (related to, for example, task-shifting, volunteering and supervision) in which these mechanisms took place were identified. Policy-makers and programme managers should take into account the broader context and could adjust CHW programmes so that they trigger mechanisms that generate trusting relationships between CHWs, communities and other actors in the health system. This can contribute to enabling CHWs to perform well and responding to the opportunities offered by their unique intermediary position.

A method for managing re-identification risk from small geographic areas in Canada

PubMed Central

2010-01-01

Background A common disclosure control practice for health datasets is to identify small geographic areas and either suppress records from these small areas or aggregate them into larger ones. A recent study provided a method for deciding when an area is too small based on the uniqueness criterion. The uniqueness criterion stipulates that an the area is no longer too small when the proportion of unique individuals on the relevant variables (the quasi-identifiers) approaches zero. However, using a uniqueness value of zero is quite a stringent threshold, and is only suitable when the risks from data disclosure are quite high. Other uniqueness thresholds that have been proposed for health data are 5% and 20%. Methods We estimated uniqueness for urban Forward Sortation Areas (FSAs) by using the 2001 long form Canadian census data representing 20% of the population. We then constructed two logistic regression models to predict when the uniqueness is greater than the 5% and 20% thresholds, and validated their predictive accuracy using 10-fold cross-validation. Predictor variables included the population size of the FSA and the maximum number of possible values on the quasi-identifiers (the number of equivalence classes). Results All model parameters were significant and the models had very high prediction accuracy, with specificity above 0.9, and sensitivity at 0.87 and 0.74 for the 5% and 20% threshold models respectively. The application of the models was illustrated with an analysis of the Ontario newborn registry and an emergency department dataset. At the higher thresholds considerably fewer records compared to the 0% threshold would be considered to be in small areas and therefore undergo disclosure control actions. We have also included concrete guidance for data custodians in deciding which one of the three uniqueness thresholds to use (0%, 5%, 20%), depending on the mitigating controls that the data recipients have in place, the potential invasion of privacy if the data is disclosed, and the motives and capacity of the data recipient to re-identify the data. Conclusion The models we developed can be used to manage the re-identification risk from small geographic areas. Being able to choose among three possible thresholds, a data custodian can adjust the definition of "small geographic area" to the nature of the data and recipient. PMID:20361870

Keeping our patients' secrets.

PubMed

Clough, J D; Rowan, D W; Nickelson, D E

1999-10-01

Protecting the privacy of the patient's medical record is a central issue in current discussions about a patient bill of rights, and controversy over a proposed "unique health identifier" has raised the decibel level of these discussions. At the heart of the debate is how best to resolve the inherent conflict between the individual's right to privacy and the need for access to patients' health information for reasons of public health, research, and health care management.

A Latent Class Analysis of Weight-Related Health Behaviors among 2- and 4-year College Students, and Associated Risk of Obesity

PubMed Central

Mathur, C; Stigler, M; Lust, K; Laska, M

2016-01-01

Little is known about the complex patterning of weight-related health behaviors in 2- and 4-year college students. The objective of this study was to identify and describe unique classes of weight-related health behaviors among college youth. Latent class analysis was used to identify homogenous, mutually exclusive classes of nine health behaviors which represent multiple theoretically/clinically relevant dimensions of obesity risk among 2- versus 4-year college students using cross-sectional statewide surveillance data (n= 17,584). Additionally, differences in class membership on selected sociodemographic characteristics were examined using a model-based approach. Analysis was conducted separately for both college groups, and 5 and 4 classes were identified for 2-and 4-year college students, respectively. Four classes were similar across 2-and 4-year college groups and were characterized as “mostly healthy dietary habits, active”, “moderately high screen time, active”, “moderately healthy dietary habits, inactive”, and “moderately high screen time, inactive”. “Moderately healthy dietary habits, high screen time” was the additional class unique to 2-year college students. These classes differed on a number of sociodemographic characteristics, including the proportion in each class who were classified as obese. Implications for prevention scientists and future intervention programs are considered. PMID:24990599

Monitoring and Protecting Health and Human Rights in Mexico.

PubMed

Gómez-Dantés; Frenk; Zorrilla

1995-01-01

This paper describes a unique system through which health care-related human rights are now being monitored and protected in Mexico. Based on the ombudsman concept, the system focuses on identifying and responding to violations of human rights and dignity which may occur in the context of health care delivery. Experience thus far has been encouraging; the Mexican population has identified and used the National Commission of Human Rights as a forum for a variety of health-related complaints. The Mexican system, while requiring strengthening and expansion, is an effort to integrate the monitoring and protection of health-related human rights into the broader field of human rights work in Mexico.

Comparing Demographic, Health Status and Psychosocial Strategies of Audience Segmentation to Promote Physical Activity

ERIC Educational Resources Information Center

Boslaugh, Sarah E.; Kreuter, Matthew W.; Nicholson, Robert A.; Naleid, Kimberly

2005-01-01

The goal of audience segmentation is to identify population subgroups that are homogeneous with respect to certain variables associated with a given outcome or behavior. When such groups are identified and understood, targeted intervention strategies can be developed to address their unique characteristics and needs. This study compares the…

Supplementary search methods were more effective and offered better value than bibliographic database searching: A case study from public health and environmental enhancement.

PubMed

Cooper, Chris; Lovell, Rebecca; Husk, Kerryn; Booth, Andrew; Garside, Ruth

2018-06-01

We undertook a systematic review to evaluate the health benefits of environmental enhancement and conservation activities. We were concerned that a conventional process of study identification, focusing on exhaustive searches of bibliographic databases as the primary search method, would be ineffective, offering limited value. The focus of this study is comparing study identification methods. We compare (1) an approach led by searches of bibliographic databases with (2) an approach led by supplementary search methods. We retrospectively assessed the effectiveness and value of both approaches. Effectiveness was determined by comparing (1) the total number of studies identified and screened and (2) the number of includable studies uniquely identified by each approach. Value was determined by comparing included study quality and by using qualitative sensitivity analysis to explore the contribution of studies to the synthesis. The bibliographic databases approach identified 21 409 studies to screen and 2 included qualitative studies were uniquely identified. Study quality was moderate, and contribution to the synthesis was minimal. The supplementary search approach identified 453 studies to screen and 9 included studies were uniquely identified. Four quantitative studies were poor quality but made a substantive contribution to the synthesis; 5 studies were qualitative: 3 studies were good quality, one was moderate quality, and 1 study was excluded from the synthesis due to poor quality. All 4 included qualitative studies made significant contributions to the synthesis. This case study found value in aligning primary methods of study identification to maximise location of relevant evidence. Copyright © 2017 John Wiley & Sons, Ltd.

Understanding critical health literacy: a concept analysis.

PubMed

Sykes, Susie; Wills, Jane; Rowlands, Gillian; Popple, Keith

2013-02-18

Interest in and debates around health literacy have grown over the last two decades and key to the discussions has been the distinction made between basic functional health literacy, communicative/interactive health literacy and critical health literacy. Of these, critical health literacy is the least well developed and differing interpretations of its constituents and relevance exist. The aim of this study is to rigorously analyse the concept of critical health literacy in order to offer some clarity of definition upon which appropriate theory, well grounded practice and potential measurement tools can be based. The study uses a theoretical and colloquial evolutionary concept analysis method to systematically identify the features associated with this concept. A unique characteristic of this method is that it practically combines an analysis of the literature with in depth interviews undertaken with practitioners and policy makers who have an interest in the field. The study also analyses how the concept is understood across the contexts of time, place, discipline and use by health professionals, policy makers and academics. Findings revealed a distinct set of characteristics of advanced personal skills, health knowledge, information skills, effective interaction between service providers and users, informed decision making and empowerment including political action as key features of critical health literacy. The potential consequences of critical health literacy identified are in improving health outcomes, creating more effective use of health services and reducing inequalities in health thus demonstrating the relevance of this concept to public health and health promotion. While critical health literacy is shown to be a unique concept, there remain significant contextual variations in understanding particularly between academics, practitioners and policy makers. Key attributes presented as part of this concept when it was first introduced in the literature, particularly those around empowerment, social and political action and the existence of the concept at both an individual and population level, have been lost in more recent representations. This has resulted in critical health literacy becoming restricted to a higher order cognitive individual skill rather than a driver for political and social change. The paper argues that in order to retain the uniqueness and usefulness of the concept in practice efforts should be made to avoid this dilution of meaning.

Intrasectoral variation in mission and values: the case of the Catholic health systems.

PubMed

White, Kenneth R; Dandi, Roberto

2009-01-01

Catholic health systems represent a unique sector of nonprofit health care delivery organizations because they must be accountable to institutional pressures of the Roman Catholic Church, in addition to responsiveness to market pressures. Mission statements and values are purported to be the driving force of Catholic institutional identity. Central to the understanding of the Catholic health care delivery sector is the exploration of variation in mission and values statements across the homogeneous field of organizations. The purposes of this study were to identify expressed organizational identity variation-in terms of keywords in mission statements and values-of Catholic health systems in the United States by applying a methodology that integrates text and social network analytical techniques. Data were obtained from the Web site of The Catholic Health Association of the United States and the Web sites of 50 Catholic health systems in 2007. Catholic health system mission statements and values were assessed using a cross-sectional study design. Text analysis and social network techniques were employed to identify the most central words in the texts and linkages among mission statement components and values. This study identifies the components of a common mission statement and the most shared and unique values for a Catholic health system. Even with tremendous similarity, there is also evidence of intrasectoral variation between Catholic health system keywords in mission statements and values. Management implications include the consideration of word relationships developing and constructing mission and values statements to form the framework for strategic vision and management decision making, to assess potential partnership arrangements based on expressed mission statements and values, and to use in executing due diligence in mergers and partnerships.

Scanning the horizon in a decentralized healthcare system: the Canadian experience.

PubMed

Morrison, Andra

2012-07-01

Canada has a highly decentralized health care system with 13 provinces and territories delivering health care within their own respective jurisdictions. Decisions regarding which innovative health technologies to adopt are often driven by the unique health care priorities of each jurisdiction's population. To understand these needs, the Canadian Agency for Drugs and Technologies in Health's (CADTH's) Early Awareness Service has expanded its activities. In addition to proactively scanning the horizon for new and emerging health technologies, the Early Awareness Service also scans the horizon for national and jurisdictional health policy issues. This paper looks at CADTH's process for identifying and monitoring policy issues at a national and jurisdictional level. CADTH's Early Awareness Service delivers timely information on emerging health care concerns and technologies that may affect health care finances, facilities, operations, and patient care. The identification of important policy issues can help determine which new and emerging technologies will have the most significant impact on the health care system. The information that CADTH scans can also be used to help decision-makers prepare for potential developments and events that may have an impact on health care systems. By improving its capability to identify and share policy issues across and within jurisdictions, CADTH is better situated to provide information that can be used by policy-makers to help them plan and anticipate for the introduction of new technologies and future developments affecting the unique health care needs of their jurisdictions.

Use of OSHA inspections data for fatal occupational injury surveillance in New Jersey.

PubMed Central

Stanbury, M; Goldoft, M

1990-01-01

Occupational Safety and Health Administration (OSHA) computerized inspections data, death certificates, and medical examiner records identified 204 fatal occupational injuries in New Jersey, 1984-85. OSHA computerized data uniquely identified seven cases. They did not identify 35 fatalities under OSHA's jurisdiction, of which 24 were investigated by OSHA but not recorded, four were not considered work-related, and seven were not known to OSHA. Eighty-seven were outside OSHA's jurisdiction; 28 were among the self-employed who are not under the health and safety protection of any governmental agency. PMID:2297066

Kindergarten Screening and Parent Engagement to Enhance Mental Health Service Utilization

ERIC Educational Resources Information Center

Girio, Erin L.

2010-01-01

The majority of youth in need of mental health services do not receive intervention as many are not identified as having a problem or their families experience practical or attitudinal barriers that interfere with service utilization. The school environment provides a unique point of access to reach all children, yet this setting has been…

The Health Care Professional as a Modern Abolitionist

PubMed Central

O'Callaghan, Michael G

2012-01-01

Health care professionals are in a unique position to identify and to assist victims of human trafficking. Human trafficking today occurs both domestically and globally. It manifests in many forms, including adult and child forced labor, involuntary domestic servitude, adult and child sexual slavery, involuntary servitude, debt bondage, and child soldiers. This article offers insight into modern human trafficking and ways health care professionals can be activists. PMID:22745622

Are attributes of organizational performance in large health care organizations relevant in primary care practices?

PubMed

Orzano, A John; Tallia, Alfred F; Nutting, Paul A; Scott-Cawiezell, Jill; Crabtree, Benjamin F

2006-01-01

Are organizational attributes associated with better health outcomes in large health care organizations applicable to primary care practices? In comparative case studies of two community family practices, it was found that attributes of organizational performance identified in larger health care organizations must be tailored to their unique context of primary care. Further work is required to adapt or establish the significance of the attributes of management infrastructure and information mastery.

The unique effects of environmental strategies in health promotion campaigns: a review.

PubMed

Randolph, Karen A; Whitaker, Pippin; Arellano, Adriana

2012-08-01

Various strategies are used as tools in health promotion campaigns to increase health-related outcomes among target populations. Evaluations of these campaigns examine effects on changing people's knowledge, attitudes, and/or behaviors. Most evaluations examine the combined impact of multiple strategies. Less is known about the unique effects of particular strategies. To address this gap, we used highly systematic methods to identify and review scientifically rigorous evaluations of 18 campaigns that examined the unique effects of three sets of intervention strategies (entertainment education, law enforcement, and mass media) on changes in knowledge, attitudes, and practice with regard to various health behaviors. Results showed differences in evaluation processes based on the type of strategy used to promote campaign messages. For instance, evaluations of mass-media based campaigns were more likely to examine changes in knowledge, relative to evaluations of campaigns that used law enforcement strategies. In addition, campaign effects varied by particular strategies. Mass media-based campaigns were more likely to affect knowledge, relative to behaviors. Law enforcement and entertainment education-based campaigns showed positive effects on behaviors. The implications for planning and evaluating health promotion campaigns are described. Copyright © 2012 Elsevier Ltd. All rights reserved.

Schools and Natural Disaster Recovery: The Unique and Vital Role That Teachers and Education Professionals Play in Ensuring the Mental Health of Students Following Natural Disasters

ERIC Educational Resources Information Center

Le Brocque, Robyne; De Young, Alexandra; Montague, Gillian; Pocock, Steven; March, Sonja; Triggell, Nikki; Rabaa, Claire; Kenardy, Justin

2017-01-01

There is growing evidence that children are vulnerable to poor psychological outcomes following exposure to a range of potentially traumatic events. Teachers are in a unique and well-placed position to provide vital support to children following potentially traumatic events and to also provide a vital role in helping to identify children who may…

A qualitative analysis of environmental policy and children's health in Mexico

PubMed Central

2010-01-01

Background Since Mexico's joining the North American Free Trade Agreement (NAFTA) and the Organization for Economic Cooperation and Development (OECD) in 1994, it has witnessed rapid industrialization. A byproduct of this industrialization is increasing population exposure to environmental pollutants, of which some have been associated with childhood disease. We therefore identified and assessed the adequacy of existing international and Mexican governance instruments and policy tools to protect children from environmental hazards. Methods We first systematically reviewed PubMed, the Mexican legal code and the websites of the United Nations, World Health Organization, NAFTA and OECD as of July 2007 to identify the relevant governance instruments, and analyzed the approach these instruments took to preventing childhood diseases of environmental origin. Secondly, we interviewed a purposive sample of high-level government officials, researchers and non-governmental organization representatives, to identify their opinions and attitudes towards children's environmental health and potential barriers to child-specific protective legislation and implementation. Results We identified only one policy tool describing specific measures to reduce developmental neurotoxicity and other children's health effects from lead. Other governance instruments mention children's unique vulnerability to ozone, particulate matter and carbon monoxide, but do not provide further details. Most interviewees were aware of Mexican environmental policy tools addressing children's health needs, but agreed that, with few exceptions, environmental policies do not address the specific health needs of children and pregnant women. Interviewees also cited state centralization of power, communication barriers and political resistance as reasons for the absence of a strong regulatory platform. Conclusions The Mexican government has not sufficiently accounted for children's unique vulnerability to environmental contaminants. If regulation and legislation are not updated and implemented to protect children, increases in preventable exposures to toxic chemicals in the environment may ensue. PMID:20331868

Validated methods for identifying tuberculosis patients in health administrative databases: systematic review.

PubMed

Ronald, L A; Ling, D I; FitzGerald, J M; Schwartzman, K; Bartlett-Esquilant, G; Boivin, J-F; Benedetti, A; Menzies, D

2017-05-01

An increasing number of studies are using health administrative databases for tuberculosis (TB) research. However, there are limitations to using such databases for identifying patients with TB. To summarise validated methods for identifying TB in health administrative databases. We conducted a systematic literature search in two databases (Ovid Medline and Embase, January 1980-January 2016). We limited the search to diagnostic accuracy studies assessing algorithms derived from drug prescription, International Classification of Diseases (ICD) diagnostic code and/or laboratory data for identifying patients with TB in health administrative databases. The search identified 2413 unique citations. Of the 40 full-text articles reviewed, we included 14 in our review. Algorithms and diagnostic accuracy outcomes to identify TB varied widely across studies, with positive predictive value ranging from 1.3% to 100% and sensitivity ranging from 20% to 100%. Diagnostic accuracy measures of algorithms using out-patient, in-patient and/or laboratory data to identify patients with TB in health administrative databases vary widely across studies. Use solely of ICD diagnostic codes to identify TB, particularly when using out-patient records, is likely to lead to incorrect estimates of case numbers, given the current limitations of ICD systems in coding TB.

Assessing the impact of a medical librarian on identification of valid and actionable practice gaps for a continuing medical education committee.

PubMed

Bartkowiak, Barbara A; Safford, Lindsey A; Stratman, Erik J

2014-01-01

Identifying educational needs related to professional practice gaps can be a complex process for continuing medical education (CME) committees and for physicians who submit activity applications. Medical librarians possess unique skills that may be useful for identifying practice gaps relevant to CME committees. We assessed this assumption by assessing a medical librarian's contributions to practice gap identification for the Marshfield Clinic's CME Committee. We reviewed all locally relevant, locally actionable practice gaps identified annually by various stakeholders and presented to our CME Committee from 2010 to 2013. Total numbers of practice gaps identified, total categorized as actionable, and numbers of subsequent activities resulting from these gaps were calculated for each year. Medical librarian totals were compared to those of other CME committee stakeholders to determine the relative contribution. The medical librarian identified unique, actionable published practice gaps that directly contributed to CME activity planning. For each study year, contributions by the medical librarian grew, from 0 of 27 actionable gaps validated by CME Committee in 2010 to 49 of 108 (45.4%) in 2013. With the librarian's assistance, the number of valid practice gaps submitted between 2010 and 2013 by stakeholders climbed from 23 for 155 activities (14.8%) to 133 for 157 activities (84.7%). Medical librarians can provide a valuable service to CME committees by identifying valid professional practice gaps that inform decisions about educational activities aimed at improving clinical practice. Medical librarians bring into deliberations unique information, including national health policy priorities, practice gaps found in the literature, and point-of-care search engine statistics. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

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

PubMed Central

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

2017-01-01

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

Innovative research methods for studying treatments for rare diseases: methodological review.

PubMed

Gagne, Joshua J; Thompson, Lauren; O'Keefe, Kelly; Kesselheim, Aaron S

2014-11-24

To examine methods for generating evidence on health outcomes in patients with rare diseases. Methodological review of existing literature. PubMed, Embase, and Academic Search Premier searched for articles describing innovative approaches to randomized trial design and analysis methods and methods for conducting observational research in patients with rare diseases. We assessed information related to the proposed methods, the specific rare disease being studied, and outcomes from the application of the methods. We summarize methods with respect to their advantages in studying health outcomes in rare diseases and provide examples of their application. We identified 46 articles that proposed or described methods for studying patient health outcomes in rare diseases. Articles covered a wide range of rare diseases and most (72%) were published in 2008 or later. We identified 16 research strategies for studying rare disease. Innovative clinical trial methods minimize sample size requirements (n=4) and maximize the proportion of patients who receive active treatment (n=2), strategies crucial to studying small populations of patients with limited treatment choices. No studies describing unique methods for conducting observational studies in patients with rare diseases were identified. Though numerous studies apply unique clinical trial designs and considerations to assess patient health outcomes in rare diseases, less attention has been paid to innovative methods for studying rare diseases using observational data. © Gagne et al 2014.

The Social Life of Health Insurance in Low- to Middle-income Countries: An Anthropological Research Agenda.

PubMed

Dao, Amy; Nichter, Mark

2016-03-01

The following article identifies new areas for engaged medical anthropological research on health insurance in low- and middle-income countries (LMICs). Based on a review of the literature and pilot research, we identify gaps in how insurance is understood, administered, used, and abused. We provide a historical overview of insurance as an emerging global health panacea and then offer brief assessments of three high-profile attempts to provide universal health coverage. Considerable research on health insurance in LMICs has been quantitative and focused on a limited set of outcomes. To advance the field, we identify eight productive areas for future ethnographic research that will add depth to our understanding of the social life and impact of health insurance in LMICs. Anthropologists can provide unique insights into shifting health and financial practices that accompany insurance coverage, while documenting insurance programs as they evolve and respond to contingencies. © 2015 by the American Anthropological Association.

Research in progress: FY 1992. Summaries of projects

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

Not Available

1993-08-01

The Biological and Environmental Research (BER) Program of OHER has two main missions: (1) to develop the knowledge base necessary to identify, understand, and anticipate the long-term health and environmental consequences of energy use and development and (2) to utilize the Department`s unique scientific and technological capabilities to solve major scientific problems in medicine, biology, and the environment. These missions reflect a commitment to develop the beneficial uses of advanced energy technologies while at the same time assuring that any potentially adverse health and environmental impacts of the Nation`s energy policies are fully identified and understood. The BER Program includesmore » research in atmospheric, marine, and terrestrial processes, including the linkage between the use in greenhouse gases, carbon dioxide, and regional and global climate change; in molecular and subcellular mechanisms underlying human somatic and genetic processes and their responses to energy-related environmental toxicants; in nuclear medicine, structural biology, the human genome, measurement sciences and instrumentation, and other areas that require the unique capabilities of the Department`s laboratory system. The principal areas of research are Health Research and Environmental Research.« less

Effectiveness of a Unique Support Group for Physicians in a Physician Health Program.

PubMed

Sanchez, Luis T; Candilis, Philip J; Arnstein, Fredrick; Eaton, Judith; Barnes Blood, Diana; Chinman, Gary A; Bresnahan, Linda R

2016-01-01

State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health.

The Importance of Partnerships in Local Health Department Practice Among Communities With Exceptional Maternal and Child Health Outcomes.

PubMed

Klaiman, Tamar; Chainani, Anjali; Bekemeier, Betty

2016-01-01

The purpose of this study was to identify unique practices underway in communities that have been empirically identified as having achieved exceptional maternal and child health (MCH) outcomes compared with their peers. We used a qualitative, positive deviance approach to identify practices implemented by local health department (LHD) jurisdictions in Florida, Washington, and New York that achieved better MCH outcomes than expected compared with their in-state peer jurisdictions. We identified a total of 50 LHDs in jurisdictions that had better than expected MCH outcomes compared with their peers, and we conducted 39 hour-long semistructured interviews with LHD staff. We conducted inductive thematic analysis to identify key themes and subthemes across all LHD cases in the sample. Partnerships with providers, partnerships for data collection/assessment, and partnerships with community-based organizations were associated with exceptional MCH outcomes based on our interviews. This study offers specific examples of practices LHDs can implement to improve MCH outcomes, even with limited resources, based on the practices of high-performing local health jurisdictions.

Couple-level Minority Stress: An Examination of Same-sex Couples' Unique Experiences.

PubMed

Frost, David M; LeBlanc, Allen J; de Vries, Brian; Alston-Stepnitz, Eli; Stephenson, Rob; Woodyatt, Cory

2017-12-01

Social stress resulting from stigma, prejudice, and discrimination-"minority stress"-negatively impacts sexual minority individuals' health and relational well-being. The present study examined how being in a same-sex couple can result in exposure to unique minority stressors not accounted for at the individual level. Relationship timeline interviews were conducted with 120 same-sex couples equally distributed across two study sites (Atlanta and San Francisco), gender (male and female), and relationship duration (at least six months but less than three years, at least three years but less than seven years, and seven or more years). Directed content analyses identified 17 unique couple-level minority stressors experienced within nine distinct social contexts. Analyses also revealed experiences of dyadic minority stress processes (stress discrepancies and stress contagion). These findings can be useful in future efforts to better understand and address the cumulative impact of minority stress on relational well-being and individual health.

Annual Surveillance Summary: Acinetobacter Infections in the Military Health System, 2015

DTIC Science & Technology

2017-05-01

pharmacy data to assess prescription practices, the Standard Inpatient Data Record to determine healthcare-associated exposures, Defense Manpower ...7 Results ...System (CHCS) microbiology data were used to identify positive Acinetobacter species laboratory results . A unique Acinetobacter species infection

Psychosocial Determinants of Health among Incarcerated Black Women: A Systematic Literature Review

PubMed Central

Mahaffey, Carlos; Stevens-Watkins, Danelle; Knighton, Joi-Sheree'

2016-01-01

Black women are disproportionately incarcerated and experience greater health outcomes compared to White and Hispanic women. This systematic literature review aims to identify the major psychosocial determinants of health and service utilization among incarcerated Black women. The ecological model for health behavior was used to frame the literature presented and explain how individual, interpersonal, and societal level factors impact health. Nineteen articles met inclusion criteria for this review. Psychosocial factors were identified at each level such as: mental health problems (individual); sexual behavior (interpersonal); and dysfunctional/negative relationships (community). The factors form a dynamic relationship that influences the health and service utilization of Black women and do not exist independently. Future research should examine within-group differences to highlight the unique needs and culture within the Black community in the context of psychosocial determinants. This synthesis of relevant studies can serve to inform change in correctional policies, practices, and reduce health disparities. PMID:27133512

Understanding critical health literacy: a concept analysis

PubMed Central

2013-01-01

Background Interest in and debates around health literacy have grown over the last two decades and key to the discussions has been the distinction made between basic functional health literacy, communicative/interactive health literacy and critical health literacy. Of these, critical health literacy is the least well developed and differing interpretations of its constituents and relevance exist. The aim of this study is to rigorously analyse the concept of critical health literacy in order to offer some clarity of definition upon which appropriate theory, well grounded practice and potential measurement tools can be based. Method The study uses a theoretical and colloquial evolutionary concept analysis method to systematically identify the features associated with this concept. A unique characteristic of this method is that it practically combines an analysis of the literature with in depth interviews undertaken with practitioners and policy makers who have an interest in the field. The study also analyses how the concept is understood across the contexts of time, place, discipline and use by health professionals, policy makers and academics. Results Findings revealed a distinct set of characteristics of advanced personal skills, health knowledge, information skills, effective interaction between service providers and users, informed decision making and empowerment including political action as key features of critical health literacy. The potential consequences of critical health literacy identified are in improving health outcomes, creating more effective use of health services and reducing inequalities in health thus demonstrating the relevance of this concept to public health and health promotion. Conclusions While critical health literacy is shown to be a unique concept, there remain significant contextual variations in understanding particularly between academics, practitioners and policy makers. Key attributes presented as part of this concept when it was first introduced in the literature, particularly those around empowerment, social and political action and the existence of the concept at both an individual and population level, have been lost in more recent representations. This has resulted in critical health literacy becoming restricted to a higher order cognitive individual skill rather than a driver for political and social change. The paper argues that in order to retain the uniqueness and usefulness of the concept in practice efforts should be made to avoid this dilution of meaning. PMID:23419015

International trends in health science librarianship part 17: a comparison of health science libraries with academic and research libraries.

PubMed

Murphy, Jeannette

2015-12-01

Over the last 4 years this Regular Feature has looked at trends in health science librarianship in the 21st century. Although there are still a few more regions to be covered in this series, this issue explores general trends in academic and research libraries with a view to discovering whether the trends identified for health science libraries are similar. Are health science libraries unique? Or do their experiences mirror those found in the wider world of academic and research libraries? © 2015 Health Libraries Group.

Measurement equivalence: a glossary for comparative population health research.

PubMed

Morris, Katherine Ann

2018-03-06

Comparative population health studies are becoming more common and are advancing solutions to crucial public health problems, but decades-old measurement equivalence issues remain without a common vocabulary to identify and address the biases that contribute to non-equivalence. This glossary defines sources of measurement non-equivalence. While drawing examples from both within-country and between-country studies, this glossary also defines methods of harmonisation and elucidates the unique opportunities in addition to the unique challenges of particular harmonisation methods. Its primary objective is to enable population health researchers to more clearly articulate their measurement assumptions and the implications of their findings for policy. It is also intended to provide scholars and policymakers across multiple areas of inquiry with tools to evaluate comparative research and thus contribute to urgent debates on how to ameliorate growing health disparities within and between countries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Can banks offer digital keys for health care?

PubMed

Casillas, John

2013-01-01

In the quest to implement electronic health care records, health care stakeholders have uncovered an elephant in the room - how to implement patient identity and integrity solutions. Without this, linking the unique records of an individual is impossible. An inaccurate record can be dangerous for prescribing treatment. Yet many consider a unique patient identifier as an unacceptable privacy risk. Medical banking, or the convergence of banking and heath IT systems, is spawning new ideas that could impact on this difficult area. This article suggests that new forms of efficiency in payment processing may yield a common, cross-industry technology platform for managing digital identity by banks. Redefining a bank based on core competencies, the article looks at three areas: (1) the "identity theft arms race"; (2) innovations in payment processing; and (3) consumer engagement, and suggests that, as banking and health care systems converge, digital identity may become the new money. This realization may find banks fully engaged in helping health care to overcome the challenge of patient identity and integrity.

Health care employee perceptions of patient-centered care.

PubMed

Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L

2015-03-01

Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.

Health Care Employee Perceptions of Patient-Centered Care: A Photovoice Project

PubMed Central

Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L.

2015-01-01

Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspective is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, several areas for improvement were identified. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. PMID:25274626

Efficient Privacy-Enhancing Techniques for Medical Databases

NASA Astrophysics Data System (ADS)

Schartner, Peter; Schaffer, Martin

In this paper, we introduce an alternative for using linkable unique health identifiers: locally generated system-wide unique digital pseudonyms. The presented techniques are based on a novel technique called collision-free number generation which is discussed in the introductory part of the article. Afterwards, attention is payed onto two specific variants of collision-free number generation: one based on the RSA-Problem and the other one based on the Elliptic Curve Discrete Logarithm Problem. Finally, two applications are sketched: centralized medical records and anonymous medical databases.

Identifying content-based and relational techniques to change behaviour in motivational interviewing.

PubMed

Hardcastle, Sarah J; Fortier, Michelle; Blake, Nicola; Hagger, Martin S

2017-03-01

Motivational interviewing (MI) is a complex intervention comprising multiple techniques aimed at changing health-related motivation and behaviour. However, MI techniques have not been systematically isolated and classified. This study aimed to identify the techniques unique to MI, classify them as content-related or relational, and evaluate the extent to which they overlap with techniques from the behaviour change technique taxonomy version 1 [BCTTv1; Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., … Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46, 81-95]. Behaviour change experts (n = 3) content-analysed MI techniques based on Miller and Rollnick's [(2013). Motivational interviewing: Preparing people for change (3rd ed.). New York: Guildford Press] conceptualisation. Each technique was then coded for independence and uniqueness by independent experts (n = 10). The experts also compared each MI technique to those from the BCTTv1. Experts identified 38 distinct MI techniques with high agreement on clarity, uniqueness, preciseness, and distinctiveness ratings. Of the identified techniques, 16 were classified as relational techniques. The remaining 22 techniques were classified as content based. Sixteen of the MI techniques were identified as having substantial overlap with techniques from the BCTTv1. The isolation and classification of MI techniques will provide researchers with the necessary tools to clearly specify MI interventions and test the main and interactive effects of the techniques on health behaviour. The distinction between relational and content-based techniques within MI is also an important advance, recognising that changes in motivation and behaviour in MI is a function of both intervention content and the interpersonal style in which the content is delivered.

Supervisory needs of research doctoral students in a university teaching hospital setting.

PubMed

Caldwell, Patrina Hy; Oldmeadow, Wendy; Jones, Cheryl A

2012-10-01

Teaching hospitals affiliated with universities are now common sites for research higher degree supervision. We hypothesised that the hospital environment poses unique challenges to supervision compared with the traditional university research institute setting. This study aimed to identify and rank important supervision issues in a clinical setting from the students' perspective. Using the Delphi method to explore issues and facilitate consensus, small group discussions were conducted with 10 research doctoral students from a tertiary teaching hospital. We identified supervision issues that are unique to the hospital-based context. These include the demands placed on supervisors combining clinical and supervisory roles, the challenges of academic medical/scientific writing and career issues for students who are already established in their professions. Other issues identified, common to all doctoral students, include differing expectations between students and supervisors (with students wanting support for their career plans, training in research skills and increasing autonomy and responsibility), supervisor access, quality and frequency of meetings, lack of training in writing and dealing with conflicts. Our research identified that postgraduate students of supervisors who combine clinical and supervisory roles report significant issues with supervision, some of which are unique to the clinical setting. Clinician researchers who supervise postgraduate students need to balance clinical and supervisory responsibilities, identify and negotiate student expectations early in candidature and provide career counselling to students who are already highly experienced. Furthermore, clinician supervisors should undertake postgraduate supervisor training programme tailored to the hospital setting to better support their students. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Satellite stories: capturing professional experiences of academic health sciences librarians working in delocalized health sciences programs.

PubMed

Phinney, Jackie; Horsman, Amanda Rose

2018-01-01

Health sciences training programs have progressively expanded onto satellite campuses, allowing students the opportunity to learn in communities away from an academic institution's main campus. This expansion has encouraged a new role for librarians to assume, in that a subset of health sciences librarians identify as "satellite librarians" who are permanently located at a distance from the main campus. Due to the unique nature of this role and lack of existing data on the topic, the authors investigated the experiences and perceptions of this unique group of information professionals. An electronic survey was distributed to health sciences librarians via two prominent North American email discussion lists. Questions addressed the librarians' demographics, feelings of social inclusion, technological support, autonomy, professional support, and more. Eighteen surveys were analyzed. While several respondents stated that they had positive working relationships with colleagues, many cited issues with technology, scheduling, and lack of consideration as barriers to feeling socially included at both the parent and local campuses. Social inclusion, policy creation, and collection management issues were subject to their unique situations and their colleagues' perceptions of their roles as satellite librarians. The results from this survey suggest that the role of the academic health sciences librarian at the satellite campus needs to be clearly communicated and defined. This, in turn, will enhance the experience for the librarian and provide better service to the client.

Accuracy of Probabilistic Linkage Using the Enhanced Matching System for Public Health and Epidemiological Studies.

PubMed

Aldridge, Robert W; Shaji, Kunju; Hayward, Andrew C; Abubakar, Ibrahim

2015-01-01

The Enhanced Matching System (EMS) is a probabilistic record linkage program developed by the tuberculosis section at Public Health England to match data for individuals across two datasets. This paper outlines how EMS works and investigates its accuracy for linkage across public health datasets. EMS is a configurable Microsoft SQL Server database program. To examine the accuracy of EMS, two public health databases were matched using National Health Service (NHS) numbers as a gold standard unique identifier. Probabilistic linkage was then performed on the same two datasets without inclusion of NHS number. Sensitivity analyses were carried out to examine the effect of varying matching process parameters. Exact matching using NHS number between two datasets (containing 5931 and 1759 records) identified 1071 matched pairs. EMS probabilistic linkage identified 1068 record pairs. The sensitivity of probabilistic linkage was calculated as 99.5% (95%CI: 98.9, 99.8), specificity 100.0% (95%CI: 99.9, 100.0), positive predictive value 99.8% (95%CI: 99.3, 100.0), and negative predictive value 99.9% (95%CI: 99.8, 100.0). Probabilistic matching was most accurate when including address variables and using the automatically generated threshold for determining links with manual review. With the establishment of national electronic datasets across health and social care, EMS enables previously unanswerable research questions to be tackled with confidence in the accuracy of the linkage process. In scenarios where a small sample is being matched into a very large database (such as national records of hospital attendance) then, compared to results presented in this analysis, the positive predictive value or sensitivity may drop according to the prevalence of matches between databases. Despite this possible limitation, probabilistic linkage has great potential to be used where exact matching using a common identifier is not possible, including in low-income settings, and for vulnerable groups such as homeless populations, where the absence of unique identifiers and lower data quality has historically hindered the ability to identify individuals across datasets.

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

PubMed

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

2018-06-01

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

Resveratrol Content in Seeds of Peanut Germlasm Quantified by HPLC.

USDA-ARS?s Scientific Manuscript database

trans-Resveratrol (trans-3,5,4'-trihydroxystilbene), a polyphenolic compound uniquely identified in plants greatly contributes to human health. Peanut (Arachis hypogaea L.) seeds of 20 germplasm accessions were harvested from the same field and used for resveratrol analysis by high performance liqui...

Linking a Total Ankle Arthroplasty Registry to Medicare Inpatient Claims without Unique Identifiers.

PubMed

Raman, Sudha R; Hammill, Bradley G; Queen, Robin M; Adams, Samuel B; Curtis, Lesley H

2018-06-20

Linking clinical registries to administrative claims data enables researchers to capitalize on the specific strengths of each data source with respect to the depth, breadth, and completeness of information. The objectives of this study were to link a health-system-based orthopaedic surgery registry to U.S. Medicare claims data without the use of unique identifiers and to assess the representativeness of the linked records. The registry included clinical data for patients ≥65 years of age who underwent elective, inpatient total ankle arthroplasty (TAA) in a single health system during the period of 2007 through 2012. Registry participants were identified within the Medicare data by linking registry procedures to TAA procedures within the claims data using a combination of procedure date, patient date of birth, and patient sex. We assessed the representativeness of the linked records by comparing them to both unlinked registry records and unlinked Medicare records for TAA procedures. Additionally, we described the availability of postsurgical data for linked records. Of 360 TAA registry participants ≥65 years of age, 280 (77.8%) were matched to a Medicare record; 250 (89.3%) of those 280 participants were matched on the basis of a linking rule that required an exact match for procedure date, date of birth, and sex. The 280 linked records comprised 5.5% of all Medicare TAA procedures among beneficiaries ≥65 years of age enrolled in the fee-for-service Medicare program (n = 5,070). Compared with linked records, unlinked records were more likely to be for patients 65 to 69 years old, but the 2 groups were similar in terms of sex, body mass index, and availability of clinical measurements. Of the linked records, 214 (76.4%) had ≥3 years of postoperative follow-up claims data. Linkage without unique patient identifiers between an orthopaedic registry and Medicare claims data is feasible, allows for assessment of representativeness, and creates a unique resource of longitudinal data for research.

Construction of a multisite DataLink using electronic health records for the identification, surveillance, prevention, and management of diabetes mellitus: the SUPREME-DM project.

PubMed

Nichols, Gregory A; Desai, Jay; Elston Lafata, Jennifer; Lawrence, Jean M; O'Connor, Patrick J; Pathak, Ram D; Raebel, Marsha A; Reid, Robert J; Selby, Joseph V; Silverman, Barbara G; Steiner, John F; Stewart, W F; Vupputuri, Suma; Waitzfelder, Beth

2012-01-01

Electronic health record (EHR) data enhance opportunities for conducting surveillance of diabetes. The objective of this study was to identify the number of people with diabetes from a diabetes DataLink developed as part of the SUPREME-DM (SUrveillance, PREvention, and ManagEment of Diabetes Mellitus) project, a consortium of 11 integrated health systems that use comprehensive EHR data for research. We identified all members of 11 health care systems who had any enrollment from January 2005 through December 2009. For these members, we searched inpatient and outpatient diagnosis codes, laboratory test results, and pharmaceutical dispensings from January 2000 through December 2009 to create indicator variables that could potentially identify a person with diabetes. Using this information, we estimated the number of people with diabetes and among them, the number of incident cases, defined as indication of diabetes after at least 2 years of continuous health system enrollment. The 11 health systems contributed 15,765,529 unique members, of whom 1,085,947 (6.9%) met 1 or more study criteria for diabetes. The nonstandardized proportion meeting study criteria for diabetes ranged from 4.2% to 12.4% across sites. Most members with diabetes (88%) met multiple criteria. Of the members with diabetes, 428,349 (39.4%) were incident cases. The SUPREME-DM DataLink is a unique resource that provides an opportunity to conduct comparative effectiveness research, epidemiologic surveillance including longitudinal analyses, and population-based care management studies of people with diabetes. It also provides a useful data source for pragmatic clinical trials of prevention or treatment interventions.

"Sometimes I've gone home feeling that my voice hasn't been heard": a focus group study exploring the views and experiences of health care assistants when caring for dying residents.

PubMed

Fryer, Susan; Bellamy, Gary; Morgan, Tessa; Gott, Merryn

2016-08-19

In most developed countries, Health Care Assistants comprise a significant, and growing, proportion of the residential aged care workforce. Despite the fact that they provide the majority of direct care for residents, little is known about a key care aspect of their work, namely their experience of caring for dying residents. Twenty-six Health Care Assistants working in aged residential care facilities in Auckland, New Zealand participated in six focus group discussions. Focus groups were designed to explore the experiences of Health Care Assistants caring for imminently dying residents in aged care facilities and to identify barriers and facilitators to their work in this area. The focus groups were digitally recorded, transcribed verbatim and analysed using a general inductive approach. Participants confirmed that Health Care Assistants provide the majority of hands on care to dying residents and believed they had a valuable role to play at this time due to their unique 'familial' relationship with residents and families. However, it was apparent that a number of barriers existed to them maximising their contribution to supporting dying residents, most notably the lack of value placed on their knowledge and experience by other members of the multidisciplinary team. Whilst a need for additional palliative and end of life care education was identified, a preference was identified for hands on education delivered by peers, rather than the didactic education they currently receive. Given ageing populations internationally coupled with a constrained health budget, the role of Health Care Assistants in most developed countries is likely to become even more significant in the short to medium term. This study makes a unique contribution to the international literature by identifying the barriers to caring for dying residents experienced by this valuable sector of the aged care workforce. These data have the potential to inform new, innovative, interventions to address the urgent need identified to improve palliative and end of life care management in aged care internationally.

Strategies for improved French-language health services: Perspectives of family physicians in northeastern Ontario.

PubMed

Gauthier, Alain P; Timony, Patrick E; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason

2015-08-01

To identify strategies to improve the quality of health services for Francophone patients. A series of semistructured key informant interviews. Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection–data analysis process and were analyzed using a detailed thematic approach. Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non–French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist.

Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups.

PubMed

Ruy, Hosihn; Young, Wendy B; Kwak, Hoil

2002-01-01

The purpose of this study is to outline a method to identify the characteristics of socioeconomic variables in determining the differences in health insurance coverage and health services utilization patterns for different ethnic groups, using the behavioural model of health service utilization. A sample drawn from Asian American adult respondents to the 1992, 1993, and 1994 National Health Interview Surveys (NHIS) in the USA formed the data set. The results showed Asian Americans as not being homogeneous. There were distinctly different demographic and socioeconomic characteristics between six Asian American ethnic groups that affect health insurance coverage and health service utilization. The study method is useful for constructing health policy and services to address the general public need without adversely affecting smaller minority groups. Secondary analysis of well-constructed national data sets such as the specific Asian ethnic groups in NHIS, offers a rich method for predicting the differential impact of specific health policies on various ethnic groups.

The mental health impact of bed bug infestations: a scoping review.

PubMed

Ashcroft, Rachelle; Seko, Yukari; Chan, Lai Fong; Dere, Jessica; Kim, Jaemin; McKenzie, Kwame

2015-11-01

We conducted a scoping review to identify and summarize the current state of knowledge regarding the mental health effects associated with bed bugs. We employed a five-stage scoping review framework, to systematically identify and review eligible articles. Eligibility criteria included a focus on bed bug infestations and reference to mental health impacts. Descriptive information was then extracted from each article, including the specific mental health effects cited. An initial search yielded 920 unique articles on the topic of bed bugs. Of these, 261 underwent abstract review, and 167 underwent full-text review. Full-text review and subsequent review of reference lists yielded a final sample of 51 articles. Numerous mental health effects were linked to bed bug infestations, including severe psychiatric symptoms. However, the majority (n = 31) of the articles were commentary papers; only five original research articles were identified. Although significant mental health effects are often linked to bed bugs, such discussions remain largely anecdotal. Despite recognition that the impact of bed bugs constitutes an important public health concern, little empirical evidence currently exists on this topic.

Engagement studios: students and communities working to address the determinants of health.

PubMed

Bainbridge, Lesley; Grossman, Susan; Dharamsi, Shafik; Porter, Jill; Wood, Victoria

2014-01-01

This article presents an innovative model for interprofessional community-oriented learning. The Engagement Studios model involves a partnership between community organizations and students as equal partners in conversations and activities aimed at addressing issues of common concern as they relate to the social determinants of health. Interprofessional teams of students from health and non-health disciplines work with community partners to identify priority community issues and explore potential solutions. The student teams work with a particular community organization, combining their unique disciplinary perspectives to develop a project proposal, which addresses the community issues that have been jointly identified. Approved proposals receive a small budget to implement the project. In this paper we present the Engagement Studios model and share lessons learned from a pilot of this educational initiative.

Modeling the shape and composition of the human body using dual energy X-ray absorptiometry images

PubMed Central

Shepherd, John A.; Fan, Bo; Schwartz, Ann V.; Cawthon, Peggy; Cummings, Steven R.; Kritchevsky, Stephen; Nevitt, Michael; Santanasto, Adam; Cootes, Timothy F.

2017-01-01

There is growing evidence that body shape and regional body composition are strong indicators of metabolic health. The purpose of this study was to develop statistical models that accurately describe holistic body shape, thickness, and leanness. We hypothesized that there are unique body shape features that are predictive of mortality beyond standard clinical measures. We developed algorithms to process whole-body dual-energy X-ray absorptiometry (DXA) scans into body thickness and leanness images. We performed statistical appearance modeling (SAM) and principal component analysis (PCA) to efficiently encode the variance of body shape, leanness, and thickness across sample of 400 older Americans from the Health ABC study. The sample included 200 cases and 200 controls based on 6-year mortality status, matched on sex, race and BMI. The final model contained 52 points outlining the torso, upper arms, thighs, and bony landmarks. Correlation analyses were performed on the PCA parameters to identify body shape features that vary across groups and with metabolic risk. Stepwise logistic regression was performed to identify sex and race, and predict mortality risk as a function of body shape parameters. These parameters are novel body composition features that uniquely identify body phenotypes of different groups and predict mortality risk. Three parameters from a SAM of body leanness and thickness accurately identified sex (training AUC = 0.99) and six accurately identified race (training AUC = 0.91) in the sample dataset. Three parameters from a SAM of only body thickness predicted mortality (training AUC = 0.66, validation AUC = 0.62). Further study is warranted to identify specific shape/composition features that predict other health outcomes. PMID:28423041

Engaging Consumer Voices in Health Care Policy: Lessons for Social Work Practice.

PubMed

Law, Kristi Lohmeier; Saunders, A

2016-02-01

Community health centers provide comprehensive public health care in some of the most disadvantaged communities in the United States. To ensure that health centers meet the needs of their consumers, they uniquely engage them in their organizational decision-making and policy-development processes by requiring that their boards of directors encompass a 51 percent consumer majority. To understand the quality of board members' experiences, a critical ethnography was conducted using Arnstein's ladder of citizen participation and the socioecological model as a framework. The analysis identified multiple influences on the quality of participation among consumer members. Findings also confirm other research that has found that knowledge of the economic, political, and cultural factors surrounding the context of the individual health center is important to understanding meaningful participation. The experience is important to understand given the shift driven by the Patient Protection and Affordable Care Act of 2010 in health care, which emphasizes a patient-entered model of care. Social work practitioners and others in the public health arena interested in empowering consumers to have a role in the provision of services need to understand the impact of each of these areas'and the experience of this unique sample of health center board members.

Access and authorisation in a Glocal e-Health Policy context.

PubMed

Scott, Richard E; Jennett, Penny; Yeo, Maryann

2004-03-31

Challenges to the development of appropriate yet adaptable policy and tools for security of the individual patient electronic health record (EHR) are proving to be significant. Compounding this is the unique capability of e-health to transgress all existing geo-political and other barriers. Initiatives to develop and advance policy, standards, and tools in relation to EHR access control and authorisation management must address this capability. Currently policy development initiatives take place largely in an isolated manner. This jeopardises the potential of e-health because decisions made in one jurisdiction might hamper, even prevent, an e-health opportunity in another. This paper places access and authorisation issues in an overall policy context through describing current Canadian initiatives. The National Initiative for Telehealth (NIFTE) Guidelines project is developing a framework of national guidelines for telehealth. The Policy and Peer Permission (PPP) project is developing a unique tool that provides persistent protection of data. The new corporate body 'Infoway' is developing a pan-Canadian electronic health record solution. Finally, the Glocal e-Health Policy initiative is developing a tool with which to identify and describe the inter-relationships of e-health issues amongst policy levels, themes, and actors.

Exploring the business case for improving the quality of health care for children.

PubMed

Homer, Charles

2004-01-01

A recent examination of the business case for improving quality in health care found few financial incentives (and sizable barriers) for health care organizations interested in investing in quality improvement. That analysis did not consider the special case of children's health care. To address this gap, an expert panel delineated aspects of children's health care-such as the need for care, patterns of use, and how care is organized and financed-that differ from adult care. It then identified barriers and solutions specific to children's health care, to ensure that children's unique needs are not lost in the debate.

Health Seeking in Men: A Concept Analysis.

PubMed

Hooper, Gwendolyn L; Quallich, Susanne A

2016-01-01

This article describes the analysis of the concept of health seeking in men. Men have shorter life expectancies and utilize health services less often than women, leading to poor health outcomes, but a gendered basis for health seeking remains poorly defined. Walker and Avant’s framework was used to guide this concept analysis. Literature published in English from 1990-2015 was reviewed. Thematic analysis identified attributes, antecedents, and consequences of the concept. Based on the analysis, a contemporary definition for health seeking in men was constructed, rooted in the concept of health. The definition is based on the concept analysis and the defining attributes that were identified. This analysis provides a definition specifically for health seeking in American men, making it more specific and gender-based than the parent concept of “health.” This concept analysis provides conceptual clarity that can guide development of a conceptual framework that may be uniquely relevant to providers in urology. Further exploration will uncover specific cultural, social, sexual, and geographic perspectives.

Kabuki syndrome: diagnostic and treatment considerations

PubMed Central

2012-01-01

Kabuki syndrome (KS) is a rare genetic disorder first diagnosed in 1981. Unknown by most primary care physicians and clinicians in the mental health fields, children with KS present with unique facial characteristics, mental retardation, health problems and socio-emotional delays that are often mistaken for other diagnostic problems. Literature detailing the psychological and psychosocial features of this disorder is scant, and psychotherapeutic approaches have not been described. In this article, we present a case description and treatment of a child with KS and her family. A brief review of KS is then provided, highlighting its signs and symptoms. Factors related to differential diagnoses are identified to aid primary care and mental health clinicians in better understanding this unique syndrome. Interventions with similar populations are discussed from which a psychological approach to KS is suggested. Finally, implications for primary care physicians are described and suggestions for further research indicated. PMID:23997823

Child and Adolescent Perceptions of Oral Health Over the Life Course

PubMed Central

Maida, Carl A.; Marcus, Marvin; Hays, Ron D.; Coulter, Ian D.; Ramos-Gomez, Francisco; Lee, Steve Y.; McClory, Patricia S.; Van, Laura V.; Wang, Yan; Shen, Jie; Cai, Li; Spolsky, Vladimir W.; Crall, James J.; Liu, Honghu

2016-01-01

Purpose To elicit perceptions of oral health in children and adolescents as an initial step in the in the development of oral health item banks for the Patient-Reported Oral Health Outcomes Measurement Information System project. Methods We conducted focus groups with ethnically, socioeconomically, and geographically diverse youth (8-12, 13-17 years) to identify perceptions of oral health status. We performed content analysis, including a thematic and narrative analysis, to identify important themes. Results We identified three unique themes that the youth associated with their oral health status: 1) understanding the value of maintaining good oral health over the life course, with respect to longevity and quality of life in the adult years; 2) positive association between maintaining good oral health and interpersonal relationships at school, and dating, for older youth; and 3) knowledge of the benefits of orthodontic treatment to appearance and positive self-image, while holding a strong view as to the discomfort associated with braces. Conclusions The results provide valuable information about core domains for the oral health item banks to be developed and generated content for new items to be developed and evaluated with cognitive interviews and in a field test. PMID:26038216

"I Don't Want Them to Feel Different": A Mixed Methods Study of Parents' Beliefs and Dietary Management Strategies for Their Young Children with Type 1 Diabetes Mellitus.

PubMed

Patton, Susana R; Clements, Mark A; George, Katie; Goggin, Kathy

2016-02-01

Many young children with type 1 diabetes mellitus (T1DM) do not consume a healthful diet; exactly why this occurs despite T1DM education remains poorly understood. This study describes parents' perceptions of healthful eating for T1DM in young children and identifies factors related to parents' dietary management. A cross-sectional, mixed-methods study was performed. Parents completed a questionnaire, 3-day weighed diet record, and a semi-structured interview regarding their perceptions of healthful eating for T1DM and their dietary management practices. Twenty-three families, recruited from a pediatric diabetes clinic in the midwestern United States between February 2012 and April 2013, participated. Eligible families had a child with T1DM who was 1 to 6 years old, at least 6 months from diagnosis, and was following an intensive insulin regimen. Mean scores and percentages were calculated from the diet diaries and parent questionnaires, and parents' interviews were coded to identify common themes. Results showed that while parents may believe they know what constitutes a healthful diet for T1DM, they do not always feed their child a healthful diet. Parent-identified barriers to healthful eating included limited time to prepare homemade meals, perceived higher costs of healthier foods, the influence of peers on children's food preferences, and picky eating. Parents also discussed a desire not to limit their child's diet or make their child "feel different," which many parents said often led them to give into their child's requests for less healthful food options. Parents of young children with T1DM identified several barriers to healthful eating that are common for all parents, such as time constraints, expense, and child food preferences. However, unique themes emerged, including parents' desire not to limit their child's diet or make their child "feel different." Nutrition components of T1DM education should include psychological and behavioral strategies to help parents manage these unique concerns. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

“I don't want them to feel different”: A mixed methods study of parents’ beliefs and dietary management strategies for their young child with type 1 diabetes mellitus

PubMed Central

Patton, Susana R.; Clements, Mark A.; George, Katie; Goggin, Kathy

2015-01-01

Background Many young children with type 1 diabetes (T1DM) do not consume a healthful diet; exactly why this occurs despite T1DM education remains poorly understood. Objective This study describes parents’ perceptions of healthful eating for T1DM in young children and identifies factors related to parents’ dietary management. Design A cross-sectional, mixed-methods study was performed. Parents completed a questionnaire, three-day weighed diet record, and a semi-structured interview regarding their perceptions of healthful eating for T1DM and their dietary management practices. Participants/setting Twenty-three families, recruited from a Pediatric Diabetes Clinic in the Mid-Western United States between February 2012 and April 2013, participated. Eligible families had a child with T1DM who was 1-6 years old, at least six months from diagnosis, and was following an intensive insulin regimen. Statistical analyses performed Mean scores and percentages were calculated from the diet diaries and parent questionnaires, while parents’ interviews were coded to identify common themes. Results Results showed that while parents may believe they know what constitutes a healthful diet for T1DM, they do not always feed their child a healthful diet. Parent-identified barriers to healthful eating included: limited time to prepare homemade meals, perceived higher costs of healthier foods, the influence of peers on children's food preferences, and picky eating. Parents also discussed a desire not to limit their child's diet or make their child “feel different”, which many parents said often led them to give into child's requests for less healthful food options. Conclusions Parents of young children with T1DM identified several barriers to healthful eating that are common for all parents, such as time constraints, expense, and child food preferences. However, unique themes emerged including parents’ desire not to limit their child's diet or make their child “feel different.” Nutrition components of T1DM education should include psychological and behavioral strategies to help parents manage these unique concerns. PMID:26260671

A Literature Review and Data Mining Project to Identify Associations between Stressors and Health Outcomes for Children

EPA Science Inventory

Children are often more vulnerable than adults to the effects of environmental contaminants found in their everyday environments. Their dynamic growth and unique interactions with the built, natural, and social environments may result in a greater susceptibility to chemical and n...

Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature

PubMed Central

Twyman, Laura; Bonevski, Billie; Paul, Christine; Bryant, Jamie

2014-01-01

Objectives To identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth. Design A systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups. Data sources MEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014. Study selection Studies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included. Data extraction Two authors independently assessed studies for inclusion and extracted data. Results 65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco). Conclusions Vulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups. Trial registration number: A protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761). PMID:25534212

The National Institutes of Health's Biomedical Translational Research Information System (BTRIS): Design, Contents, Functionality and Experience to Date

PubMed Central

Cimino, James J.; Ayres, Elaine J.; Remennik, Lyubov; Rath, Sachi; Freedman, Robert; Beri, Andrea; Chen, Yang; Huser, Vojtech

2013-01-01

The US National Institutes of Health (NIH) has developed the Biomedical Translational Research Information System (BTRIS) to support researchers’ access to translational and clinical data. BTRIS includes a data repository, a set of programs for loading data from NIH electronic health records and research data management systems, an ontology for coding the disparate data with a single terminology, and a set of user interface tools that provide access to identified data from individual research studies and data across all studies from which individually identifiable data have been removed. This paper reports on unique design elements of the system, progress to date and user experience after five years of development and operation. PMID:24262893

Understanding why veterans are reluctant to access help for alcohol problems: Considerations for nurse education.

PubMed

Kiernan, Matthew D; Moran, Sandra; Hill, Mick

2016-12-01

To effectively engage veterans with substance misuse services, nurses need to understand their unique needs and the potential barriers that prevent them from accessing care. Nurses need to have an understanding and awareness of the cultural sensitivities associated with having been a member of the armed forces. The aim of this study was to investigate the perceived barriers to care amongst those planning, commissioning and delivering services for veterans with substance misuse problems, and to identify and explore subject areas which nurse educators should consider for inclusion in nursing and health education programmes. The findings reported in this paper come from one phase of a larger three phase research project and used an applied qualitative research approached based on methods developed for applied social policy research. The study was undertaken in the north-east of England. The study consisted of a purposive sample of planners, commissioners of services, and service providers in the North East of England. Data was collected using a semi-structured interview schedule. Framework analysis was used to analyse the data. Complexity of services and care, complexity of need and a lack of understanding of veterans were identified as factors that made accessing substance misuse care difficult. To help nurses better understand the unique needs of veterans three educational topics were identified for consideration in pre-registration nurse education: understanding military and veteran culture and the nature of modern warfare, the military 'veteran as institutionalised' hypothesis and stigma. Health and social services can struggle to truly understand the unique needs and experiences of the veteran community. We have identified three broad subject areas that should be considered as the theoretical basis for a veteran specific education programme within pre and post-registration nurse education. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reducing Cancer Disparities Through Innovative Partnerships: A Collaboration of the South Carolina Cancer Prevention and Control Research Network and Federally Qualified Health Centers

PubMed Central

Young, Vicki M.; Freedman, Darcy A.; Adams, Swann Arp; Brandt, Heather M.; Xirasagar, Sudha; Felder, Tisha M.; Ureda, John R.; Hurley, Thomas; Khang, Leepao; Campbell, Dayna; Hébert, James R.

2011-01-01

The South Carolina Cancer Prevention and Control Research Network, in partnership with the South Carolina Primary Health Care Association, and Federally Qualified Health Centers (FQHCs), aims to promote evidence-based cancer interventions in community-based primary care settings. Partnership activities include (1) examining FQHCs’ readiness and capacity for conducting research, (2) developing a cancer-focused data sharing network, and (3) integrating a farmers’ market within an FQHC. These activities identify unique opportunities for public health and primary care collaborations. PMID:21932143

Family caregivers of individuals with frontotemporal dementia: examining the relationship between coping and caregiver physical and mental health.

PubMed

Wong, Cindy C; Wallhagen, Margaret I

2014-01-01

To identify strategies to assist family caregivers of individuals with frontotemporal dementia (FTD) in dealing with their caregiving demands, nurses must understand these family members' unique needs and how they currently deal with their demands. The purpose of this study was to examine the relationship between coping and caregiver physical and mental health among FTD family caregivers. Participants were primary caregivers of individuals with FTD (with behavioral symptoms) living at home (N = 61). A small positive association was noted between problem-focused coping and caregiver physical health (r = 0.29, p < 0.05), and a small but nonsignificant positive correlation was noted between emotion-focused coping and caregiver mental health (r = 0.21, p = 0.10). However, multiple regression analysis showed that emotion-focused coping (β = 0.46, p < 0.05) made a statistically significant, unique contribution to caregiver mental health and explained approximately 14% of its variance. These findings support the potential value of emotion-focused coping strategies when dealing with behavioral symptoms manifested by individuals with FTD. Copyright 2014, SLACK Incorporated.

Kent County Health Department: Using an Agency Strategic Plan to Drive Improvement.

PubMed

Saari, Chelsey K

The Kent County Health Department (KCHD) was accredited by the Public Health Accreditation Board (PHAB) in September 2014. Although Michigan has had a state-level accreditation process for local health departments since the late 1990s, the PHAB accreditation process presented a unique opportunity for KCHD to build on successes achieved through state accreditation and enhance performance in all areas of KCHD programs, services, and operations. PHAB's standards, measures, and peer-review process provided a standardized and structured way to identify meaningful opportunities for improvement and to plan and implement strategies for enhanced performance and established a platform for being recognized nationally as a high-performing local health department. The current case report highlights the way in which KCHD has developed and implemented its strategic plan to guide efforts aimed at addressing gaps identified through the accreditation process and to drive overall improvement within our agency.

Integrative Spatial Data Analytics for Public Health Studies of New York State

PubMed Central

Chen, Xin; Wang, Fusheng

2016-01-01

Increased accessibility of health data made available by the government provides unique opportunity for spatial analytics with much higher resolution to discover patterns of diseases, and their correlation with spatial impact indicators. This paper demonstrated our vision of integrative spatial analytics for public health by linking the New York Cancer Mapping Dataset with datasets containing potential spatial impact indicators. We performed spatial based discovery of disease patterns and variations across New York State, and identify potential correlations between diseases and demographic, socio-economic and environmental indicators. Our methods were validated by three correlation studies: the correlation between stomach cancer and Asian race, the correlation between breast cancer and high education population, and the correlation between lung cancer and air toxics. Our work will allow public health researchers, government officials or other practitioners to adequately identify, analyze, and monitor health problems at the community or neighborhood level for New York State. PMID:28269834

Application of a gender-based approach to conducting a community health assessment for rural women in Southern Illinois.

PubMed

Zimmermann, Kristine; Khare, Manorama M; Wright, Cherie; Hasler, Allison; Kerch, Sarah; Moehring, Patricia; Geller, Stacie

2015-08-01

Rural populations in the United States experience unique challenges in health and health care. The health of rural women, in particular, is influenced by their knowledge, work and family commitments, as well as environmental barriers in their communities. In rural southern Illinois, the seven southernmost counties form a region that experiences high rates of cancer and other chronic diseases. To identify, understand, and prioritize the health needs of women living in these seven counties, a comprehensive gender-based community health assessment was conducted with the goal of developing a plan to improve women's health in the region. A gender-analysis framework was adapted, and key stakeholder interviews and focus groups with community women were conducted and analyzed to identify factors affecting ill health. The gender-based analysis revealed that women play a critical role in the health of their families and their communities, and these roles can influence their personal health. The gender-based analysis also identified several gender-specific barriers and facilitators that affect women's health and their ability to engage in healthy behaviors. These results have important implications for the development of programs and policies to improve health among rural women. Copyright © 2014 Elsevier Ltd. All rights reserved.

Design and implementation of a privacy preserving electronic health record linkage tool in Chicago

PubMed Central

Cashy, John P; Jackson, Kathryn L; Pah, Adam R; Goel, Satyender; Boehnke, Jörn; Humphries, John Eric; Kominers, Scott Duke; Hota, Bala N; Sims, Shannon A; Malin, Bradley A; French, Dustin D; Walunas, Theresa L; Meltzer, David O; Kaleba, Erin O; Jones, Roderick C; Galanter, William L

2015-01-01

Objective To design and implement a tool that creates a secure, privacy preserving linkage of electronic health record (EHR) data across multiple sites in a large metropolitan area in the United States (Chicago, IL), for use in clinical research. Methods The authors developed and distributed a software application that performs standardized data cleaning, preprocessing, and hashing of patient identifiers to remove all protected health information. The application creates seeded hash code combinations of patient identifiers using a Health Insurance Portability and Accountability Act compliant SHA-512 algorithm that minimizes re-identification risk. The authors subsequently linked individual records using a central honest broker with an algorithm that assigns weights to hash combinations in order to generate high specificity matches. Results The software application successfully linked and de-duplicated 7 million records across 6 institutions, resulting in a cohort of 5 million unique records. Using a manually reconciled set of 11 292 patients as a gold standard, the software achieved a sensitivity of 96% and a specificity of 100%, with a majority of the missed matches accounted for by patients with both a missing social security number and last name change. Using 3 disease examples, it is demonstrated that the software can reduce duplication of patient records across sites by as much as 28%. Conclusions Software that standardizes the assignment of a unique seeded hash identifier merged through an agreed upon third-party honest broker can enable large-scale secure linkage of EHR data for epidemiologic and public health research. The software algorithm can improve future epidemiologic research by providing more comprehensive data given that patients may make use of multiple healthcare systems. PMID:26104741

Design and implementation of a privacy preserving electronic health record linkage tool in Chicago.

PubMed

Kho, Abel N; Cashy, John P; Jackson, Kathryn L; Pah, Adam R; Goel, Satyender; Boehnke, Jörn; Humphries, John Eric; Kominers, Scott Duke; Hota, Bala N; Sims, Shannon A; Malin, Bradley A; French, Dustin D; Walunas, Theresa L; Meltzer, David O; Kaleba, Erin O; Jones, Roderick C; Galanter, William L

2015-09-01

To design and implement a tool that creates a secure, privacy preserving linkage of electronic health record (EHR) data across multiple sites in a large metropolitan area in the United States (Chicago, IL), for use in clinical research. The authors developed and distributed a software application that performs standardized data cleaning, preprocessing, and hashing of patient identifiers to remove all protected health information. The application creates seeded hash code combinations of patient identifiers using a Health Insurance Portability and Accountability Act compliant SHA-512 algorithm that minimizes re-identification risk. The authors subsequently linked individual records using a central honest broker with an algorithm that assigns weights to hash combinations in order to generate high specificity matches. The software application successfully linked and de-duplicated 7 million records across 6 institutions, resulting in a cohort of 5 million unique records. Using a manually reconciled set of 11 292 patients as a gold standard, the software achieved a sensitivity of 96% and a specificity of 100%, with a majority of the missed matches accounted for by patients with both a missing social security number and last name change. Using 3 disease examples, it is demonstrated that the software can reduce duplication of patient records across sites by as much as 28%. Software that standardizes the assignment of a unique seeded hash identifier merged through an agreed upon third-party honest broker can enable large-scale secure linkage of EHR data for epidemiologic and public health research. The software algorithm can improve future epidemiologic research by providing more comprehensive data given that patients may make use of multiple healthcare systems. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Big Events and Risks to Global Substance Using Populations: Unique Threats and Common Challenges.

PubMed

Mackey, Tim K; Strathdee, Steffanie A

2015-01-01

In this commentary, we review a set of "Big Events" from around the world that have adversely impacted substance using populations by first identifying common thematic areas between them, and then describing the unique challenges faced by the diverse and vulnerable populations impacted. The Big Events reviewed are multifaceted and complex in nature, and include the recent global financial crisis, economic and trade sanctions, political transition and its impact on ethnic minorities, colonialism and indigenous communities, and ecological disasters. All have led to immense trauma, displacement, and disruption to critical healthcare services/treatment for people who use drugs, populations who are left underserved in the midst of these crises. It is our hope that through this comparative assessment, global policymakers will proactively identify Big Events and prioritize the development of interventions and policy that meet the unique and immediate needs of substance using population in order to mitigate the significant negative short- and long-term impacts on global public health.

Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings.

PubMed

Baig, Arshiya A; Lopez, Fanny Y; DeMeester, Rachel H; Jia, Justin L; Peek, Monica E; Vela, Monica B

2016-10-01

Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons' culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient-provider experiences with SDM and develop tools that can better facilitate SDM in this patient population.

Addressing Barriers to Shared Decision Making Among Latino LGBTQ Patients and Healthcare Providers in Clinical Settings

PubMed Central

Lopez, Fanny Y.; DeMeester, Rachel H.; Jia, Justin L.; Peek, Monica E.; Vela, Monica B.

2016-01-01

Abstract Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons’ culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient–provider experiences with SDM and develop tools that can better facilitate SDM in this patient population. PMID:27617356

Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges.

PubMed

Hill, Sarah R; Vale, Luke; Hunter, David; Henderson, Emily; Oluboyede, Yemi

2017-12-01

Public health interventions have unique characteristics compared to health technologies, which present additional challenges for economic evaluation (EE). High quality EEs that are able to address the particular methodological challenges are important for public health decision-makers. In England, they are even more pertinent given the transition of public health responsibilities in 2013 from the National Health Service to local government authorities where new agents are shaping policy decisions. Addressing alcohol misuse is a globally prioritised public health issue. This article provides a systematic review of EE and priority-setting studies for interventions to prevent and reduce alcohol misuse published internationally over the past decade (2006-2016). This review appraises the EE and priority-setting evidence to establish whether it is sufficient to meet the informational needs of public health decision-makers. 619 studies were identified via database searches. 7 additional studies were identified via hand searching journals, grey literature and reference lists. 27 met inclusion criteria. Methods identified included cost-utility analysis (18), cost-effectiveness analysis (6), cost-benefit analysis (CBA) (1), cost-consequence analysis (CCA) (1) and return-on-investment (1). The review identified a lack of consideration of methodological challenges associated with evaluating public health interventions and limited use of methods such as CBA and CCA which have been recommended as potentially useful for EE in public health. No studies using other specific priority-setting tools were identified. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Systematic review and overview of health economic evaluation models in obesity prevention and therapy.

PubMed

Schwander, Bjoern; Hiligsmann, Mickaël; Nuijten, Mark; Evers, Silvia

2016-10-01

Given the increasing clinical and economic burden of obesity, it is of major importance to identify cost-effective approaches for obesity management. Areas covered: This study aims to systematically review and compile an overview of published decision models for health economic assessments (HEA) in obesity, in order to summarize and compare their key characteristics as well as to identify, inform and guide future research. Of the 4,293 abstracts identified, 87 papers met our inclusion criteria. A wide range of different methodological approaches have been identified. Of the 87 papers, 69 (79%) applied unique /distinctive modelling approaches. Expert commentary: This wide range of approaches suggests the need to develop recommendations /minimal requirements for model-based HEA of obesity. In order to reach this long-term goal, further research is required. Valuable future research steps would be to investigate the predictiveness, validity and quality of the identified modelling approaches.

Provider reported barriers and solutions to improve testing among tuberculosis patients ‘eligible for drug susceptibility test’: A qualitative study from programmatic setting in India

PubMed Central

Parmar, Malik; Verma, Manoj; Desikan, Prabha; Khan, Sheeba Naz; Kumar, Ajay M. V.

2018-01-01

Background In a study conducted in Bhopal district (a setting with facility for molecular drug susceptibility testing (DST)) located in central India in 2014–15, we found high levels of pre-diagnosis attrition among patients with presumptive multi drug-resistant tuberculosis (MDR-TB)–meaning TB patients who were eligible for DST, were not being tested. Objectives In this study, we explored the health care provider perspectives into barriers and suggested solutions for improving DST. Methods This was a descriptive qualitative study. One to one interviews (n = 10) and focus group discussions (n = 2) with experienced key informants involved in programmatic management of DR-TB were conducted in April 2017. Manual descriptive thematic analysis was performed. Results The key barriers reported were a) lack of or delay in identification of patients eligible for DST because of using treatment register as the source for identifying patients b) lack of assured specimen transport after patient identification and c) lack of tracking. Extra pulmonary TB patients were not getting identified as eligible for DST. Solutions suggested by the health care providers were i) generation of unique identifier at identification in designated microscopy center (DMC), immediate intimation of unique identifier to district and regular monitoring by senior TB laboratory and senior treatment supervisors of patients eligible for DST that were missed; ii) documentation of unique identifier at each step of cascade; iii) use of human carriers/couriers to transport specimen from DMCs especially in rural areas; and iv) routine entry of all presumptive extra-pulmonary TB specimen, as far as possible, in DMC laboratory register. Conclusion Lack of assured specimen transport and lack of accountability for tracking patient after identification and referral were the key barriers. The identification of patients eligible for DST among microbiologically confirmed TB at the time of diagnosis and among clinically confirmed TB at the time of treatment initiation is the key. Use of unique identifier at identification and its use to ensure cohort wise tracking has to be complemented with specimen transport support and prompt feedback to the DMC. The study has implications to improve detection of MDR-TB among diagnosed/notified TB patients. PMID:29677210

Strategies for improved French-language health services

PubMed Central

Gauthier, Alain P.; Timony, Patrick E.; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason

2015-01-01

Abstract Objective To identify strategies to improve the quality of health services for Francophone patients. Design A series of semistructured key informant interviews. Setting Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. Methods Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection–data analysis process and were analyzed using a detailed thematic approach. Main findings Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non–French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). Conclusion Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist. PMID:26505060

Developing a Comprehensive Animal Care Occupational Health and Safety Program at a Land-Grant Institution

PubMed Central

Goodly, Lyndon J; Jarrell, Vickie L; Miller, Monica A; Banks, Maureen C; Anderson, Thomas J; Branson, Katherine A; Woodward, Robert T; Peper, Randall L; Myers, Sara J

2016-01-01

The Public Health Service Policy on the Humane Care and Use of Laboratory Animals and sound ethical practices require institutions to provide safe working environments for personnel working with animals; this mandate is achieved in part by establishing an effective animal care Occupational Health and Safety Program (OHSP). Land-grant institutions often face unique organizational challenges in fulfilling this requirement. For example, responsibilities for providing health and safety programs often have historically been dispersed among many different divisions scattered around the campus. Here we describe how our institutional management personnel overcame organizational structure and cultural obstacles during the formation of a comprehensive campus-wide animal care OHSP. Steps toward establishing the animal care OHSP included assigning overall responsibility, identifying all stakeholders, creating a leadership group, and hiring a fulltime Animal Care OHSP Specialist. A web-based portal was developed, implemented, and refined over the past 7 y and reflected the unique organizational structures of the university and the needs of our research community. Through this web-based portal, hazards are identified, risks are assessed, and training is provided. The animal care OHSP now provides easy mandatory enrollment, supports timely feedback regarding hazards, and affords enrollees the opportunity to participate in voluntary medical surveillance. The future direction and development of the animal care OHSP will be based on the research trends of campus, identification of emerging health and safety hazards, and ongoing evaluation and refinement of the program. PMID:26817980

Developing a Comprehensive Animal Care Occupational Health and Safety Program at a Land-Grant Institution.

PubMed

Goodly, Lyndon J; Jarrell, Vickie L; Miller, Monica A; Banks, Maureen C; Anderson, Thomas J; Branson, Katherine A; Woodward, Robert T; Peper, Randall L; Myers, Sara J

2016-01-01

The Public Health Service Policy on the Humane Care and Use of Laboratory Animals and sound ethical practices require institutions to provide safe working environments for personnel working with animals; this mandate is achieved in part by establishing an effective animal care Occupational Health and Safety Program (OHSP). Land-grant institutions often face unique organizational challenges in fulfilling this requirement. For example, responsibilities for providing health and safety programs often have historically been dispersed among many different divisions scattered around the campus. Here we describe how our institutional management personnel overcame organizational structure and cultural obstacles during the formation of a comprehensive campus-wide animal care OHSP. Steps toward establishing the animal care OHSP included assigning overall responsibility, identifying all stakeholders, creating a leadership group, and hiring a fulltime Animal Care OHSP Specialist. A web-based portal was developed, implemented, and refined over the past 7 y and reflected the unique organizational structures of the university and the needs of our research community. Through this web-based portal, hazards are identified, risks are assessed, and training is provided. The animal care OHSP now provides easy mandatory enrollment, supports timely feedback regarding hazards, and affords enrollees the opportunity to participate in voluntary medical surveillance. The future direction and development of the animal care OHSP will be based on the research trends of campus, identification of emerging health and safety hazards, and ongoing evaluation and refinement of the program.

Discovering eHealth Technology: An Innovative Interprofessional Graduate Student Learning Experience.

PubMed

Estes, Krista; Gilliam, Eric; Knapfel, Sarah; Lee, Chanmi; Skiba, Diane

2016-01-01

The use of eHealth has grown in recent years and is projected to continue to increase exponentially. In order to empower and prepare advanced practice providers to integrate eHealth into their clinical practice, curricular changes need to occur. The iTEAM grant provides a unique opportunity to prepare advanced practice disciplines to provide collaborative care using eHealth. Through the integration of a simulated telehealth using a standardized patient, Doctor of Pharmacy and Advanced Practice Registered Nursing students learned how to apply health information technology and coordinate care in an interprofessional manner. Opportunities and challenges to guide future efforts to integrate eHealth-learning experiences into the curriculum are identified.

FROM NEEDS ASSESSMENT TO PARTICIPATORY RESEARCH: A COMMUNITY VISION OF HEALTH PROMOTION PROGRAMS IN ONE NATIVE AMERICAN COMMUNITY

USDA-ARS?s Scientific Manuscript database

OBJECTIVE: Identify unique cultural needs, priorities, program delivery preferences and barriers to achieving a healthy diet and lifestyle in one Native American community. DESIGN: A novel modified nominal group technique (NGT) conducted in four districts and three age groups (Elders, adults and...

Using Concept Mapping in the Development of a School of Public Health.

PubMed

Hsu, Laura J; Pacheco, Misty Y; Crabtree, Christopher; Maddock, Jay E

2015-07-01

Schools of Public Health have a wide variety of essential stakeholders. Broad input in program planning should assist in ensuring well-developed plans and strong community buy-in. The planning of a school can better address the needs of multiple stakeholders from systematic broad-based input from these constituents using concept mapping. In this study, we used concept mapping to prioritize a set of recommendations from diverse stakeholders to assist in the process of planning a school. A set of statements was generated on essential elements for the proposed school from a broad group of stakeholders. The statements were then distilled into unique themes, which were then rated on importance and feasibility. Cluster maps and pattern matches were used to analyze the ratings. Unique themes (N = 147) were identified and grouped into 12 clusters. Cluster themes included leadership, faculty, culture, school, and curriculum. Pattern matches revealed a significant, modest correlation between importance and feasibility (r = 0.27). A broad range of perspectives was used to identify relevant areas to address in the development of a school.

Method for identifying eligible individuals for a prevalence survey in the absence of a disease register or population register.

PubMed

Richardson, A K; Clarke, G; Sabel, C E; Pearson, J F; Mason, D F; Taylor, B V

2012-11-01

Identifying eligible individuals for a prevalence survey is difficult in the absence of a disease register or a national population register. To develop a method to identify and invite eligible individuals to participate in a national prevalence survey while maintaining confidentiality and complying with privacy legislation. A unique identifier (based on date of birth, sex and initials) was developed so that database holders could identify eligible individuals, notify us and invite them on our behalf to participate in a national multiple sclerosis prevalence survey while maintaining confidentiality and complying with privacy legislation. Several organisations (including central government, health and non-governmental organisations) used the method described to assign unique identifiers to individuals listed on their databases and to forward invitations and consent forms to them. The use of a unique identifier allowed us to recognise and record all the sources of identification for each individual. This prevented double counting or approaching the same individual more than once and facilitated the use of capture-recapture methods to improve the prevalence estimate. Capture-recapture analysis estimated that the method identified over 96% of eligible individuals in this prevalence survey. This method was developed and used successfully in a national prevalence survey of multiple sclerosis in New Zealand. The method may be useful for prevalence surveys of other diseases in New Zealand and for prevalence surveys in other countries with similar privacy legislation and lack of disease registers and population registers. © 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

Analysis of Information Needs of Users of MEDLINEplus, 2002 – 2003

PubMed Central

Scott-Wright, Alicia; Crowell, Jon; Zeng, Qing; Bates, David W.; Greenes, Robert

2006-01-01

We analyzed query logs from use of MEDLINEplus to answer the questions: Are consumers’ health information needs stable over time? and To what extent do users’ queries change over time? To determine log stability, we assessed an Overlap Rate (OR) defined as the number of unique queries common to two adjacent months divided by the total number of unique queries in those months. All exactly matching queries were considered as one unique query. We measured ORs for the top 10 and 100 unique queries of a month and compared these to ORs for the following month. Over ten months, users submitted 12,234,737 queries; only 2,179,571 (17.8%) were unique and these had a mean word count of 2.73 (S.D., 0.24); 121 of 137 (88.3%) unique queries each comprised of exactly matching search term(s) used at least 5000 times were of only one word. We could predict with 95% confidence that the monthly OR for the top 100 unique queries would lie between 67% – 87% when compared with the top 100 from the previous month. The mean month-to-month OR for top 10 queries was 62% (S.D., 20%) indicating significant variability; the lowest OR of 33% between the top 10 in Mar. compared to Apr. was likely due to “new” interest in information about SARS pneumonia in Apr. 2003. Consumers’ health information needs are relatively stable and the 100 most common unique queries are about 77% the same from month to month. Website sponsors should provide a broad range of information about a relatively stable number of topics. Analyses of log similarity may identify media-induced, cyclical, or seasonal changes in areas of consumer interest. PMID:17238431

A Qualitative Study of Mental Health Problems among Orphaned Children and Adolescents in Tanzania

PubMed Central

Dorsey, Shannon; Lucid, Leah; Murray, Laura; Bolton, Paul; Itemba, Dafrosa; Manongi, Rachel; Whetten, Kathryn

2015-01-01

Low- and middle-income countries (LMIC) have a high number of orphans, many of whom have unmet mental health needs. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived locally in order to tailor interventions and refine measurement of intervention effects. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of orphans and guardians to inform a subsequent randomized controlled trial of a Western-developed, evidence-based psychosocial intervention, Trauma-focused Cognitive Behavioral Therapy (TF-CBT). Local, Kiswahili-speaking interviewers conducted 73 free list interviews and 34 key informant interviews. Results identified both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., lacking peace, being discriminated against) not typically targeted by the intervention or included on standardized measures of intervention effects. We discuss implications for adapting mental health interventions in LMIC and assessing effectiveness. PMID:26488916

Beyond Strain: Personal Strengths and Mental Health of Mexican and Argentinean Dementia Caregivers.

PubMed

Sutter, Megan; Perrin, Paul B; Peralta, Silvina Victoria; Stolfi, Miriam E; Morelli, Eliana; Peña Obeso, Leticia Aracely; Arango-Lasprilla, Juan Carlos

2016-07-01

Life expectancy is increasing in Latin America resulting in the need for more family caregivers for older adults with dementia. The purpose of the current study was to examine the relationships between personal strengths (optimism, sense of coherence [SOC], and resilience) and the mental health of dementia caregivers from Latin America. Primary family dementia caregivers (n = 127) were identified via convenience sampling at the Instituto de Neurociencias de San Lucas, Argentina, and CETYS University, in Baja California, Mexico and completed measures of these constructs. Personal strengths explained between 32% and 50% of the variance in caregiver mental health. In a series of hierarchical multiple regressions, more manageability (β = -.38, p = .001), general resilience (β = -.24, p = .012), and social competence (β = -.21, p = .034) were uniquely associated with lower depression. Greater comprehensibility (β = -.28, p = .008) was uniquely associated with decreased burden, and manageability was marginally related (β = -.21, p< .10). Greater optimism (β = .37, p< .001) and manageability (β = .27, p = .004) were uniquely associated with increased life satisfaction. The personal strengths of caregivers in Latin America may be particularly important for their mental health because of the culturally imbedded sense of duty toward older family members. Incorporating strengths-based approaches into research on caregiver interventions in regions where caregiving is a highly culturally valued role such as Latin America may have the potential to improve the mental health of dementia caregivers. © The Author(s) 2015.

Multiple Health Behavior Change Research: An Introduction and Overview

PubMed Central

Prochaska, Judith J.; Spring, Bonnie; Nigg, Claudio R.

2008-01-01

In 2002, the Society of Behavioral Medicine’s special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable. PMID:18319098

Developing perspectives on Korean nursing theory: the influences of Taoism.

PubMed

Shin, K R

2001-10-01

Nursing theory provides a systematic explanation and description of nursing phenomena. Western nursing theories have widely influenced Korean nursing. And yet, although nursing theory has universal aspects, the differences in philosophy and culture that are unique to each country need to be considered. This inquiry seeks to investigate the Korean cultural heritage, which integrates Confucianism, Buddhism, and Taoism, and how it provides a unique worldview of human beings, the universe, health, and nursing. Essential principles and therapies consistent with Taoist philosophy are also identified. This framework is proffered as the basis for establishing understanding between Korean nurses and patients.

Emerging issues and future directions of the field of health communication.

PubMed

Hannawa, Annegret F; Kreps, Gary L; Paek, Hye-Jin; Schulz, Peter J; Smith, Sandi; Street, Richard L

2014-01-01

The interdisciplinary intersections between communication science and health-related fields are pervasive, with numerous differences in regard to epistemology, career planning, funding perspectives, educational goals, and cultural orientations. This article identifies and elaborates on these challenges with illustrative examples. Furthermore, concrete suggestions for future scholarship are recommended to facilitate compatible, coherent, and interdisciplinary health communication inquiry. The authors hope that this article helps current and future generations of health communication scholars to make more informed decisions when facing some of the challenges discussed in this article so that they will be able to seize the interdisciplinary and international potential of this unique and important field of study.

Providing Health Sciences Services in a Joint-Use Distributed Learning Library System: An Organizational Case Study.

PubMed

Enslow, Electra; Fricke, Suzanne; Vela, Kathryn

2017-01-01

The purpose of this organizational case study is to describe the complexities librarians face when serving a multi-campus institution that supports both a joint-use library and expanding health sciences academic partnerships. In a system without a centralized health science library administration, liaison librarians are identifying dispersed programs and user groups and collaborating to define their unique service and outreach needs within a larger land-grant university. Using a team-based approach, health sciences librarians are communicating to integrate research and teaching support, systems differences across dispersed campuses, and future needs of a new community-based medical program.

An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District.

PubMed

Houghton, Adele; Austin, Jessica; Beerman, Abby; Horton, Clayton

2017-01-01

Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as "high vulnerability." Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment.

Evaluating the impact of decentralising tuberculosis microscopy services to rural township hospitals in gansu province, china

PubMed Central

2011-01-01

Background In 2004, the Ministry of Health issued the policy of decentralising microscopy services (MCs) to one third of all township hospitals in China. The study was conducted in Gansu Province, a poor western one in China. Ganzhou was one county in Gansu Province. Ganzhou County was identified as a unique case of further decentralisation of tuberculosis (TB) treatment services in township hospitals. The study evaluated the impact of the MC policy on providers and patients in Gansu Province. The second objective was to assess the unique case of Ganzhou County compared with other counties in the province. Methods Both quantitative and qualitative methods were used. All 523 MCs in the province completed an institutional survey regarding their performance. Four counties were selected for in-depth investigation, where 169 TB suspects were randomly selected from the MC and county TB dispensary registers for questionnaire surveys. Informant interviews were conducted with 38 health staff at the township and county levels in the four counties. Results Gansu established MCs in 39% of its township hospitals. From January 2006 to June 2007, 8% of MCs identified more than 10 TB sputum smear positive patients while 54% did not find any. MCs identified 1546 TB sputum smear positive patients, accounting for 9% of the total in the province. The throughputs of MCs in Ganzhou County were eight times of those in other counties. Interviews identified several barriers to implement the MC policy, such as inadequate health financing, low laboratory capacity, lack of human resources, poor treatment and management capacities, and lack of supervisions from county TB dispensaries. Conclusion Microscopy centre throughputs were generally low in Gansu Province, and the contribution of MCs to TB case detection was insignificant taking account the number of MCs established. As a unique case of full decentralisation of TB service, Ganzhou County presented better results. However, standards and quality of TB care needed to be improved. The MC policy needs to be reviewed in light of evidence from this study. PMID:21324106

Priorities of Legislatively-Active Veteran Services Organizations: A Content Analysis and Review for Health Promotion Initiatives

PubMed Central

Jahnke, Sara A.; Haddock, Christopher K.; Carlos Poston, Walker S.; Jitnarin, Nattinee

2014-01-01

Military and Veterans Service Organizations (MVSOs) have a unique opportunity to influence legislation and advocate for the interests of their members. However, little is known about what legislative priorities MVSOs see as important. Understanding the legislative priorities of MVSOs can inform efforts by health scientists to promote policy and laws designed to improve the health of our nation’s veterans. Using a mixed methods approach, we conducted a thematic analysis of legislative priorities MVSOs promote with their legislative agendas. Most commonly, MVSOs addressed issues related to disability evaluations and ratings with the Veterans Administration (VA) and access to VA services. Other common themes identified as priorities include benefits such as retirement, education, housing assistance for veterans, and TRICARE benefits. Findings highlight the broad range of topics MVSOs identify as legislative priorities as well as some health issues that receive relatively limited attention. PMID:25373063

Health and healing: spiritual, pharmaceutical, and mechanical medicine.

PubMed

Hutch, Richard A

2013-09-01

Modern medical practice is identified as a relatively recent way of approaching human ill health in the wide scope of how people have addressed sickness throughout history and across a wide range of cultures. The ideological biases of medical or "allopathic" (disease as "other" or "outsider") practice are identified and grafted onto other perspectives on how people not engaged in modern medicine have achieved healing and health. Alternative forms of healing and health open a consideration of ethnomedicine, many forms of which are unknown and, hence, untested by modern medical research. Ethnomedicine the world over and throughout human history has displayed unique spiritual (vitalism), pharmaceutical (herbs/drugs), and mechanical (manipulation/surgery) approaches to treating illness. The argument is that modern allopathic medicine would do well to consider such "world medicine" as having valuable alternative and complementary therapies, the use of which could enhance contemporary medical advice and practice.

Navigating the Leadership Landscape: Creating an Inventory to Identify Leadership Education Programs for Health Professionals.

PubMed

Gertler, Matthew; Verma, Sarita; Tassone, Maria; Seltzer, Jane; Careau, Emmanuelle

2015-01-01

As health systems become increasingly complex, there is growing emphasis on collaborative leadership education for health system change. The Canadian Interprofessional Health Leadership Collaborative conducted research on this phenomenon through a scoping and systematic review of the health leadership literature, key informant interviews and an inventory of health leadership programs in Canada. The inventory is unique, accounting for educational programming missed by traditional scholarly literature reviews. A major finding is that different health professions have access to health leadership education in different stages of their careers. This pioneering inventory suggests that needs may differ between health professions but also that there is a growing demand for multiple types of programs for specific targeted audiences, and a strategic need for collaborative leadership education in healthcare.

Educating the future public health workforce: do schools of public health teach students about the private sector?

PubMed

Rutkow, Lainie; Traub, Arielle; Howard, Rachel; Frattaroli, Shannon

2013-01-01

Recent surveys indicate that approximately 40% of graduates from schools of public health are employed within the private sector or have an employer charged with regulating the private sector. These data suggest that schools of public health should provide curricular opportunities for their students--the future public health workforce--to learn about the relationship between the private sector and the public's health. To identify opportunities for graduate students in schools of public health to select course work that educates them about the relationship between the private sector and public health. We systematically identified and analyzed data gathered from publicly available course titles and descriptions on the Web sites of accredited schools of public health. Data were collected in the United States. The sample consisted of accredited schools of public health. Descriptions of the number and types of courses that schools of public health offer about the private sector and identification of how course descriptions frame the private sector relative to public health. We identified 104 unique courses with content about the private sector's relationship to public health. More than 75% of accredited schools of public health offered at least 1 such course. Nearly 25% of identified courses focused exclusively on the health insurance industry. Qualitative analysis of the data revealed 5 frames used to describe the private sector, including its role as a stakeholder in the policy process. Schools of public health face a curricular gap, with relatively few course offerings that teach students about the relationship between the private sector and the public's health. By developing new courses or revising existing ones, schools of public health can expose the future public health workforce to the varied ways public health professionals interact with the private sector, and potentially influence students' career paths.

Access to Care for Transgender Veterans in the Veterans Health Administration: 2006–2013

PubMed Central

Shipherd, Jillian C.; Lindsay, Jan; Blosnich, John R.; Brown, George R.; Jones, Kenneth T.

2014-01-01

A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care. PMID:25100417

Access to care for transgender veterans in the Veterans Health Administration: 2006-2013.

PubMed

Kauth, Michael R; Shipherd, Jillian C; Lindsay, Jan; Blosnich, John R; Brown, George R; Jones, Kenneth T

2014-09-01

A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care.

Improving Patient Safety, Health Data Accuracy, and Remote Self-Management of Health Through the Establishment of a Biometric-Based Global UHID.

PubMed

Hembroff, Guy

2016-01-01

Healthcare systems globally continue to face challenges surrounding patient identification. Consequences of misidentification include incomplete and inaccurate electronic patient health records potentially jeopardizing patients' safety, a significant amount of cases of medical fraud because of inadequate identification mechanisms, and difficulties affiliated with the value of remote health self-management application data being aggregated accurately into the user's Electronic Health Record (EHR). We introduce a new technique of user identification in healthcare capable of establishing a global identifier. Our research has developed algorithms capable of establishing a Unique Health Identifier (UHID) based on the user's fingerprint biometric, with the utilization of facial-recognition as a secondary validation step before health records can be accessed. Biometric captures are completed using standard smartphones and Web cameras in a touchless method. We present a series of experiments to demonstrate the formation of an accurate, consistent, and scalable UHID. We hope our solution will aid in the reduction of complexities associated with user misidentification in healthcare resulting in lowering costs, enhancing population health monitoring, and improving patient-safety.

Obstacles to the take-up of mental health-care provision by adult males in rural and remote areas of Australia: A systematic review protocol.

PubMed

Stroud, Peter; Lockwood, Craig

The objective is to identify and synthesise the best available evidence on the obstacles to the take-up of health-care provision by adult rural and remote dwelling males in Australia seeking mental health services. Men's health, in general health-care practice, is defined as the global management of mental, emotional, and physical health conditions, and related risk factors, that are specific to men in order to promote and generate optimal health.Research and practice tends to suggest that health-care and mental-health care practitioners seem to be confronted with obstacles such as distance clients need to travel and rurality in delivering care to adult rural males. Possible issues might be whether, or to what extent, care providers are conscious of these obstacles. Another issue might be how care providers work with these obstacles in practice, and whether or not they may, also to some extent, share some of the responsibility for the existence of these obstacles, on their own, or in conjunction with other factors which might be said to exist purely in the rural context. There is also a need to explore the contributions to obstacles from the adult rural male side as well. There may also be factors at work in the particular unique nature of rural and remote health-care and mental-health care as well, which could also be involved in the creation of obstacles.The structure and functioning of rural care available to adult males of all cultural backgrounds and the obstacles to the take-up of that care represents an area which warrants further exploration and understanding. A foundation paper in this field by Karoski suggests that obstacles exist in health-care provision, particularly in the field of mental-health care to adult males. Other research suggests that, while obstacles in service provision are common to all areas, some obstacles are more significant for rural and remote areas.The reasons for framing this review in terms of the adult rural and remote male (ARRM) context is as follows. Research suggests there is a consensus that Australian rural male health is a unique social problem, and there appears to be a possible perception that the state and national health systems may have failed ARRM's. This research also discusses that ARRM's respond differently and uniquely, compared to their international counterparts, and this might be especially true in the case of Australian Indigenous populations. There is a suggestion in the research that the Australian rural health-care environment is unique because of its mix of ARRM's among a population which includes culturally and linguistically diverse populations, local Indigenous people as well as people of Anglo-Saxon descent. Some research suggests that there are unique complexities confronting the ARRM population mix when access to health-care is considered. Research also suggests unique complexities might exist in the mix of care provision, delivery systems, and funding arrangements in the ARRM context. An interesting area of research in terms of social capital, and moral distress, suggests the Australian context might be unique in terms of its formal and informal care structures and arrangements.. Moral distress is believed to represent an issue in the professional delivery of quality health-care Other research considers the notion of structural disadvantage in the provision of, and access to, care services for ARRM's. Structural disadvantage refers to the dearth of asset-based community development opportunities that play a role in health-care provision.A screening search of Pubmed, Cinahl, the Cochrane Library and the JBI Systematic Review Library did not identify published systematic reviews, or active protocols in this topic of research. Therefore this systematic review will help address this gap. Obstacle: A barrier to the utilisation of health-care/mental-health care.Take-up: The accessing of health-care/mental-health care services.Health-care: Services which promote, maintain, and preserve health, life, and well-being.Mental-Health care: The assessment, diagnosis and treatment of people who are experiencing psychological and situational stressors which create mental-health conditions and disorders such as depression and anxiety.Provision: Professional services for health-care/mental-health care provided by Doctors, Nurses, Medical Specialists, Psychologists, Social Workers, Psychotherapists, and other care providers.Rural and Remote: This term can be conceptualised as a set of characteristics which can impact on the way a health-care service can be delivered and includes: geographical isolation from major population centres of Australia; greater distances; lower socioeconomic status; lower educational levels; higher proportion of Indigenous people; specific occupational health safety and welfare risks; a relatively close relationship with nature; specific cultural attitudes; poor access to services; and, smaller population centres where there is a distinctive occupational profile dominated by primary and resource production.

A unique measles B3 cluster in the United Kingdom and the Netherlands linked to air travel and transit at a large international airport, February to April 2014.

PubMed

Nic Lochlainn, Laura; Mandal, Sema; de Sousa, Rita; Paranthaman, Karthik; van Binnendijk, Rob; Ramsay, Mary; Hahné, Susan; Brown, Kevin E

2016-01-01

This report describes a joint measles outbreak investigation between public health officials in the United Kingdom (UK) and the Netherlands following detection of a measles cluster with a unique measles virus strain. From 1 February to 30 April 2014, 33 measles cases with a unique measles virus strain of genotype B3 were detected in the UK and the Netherlands, of which nine secondary cases were epidemiologically linked to an infectious measles case travelling from the Philippines. Through a combination of epidemiological investigation and sequence analysis, we found that measles transmission occurred in flight, airport and household settings. The secondary measles cases included airport workers, passengers in transit at the same airport or travelling on the same flight as the infectious case and also household contacts. This investigation highlighted the particular importance of measles genotyping in identifying transmission networks and the need to improve vaccination, public health follow-up and management of travellers and airport staff exposed to measles.

Health-Related Quality of Life of Adolescent and Young Adult Survivors of Central Nervous System Tumors: Identifying Domains From a Survivor Perspective.

PubMed

Kuhlthau, Karen; Luff, Donna; Delahaye, Jennifer; Wong, Alicia; Yock, Torunn; Huang, Mary; Park, Elyse R

2015-01-01

This article uses qualitative methods to describe the domains of health-related quality of life (HRQoL) that adolescent and young adult (AYA) survivors of central nervous system (CNS) tumors identify as important. Survivors clearly attributed aspects of their current HRQoL to their disease or its treatment. We identified 7 key domains of AYA CNS tumor survivorship: physical health, social well-being, mental health, cognitive functioning, health behaviors, sexual and reproductive health, and support systems. Although most aspects of HRQoL that survivors discussed represented new challenges, there were several areas where survivors pointed out positive outcomes. There is a need for a HRQoL tool designed for this population of survivors, given their unique treatment and survivorship experience. Aspects of HRQoL related to cognition, sexual and reproductive health, health behaviors, and support systems are not typically included in generic HRQoL tools but should be assessed for this population. Developing HRQoL measurement instruments that capture the most significant aspects of HRQoL will improve the ability to track HRQoL in AYA CNS tumor survivors and in the long-term management of common sequelae from CNS tumors and their treatments. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

Six essential roles of health promotion research centres: the Atlantic Canada experience

PubMed Central

Langille, Lynn L.; Crowell, Sandra J.; Lyons, Renée F.

2009-01-01

SUMMARY Over the past 20 years, the federal government and universities across Canada have directed resources towards the development of university-based health promotion research centres. Researchers at health promotion research centres in Canada have produced peer-reviewed papers and policy documents based on their work, but no publications have emerged that focus on the specific roles of the health promotion research centres themselves. The purpose of this paper is to propose a framework, based on an in-depth examination of one centre, to help identify the unique roles of health promotion research centres and to clarify the value they add to promoting health and advancing university goals. Considering the shifting federal discourse on health promotion over time and the vulnerability of social and health sciences to changes in research funding priorities, health promotion research centres in Canada and elsewhere may need to articulate their unique roles and contributions in order to maintain a critical focus on health promotion research. The authors briefly describe the Atlantic Health Promotion Research Centre (AHPRC), propose a framework that illustrates six essential roles of health promotion research centres and describe the policy contexts and challenges of health promotion research centres. The analysis of research and knowledge translation activities over 15 years at AHPRC sheds light on the roles that health promotion research centres play in applied research. The conclusion raises questions regarding the value of university-based research centres and challenges to their sustainability. PMID:19171668

Health-related quality of life among US military personnel injured in combat: findings from the Wounded Warrior Recovery Project.

PubMed

Woodruff, Susan I; Galarneau, Michael R; McCabe, Cameron T; Sack, Daniel I; Clouser, Mary C

2018-05-01

Little is known about the long-term, health-related quality of life (HRQOL) of those wounded in combat during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. The present study described the overall HRQOL for a large group of US service members experiencing mild-to-severe combat-related injuries, and assessed the unique contribution of demographics, service- and injury-related characteristics, and mental health factors on long-term HRQOL. The Wounded Warrior Recovery Project examines patient-reported outcomes in a cohort of US military personnel wounded in combat. Participants were identified from the Expeditionary Medical Encounter Database, a US Navy-maintained deployment health database, and invited to complete a web-based survey. At the time of this study, 3245 service members consented and completed the survey. Hierarchical linear regression analyses were conducted to assess the unique contribution of each set of antecedents on HRQOL scores. HRQOL was uniquely associated with a number of demographics, and service- and injury-related characteristics. Nevertheless, screening positive for posttraumatic stress disorder (B = - .09; P < .001), depression (B = - .10; P < .001), or both as a set (B = - .19; P < .001) were the strongest predictors of lower long-term HRQOL. Postinjury HRQOL among service members wounded in combat was associated with service and injury experience, and demographic factors, but was most strongly linked with current mental health status. These findings underscore the significance of mental health issues long after injury. Further, findings reinforce that long-term mental health screening, services, and treatment are needed for those injured in combat.

77 FR 22949 - Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-17

..., MD 21244-8013. Please allow sufficient time for mailed comments to be received before the close of... addresses prior to the close of the comment period: a. For delivery in Washington, DC-- Centers for Medicare... comments received before the close of the comment period are available for viewing by the public, including...

Revising an Extension Education Website for Limited Resource Audiences Using Social Marketing Theory

ERIC Educational Resources Information Center

Francis, Sarah L.; Martin, Peggy; Taylor, Kristin

2011-01-01

Spend Smart Eat Smart (SSES), a unique website combining nutrition and food buying education for limited resource audiences (LRAs), was revised using social marketing theory to make it more appealing and relevant to LRAs (25-40 years). Focus groups and surveys identified the needs and preferences of LRAs. Needs were cooking, basic health, and…

Use of satellite image data to identify changes in hemlock health over space and time

Treesearch

Laurent R. Bonneau; Kathleen S. Shields; Daniel L. Civco; David R. Mikus

2000-01-01

Eastern hemlock (Tsuga canadensis (L.) Carriere), is an important component of ecosystems in the northeastern United States and is the primary coniferous species in southern Connecticut. Hemlocks play a unique role in the region by providing spatial and structural habitat diversity that supports many wildlife and fish populations. Widespread damage...

17 CFR 45.5 - Unique swap identifiers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... transmit a unique swap identifier as provided in paragraphs (a)(1) and (2) of this section. (1) Creation... prior to the reporting of required swap creation data. The unique swap identifier shall consist of a... execution facility or designated contract market with respect to unique swap identifier creation; and (ii...

17 CFR 45.5 - Unique swap identifiers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... transmit a unique swap identifier as provided in paragraphs (a)(1) and (2) of this section. (1) Creation... prior to the reporting of required swap creation data. The unique swap identifier shall consist of a... execution facility or designated contract market with respect to unique swap identifier creation; and (ii...

17 CFR 45.5 - Unique swap identifiers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... transmit a unique swap identifier as provided in paragraphs (a)(1) and (2) of this section. (1) Creation... prior to the reporting of required swap creation data. The unique swap identifier shall consist of a... execution facility or designated contract market with respect to unique swap identifier creation; and (ii...

A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania.

PubMed

George, Siân; Daniels, Katy; Fioratou, Evridiki

2018-04-03

Minority vulnerable communities, such as the European Roma, often face numerous barriers to accessing healthcare services, resulting in negative health outcomes. Both these barriers and outcomes have been reported extensively in the literature. However, reports on barriers faced by European non-Roma native communities are limited. The "Health Care Access Barriers" (HCAB) model identifies pertinent financial, structural and cognitive barriers that can be measured and potentially modified. The present study thus aims to explore the barriers to accessing healthcare for a vulnerable population of mixed ethnicity from a charity community centre in Romania, as perceived by the centre's family users and staff members, and assess whether these reflect the barriers identified from the HCAB model. Eleven community members whose children attend the centre and seven staff members working at the centre participated in face-to-face semi-structured interviews, exploring personal experiences and views on accessing healthcare. The interviews were transcribed and analysed using an initial deductive and secondary inductive approach to identify HCAB themes and other emerging themes and subthemes. Identified themes from both groups aligned with HCAB's themes of financial, structural and cognitive barriers and emergent subthemes important to the specific population were identified. Specifically, financial barriers related mostly to health insurance and bribery issues, structural barriers related mostly to service availability and accessibility, and cognitive barriers related mostly to healthcare professionals' attitudes and discrimination and the vulnerable population's lack of education and health literacy. A unique theme of psychological barriers emerged from both groups with associated subthemes of mistrust, hopelessness, fear and anxiety of this vulnerable population. The current study highlights healthcare access barriers to a vulnerable non-Roma native population involved with a charity community centre in Romania. The "Healthcare Access Barriers for Vulnerable Populations" (HABVP) model is proposed as an adaption to the existing HCAB model to account for the unique perceived barriers to healthcare for this population. Recommendations for future resolution of these identified barriers are proposed.

What constitutes 'support' for the role of the Aboriginal and Torres Strait Islander child health workforce?

PubMed

Watson, Karen; Young, Jeanine; Barnes, Margaret

2013-02-01

As well as providing primary health care services, Aboriginal and Torres Strait Islander health workers are known to significantly contribute to the overall acceptability, access and use of health services through their role of cultural brokerage in the communities within which they work. As such they are uniquely positioned to positively influence health improvements for this vulnerable population. This study sought to identify key areas that both Aboriginal and Torres Strait Islander and non-Indigenous health professionals working within Indigenous communities felt were important in providing support for their roles. This group of workers require support within their roles particularly in relation to cultural awareness and capability, resource provision, educational opportunities, collaboration with colleagues and peers, and professional mentorship.

Rationale for the prevention of oral diseases in primary health care: an international collaborative study in oral health education.

PubMed

Bourgeois, Denis M; Phantumvanit, Prathip; Llodra, Juan Carlos; Horn, Virginie; Carlile, Monica; Eiselé, Jean-Luc

2014-10-01

Ensuring that members of society are healthy and reaching their full potential requires the prevention of oral diseases through the promotion of oral health and well-being. The present article identifies the best policy conditions of effective public health and primary care integration and the actors who promote and sustain these efforts. In this review, arguments and recommendations are provided to introduce an oral health collaborative promotion programme called Live.Learn.Laugh. phase 2, arising from an unique partnership between FDI World Dental Federation, the global company Unilever plc and an international network of National Dental Associations, health-care centres, schools and educators populations. © 2014 FDI World Dental Federation.

Improving Nutritional Health of the Public through Social Change: Finding Our Roles in Collective Action.

PubMed

Raine, Kim D

2014-09-01

Improving the nutritional health of the public continues to be a major challenge. Our mission of advancing health through food and nutrition has become increasingly complex, particularly as food environments shape the availability, affordability, and social acceptability of food and nutrition "choices". Promoting nutritional health requires that dietitians expand our knowledge in understanding the determinants of healthy eating and of social change strategies that advocates for and acts on improving food environments. While no single strategy can solve the challenges of public health nutrition, we can each identify unique strengths and opportunities. If we practice in complementary ways, using those strengths for collective action will make us stronger together toward social change supporting improved nutritional health of the public.

Academic-correctional health partnerships: preparing the correctional health workforce for the changing landscape-focus group research results.

PubMed

Hale, Janet Fraser; Haley, Heather-Lyn; Jones, Judy L; Brennan, Allyson; Brewer, Arthur

2015-01-01

Providing health care in corrections is challenging. Attracting clinicians can be equally challenging. The future holds a shortage of nurses and primary care physicians. We have a unique opportunity, now, to develop and stabilize our workforce, create a positive image, and enhance quality before the health care landscape changes even more dramatically. Focus groups were conducted with 22 correctional health care professionals divided into three groups: physicians (6), nurses (4), and nurse practitioners/physician assistants (12). Content focused on curricular themes, but additional themes emerged related to recruitment and retention. This article describes recruitment challenges, strategic themes identified, and the proposed initiatives to support a stable, high-quality correctional health workforce. © The Author(s) 2014.

Direct and interactive effects of parent, friend and schoolmate drinking on alcohol use trajectories.

PubMed

Lynch, Alicia Doyle; Coley, Rebekah Levine; Sims, Jacqueline; Lombardi, Caitlin McPherran; Mahalik, James R

2015-01-01

This study considered the unique and interactive roles of social norms from parents, friends and schools in predicting developmental trajectories of adolescent drinking and intoxication. Using data from the National Longitudinal Study of Adolescent Health, which followed adolescents (N = 18,921) for 13 years, we used discrete mixture modelling to identify unique developmental trajectories of drinking and of intoxication. Next, multilevel multinomial regression models examined the role of alcohol-related social norms from parents, friends and schoolmates in the prediction of youths' trajectory group membership. Results demonstrated that social norms from parents, friends and schoolmates that were favourable towards alcohol use uniquely predicted drinking and intoxication trajectory group membership. Interactions between social norms revealed that schoolmate drinking played an important moderating role, frequently augmenting social norms from parents and friends. The current findings suggest that social norms from multiple sources (parents, friends and schools) work both independently and interactively to predict longitudinal trajectories of adolescent alcohol use. Results highlight the need to identify and understand social messages from multiple developmental contexts in efforts to reduce adolescent alcohol consumption and alcohol-related risk-taking.

Identification of iPhone and iPad applications for obstetrics and gynecology providers.

PubMed

Farag, Sara; Chyjek, Kathy; Chen, Katherine T

2014-11-01

To systematically identify the number of applications ("apps") compatible with the iPhone and the iPad that are potentially useful to obstetrician-gynecologists (ob-gyns). Obstetrics and gynecology MeSH terms were searched in the Apple iTunes Store. A master list of unique apps was created and the apps were divided into categories and subcategories. A total of 1,816 unique apps using 55 different obstetrics and gynecology MeSH terms were found. Of these unique apps, 242 apps (13.3%) were considered potentially useful to ob-gyns. The MeSH terms that yielded the highest number of potentially useful apps were "gynecology" (23%), "breast cancer" (17%), "obstetrics" (14%), and "pregnancy" (12%). Less than 15% of apps found were considered potentially useful to ob-gyns. Thus, the obstetrics and gynecology community is in need of an organized effort to identify, review, and determine the accuracy of apps that can potentially improve the performance of health care providers and lead to better patient outcomes. We propose the formation of a committee to guide in this important task.

LGBTQ+ Latinx young adults' health autonomy in resisting cultural stigma.

PubMed

Schmitz, Rachel M; Sanchez, Julissa; Lopez, Bianca

2018-03-20

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) young people of colour are exposed to intersecting dynamics of social prejudice and discrimination related to sexuality and gender as well as race/ethnicity. In particular, Latinx-identifying LGBTQ+ young people face unique challenges in their lives, due to cultural stressors that stigmatise expansive gender and sexual identities. While it is crucial to examine the effects of multiple stressors on the well-being of LGBTQ+ young people of colour, this risk-based focus can overshadow the resilient capacities of multiply marginalised groups. Guided by an intersectional minority stress resilience framework, we asked: how do self-identified LGBTQ+ Latinx young adults manage cultural messages of prejudice and discrimination in relation to their health? Findings underscore how LGBTQ+ Latinx young adults established a strong sense of health autonomy to resist cultural stigma related to their intersecting identities. Young people actively educated themselves on health-related concerns, engaged in health-promoting tactics, and practised cultural negativity management to effectively navigate exposure to prejudice and discrimination.

Providing and funding breast health services in urban nurse-managed health centers.

PubMed

Tsai, Pei-Yun; Peterman, Beth; Baisch, Mary Jo; Ji, Eun Sun; Zwiers, Kelly

2014-01-01

Nurse-managed health centers (NMHCs) are an innovative health care delivery model that serves as an important point of health care access for populations at risk for disparities in health outcomes. This article describes the process and outcomes of clinical breast health services in two NMHCs located in a large Midwestern city. Findings indicate that client's knowledge about breast health was increased after they received breast health services from NMHC nurses. Significant positive changes in behavior related to the early detection of breast cancer were found in the study. NMHCs, identified for expansion in the Patient Protection and Affordable Care Act, offer a unique health care services delivery model that promotes access to care and early identification of breast cancer in very low-income and uninsured women. Copyright © 2014 Elsevier Inc. All rights reserved.

The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample

PubMed Central

Trujillo, Michael A.; Perrin, Paul B.; Sutter, Megan; Tabaac, Ariella; Benotsch, Eric G.

2017-01-01

INTRODUCTION Per the minority stress framework, trans individuals often experience psychological distress given the unique stress engendered by gender identity-related discrimination. Prior research has identified social support as particularly important for psychological distress and has suggested that social support may moderate this relationship. AIMS: The purpose of the current study was to explore the patterns of connections among discrimination, mental health, and suicidal ideation in trans individuals, and whether social support moderates these relationships. METHODS Participants (N = 78) completed measures of these constructs as part of a national online survey. RESULTS A series of simultaneous multiple regressions found that harassment/rejection discrimination was a unique positive predictor of mental health symptoms and suicidal ideation, with depression positively predicting suicidal ideation. A mediational model indicated that the association between harassment/rejection discrimination and suicidal ideation was fully mediated by depression. Three moderated meditational models were run, and one yielded a significant interaction, such that discrimination predicted suicidal ideation most strongly when participants had low social support from a significant other in comparison to moderate or high support. Further, conditional direct effects identified that discrimination led to ideation only for individuals with low support from friends or a significant other but not for those with moderate or high support. CONCLUSIONS Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population. PMID:29904324

The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample.

PubMed

Trujillo, Michael A; Perrin, Paul B; Sutter, Megan; Tabaac, Ariella; Benotsch, Eric G

2017-01-01

Per the minority stress framework, trans individuals often experience psychological distress given the unique stress engendered by gender identity-related discrimination. Prior research has identified social support as particularly important for psychological distress and has suggested that social support may moderate this relationship. AIMS: The purpose of the current study was to explore the patterns of connections among discrimination, mental health, and suicidal ideation in trans individuals, and whether social support moderates these relationships. Participants ( N = 78) completed measures of these constructs as part of a national online survey. A series of simultaneous multiple regressions found that harassment/rejection discrimination was a unique positive predictor of mental health symptoms and suicidal ideation, with depression positively predicting suicidal ideation. A mediational model indicated that the association between harassment/rejection discrimination and suicidal ideation was fully mediated by depression. Three moderated meditational models were run, and one yielded a significant interaction, such that discrimination predicted suicidal ideation most strongly when participants had low social support from a significant other in comparison to moderate or high support. Further, conditional direct effects identified that discrimination led to ideation only for individuals with low support from friends or a significant other but not for those with moderate or high support. Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population.

Using Java to generate globally unique identifiers for DICOM objects.

PubMed

Kamauu, Aaron W C; Duvall, Scott L; Avrin, David E

2009-03-01

Digital imaging and communication in medicine (DICOM) specifies that all DICOM objects have globally unique identifiers (UIDs). Creating these UIDs can be a difficult task due to the variety of techniques in use and the requirement to ensure global uniqueness. We present a simple technique of combining a root organization identifier, assigned descriptive identifiers, and JAVA generated unique identifiers to construct DICOM compliant UIDs.

An Empirical Typology of Social Networks and Its Association With Physical and Mental Health: A Study With Older Korean Immigrants

PubMed Central

Jang, Yuri; Lee, Beom S.; Ko, Jung Eun; Haley, William E.; Chiriboga, David A.

2015-01-01

Objectives. In the context of social convoy theory, the purposes of the study were (a) to identify an empirical typology of the social networks evident in older Korean immigrants and (b) to examine its association with self-rated health and depressive symptoms. Method. The sample consisted of 1,092 community-dwelling older Korean immigrants in Florida and New York. Latent class analyses were conducted to identify the optimal social network typology based on 8 indicators of interpersonal relationships and activities. Bivariate and multivariate analyses were conducted to examine how the identified social network typology was associated with self-rating of health and depressive symptoms. Results. Results from the latent class analysis identified 6 clusters as being most optimal, and they were named diverse, unmarried/diverse, married/coresidence, family focused, unmarried/restricted, and restricted. Memberships in the clusters of diverse and married/coresidence were significantly associated with more favorable ratings of health and lower levels of depressive symptoms. Discussion. Notably, no distinct network solely composed of friends was identified in the present sample of older immigrants; this may reflect the disruptions in social convoys caused by immigration. The findings of this study promote our understanding of the unique patterns of social connectedness in older immigrants. PMID:23887929

A taxonomy of adolescent health: development of the adolescent health profile-types.

PubMed

Riley, A W; Green, B F; Forrest, C B; Starfield, B; Kang, M; Ensminger, M E

1998-08-01

The aim of this study was to develop a taxonomy of health profile-types that describe adolescents' patterns of health as self-reported on a health status questionnaire. The intent was to be able to assign individuals to mutually exclusive and exhaustive groups that characterize the important aspects of their health and need for health services. Cluster analytic empirical methods and clinically based conceptual methods were used to identify patterns of health in samples of adolescents from schools and from clinics that serve adolescents with chronic conditions and acute illnesses. Individuals with similar patterns of scores across multiple domains were assigned to the same profile-type. Results from the empirical and conceptually based methods were integrated to produce a practical system for assigning youths to profile-types. Four domains of health (Satisfaction, Discomfort, Risks and Resilience) were used to group individuals into 13 distinct profile-types. The profile-types were characterized primarily by the number of domains in which health is poor, identifying the unique combinations of problems that characterize different subgroups of adolescents. This method of reporting the information available on health status surveys is potentially a more informative way of identifying and classifying the health needs of subgroups in the population than is available from global scores or multiple scale scores. The reliability and validity of this taxonomy of health profile-types for the purposes of planning and evaluating health services must be demonstrated. That is the purpose of the accompanying study.

Connecting Refugees to Substance Use Treatment: A Qualitative Study.

PubMed

McCleary, Jennifer S; Shannon, Patricia J; Cook, Tonya L

2016-01-01

An emerging body of literature identifies substance use as a growing concern among refugees resettling in the United States. Like immigrants, refugees may face cultural, linguistic, or systems barriers to connecting with mainstream substance use treatment programs, which may be compounded by refugees' unique experiences with exposure to trauma, displacement in refugee camps, and resettlement. This qualitative study explores factors that support and prevent refugees from connecting with chemical health treatment. Fifteen participants who identified as social service or public health professionals who work with refugees responded to an online, semistructured survey about their experiences referring refugees to substance use treatment. Resulting data was analyzed using thematic analysis. Themes emerged identifying a lack of culturally informed treatment models, policy issues, and client characteristics such as motivation and past trauma as barriers to engaging with treatment. Ongoing case management and coordination were identified as important to successful linkage. Findings from this study contribute to a better understanding of how to support refugees seeking substance use treatment and suggest that developing trauma informed, culturally relevant models of treatment that are integrated with primary health care and geographically accessible may enhance treatment linkage.

Tradeoffs of Using Administrative Claims and Medical Records to Identify the Use of Personalized Medicine for Patients with Breast Cancer

PubMed Central

Liang, Su-Ying; Phillips, Kathryn A.; Wang, Grace; Keohane, Carol; Armstrong, Joanne; Morris, William M.; Haas, Jennifer S.

2012-01-01

Background Administrative claims and medical records are important data sources to examine healthcare utilization and outcomes. Little is known about identifying personalized medicine technologies in these sources. Objectives To describe agreement, sensitivity, and specificity of administrative claims compared to medical records for two pairs of targeted tests and treatments for breast cancer. Research Design Retrospective analysis of medical records linked to administrative claims from a large health plan. We examined whether agreement varied by factors that facilitate tracking in claims (coding and cost) and that enhance medical record completeness (records from multiple providers). Subjects Women (35 – 65 years) with incident breast cancer diagnosed in 2006–2007 (n=775). Measures Use of human epidermal growth factor receptor 2 (HER2) and gene expression profiling (GEP) testing, trastuzumab and adjuvant chemotherapy in claims and medical records. Results Agreement between claims and records was substantial for GEP, trastuzumab, and chemotherapy, and lowest for HER2 tests. GEP, an expensive test with unique billing codes, had higher agreement (91.6% vs. 75.2%), sensitivity (94.9% vs. 76.7%), and specificity (90.1% vs. 29.2%) than HER2, a test without unique billing codes. Trastuzumab, a treatment with unique billing codes, had slightly higher agreement (95.1% vs. 90%) and sensitivity (98.1% vs. 87.9%) than adjuvant chemotherapy. Conclusions Higher agreement and specificity were associated with services that had unique billing codes and high cost. Administrative claims may be sufficient for examining services with unique billing codes. Medical records provide better data for identifying tests lacking specific codes and for research requiring detailed clinical information. PMID:21422962

Implications of the behavioural immune system for social behaviour and human health in the modern world.

PubMed

Schaller, Mark; Murray, Damian R; Bangerter, Adrian

2015-05-26

The 'behavioural immune system' is composed of mechanisms that evolved as a means of facilitating behaviours that minimized infection risk and enhanced fitness. Recent empirical research on human populations suggests that these mechanisms have unique consequences for many aspects of human sociality--including sexual attitudes, gregariousness, xenophobia, conformity to majority opinion and conservative sociopolitical attitudes. Throughout much of human evolutionary history, these consequences may have had beneficial health implications; but health implications in modern human societies remain unclear. This article summarizes pertinent ways in which modern human societies are similar to and different from the ecologies within which the behavioural immune system evolved. By attending to these similarities and differences, we identify a set of plausible implications-both positive and negative-that the behavioural immune system may have on health outcomes in contemporary human contexts. We discuss both individual-level infection risk and population-level epidemiological outcomes. We also discuss a variety of additional implications, including compliance with public health policies, the adoption of novel therapeutic interventions and actual immunological functioning. Research on the behavioural immune system, and its implications in contemporary human societies, can provide unique insights into relationships between fitness, sociality and health. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Lessons from the domestic Ebola response: Improving health care system resilience to high consequence infectious diseases.

PubMed

Meyer, Diane; Kirk Sell, Tara; Schoch-Spana, Monica; Shearer, Matthew P; Chandler, Hannah; Thomas, Erin; Rose, Dale A; Carbone, Eric G; Toner, Eric

2018-05-01

The domestic response to the West Africa Ebola virus disease (EVD) epidemic from 2014-2016 provides a unique opportunity to distill lessons learned about health sector planning and operations from those individuals directly involved. This research project aimed to identify and integrate these lessons into an actionable checklist that can improve health sector resilience to future high-consequence infectious disease (HCID) events. Interviews (N = 73) were completed with individuals involved in the domestic EVD response in 4 cities (Atlanta, Dallas, New York, and Omaha), and included individuals who worked in academia, emergency management, government, health care, law, media, and public health during the response. Interviews were transcribed and analyzed qualitatively. Two focus groups were then conducted to expand on themes identified in the interviews. Using these themes, an evidence-informed checklist was developed and vetted for completeness and feasibility by an expert advisory group. Salient themes identified included health care facility issues-specifically identifying assessment and treatment hospitals, isolation and treatment unit layout, waste management, community relations, patient identification, patient isolation, limitations on treatment, laboratories, and research considerations-and health care workforce issues-specifically psychosocial impact, unit staffing, staff training, and proper personal protective equipment. The experiences of those involved in the domestic Ebola response provide critical lessons that can help strengthen resilience of health care systems and improve future responses to HCID events. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Smoking cessation support for pregnant women: role of mobile technology

PubMed Central

Heminger, Christina L; Schindler-Ruwisch, Jennifer M; Abroms, Lorien C

2016-01-01

Background Smoking during pregnancy has deleterious health effects for the fetus and mother. Given the high risks associated with smoking in pregnancy, smoking cessation programs that are designed specifically for pregnant smokers are needed. This paper summarizes the current landscape of mHealth cessation programs aimed at pregnant smokers and where available reviews evidence to support their use. Methods A search strategy was conducted in June–August 2015 to identify mHealth programs with at least one component or activity that was explicitly directed at smoking cessation assistance for pregnant women. The search for text messaging programs and applications included keyword searches within public health and medical databases of peer-reviewed literature, Google Play/iTunes stores, and gray literature via Google. Results Five unique short message service programs and two mobile applications were identified and reviewed. Little evidence was identified to support their use. Common tools and features identified included the ability to set your quit date, ability to track smoking status, ability to get help during cravings, referral to quitline, and tailored content for the individual participant. The theoretical approach utilized was varied, and approximately half of the programs included pregnancy-related content, in addition to cessation content. With one exception, the mHealth programs identified were found to have low enrollment. Conclusion Globally, there are a handful of applications and text-based mHealth programs available for pregnant smokers. Future studies are needed that examine the efficacy of such programs, as well as strategies to best promote enrollment. PMID:27110146

Using the OCLC union listing component for a statewide health sciences union list of serials.

PubMed Central

Sutton, L S; Wolfgram, P A

1986-01-01

Union lists of serials are critical to the effective operation of interlibrary loan networks. The Michigan Health Sciences Libraries Association used the OCLC union list component to produce the Michigan Statewide Health Sciences Union List of Serials (MISHULS). MISHULS, which includes the serials holdings of ninety-three hospital health sciences libraries, is a subset of a statewide multi-type union list maintained on OCLC. The rationale for a statewide list and the criteria for choosing vendors are discussed. Typical costs are provided. Funding sources are identified and a unique approach to decentralized input is described. The benefits of resource sharing in a larger, multi-type library network are also explored. PMID:3708192

Using the OCLC union listing component for a statewide health sciences union list of serials.

PubMed

Sutton, L S; Wolfgram, P A

1986-04-01

Union lists of serials are critical to the effective operation of interlibrary loan networks. The Michigan Health Sciences Libraries Association used the OCLC union list component to produce the Michigan Statewide Health Sciences Union List of Serials (MISHULS). MISHULS, which includes the serials holdings of ninety-three hospital health sciences libraries, is a subset of a statewide multi-type union list maintained on OCLC. The rationale for a statewide list and the criteria for choosing vendors are discussed. Typical costs are provided. Funding sources are identified and a unique approach to decentralized input is described. The benefits of resource sharing in a larger, multi-type library network are also explored.

PTSD Treatment-Seeking Among Rural Latino Combat Veterans: A Review of the Literature*

PubMed Central

Duke, Michael R.; Moore, Roland S.; Ames, Genevieve M.

2013-01-01

Latino combat soldiers report both higher prevalence and greater overall severity of post-traumatic stress disorder (PTSD) symptoms than non-Hispanic Caucasians. However, these veterans face unique social and cultural barriers to accessing treatment for PTSD that distinguish them from their non-Hispanic white counterparts. Latino veterans who reside in rural settings face additional socio-cultural and structural impediments, in that they are likely to reside far from VA (Veterans Administration) medical facilities, have limited access to public transportation, and hold more conservative views toward mental health treatment than those residing in urban locales. However, little is known about the unique individual, sociocultural, and structural barriers to treatment faced by rural Latino veterans. This paper synthesizes the separate mental health and treatment-seeking literatures pertaining to Latinos, rural populations, and veterans, with the goal of identifying fruitful areas of conceptual overlap, and providing direction for future theory building, research, and targeted interventions. PMID:23762782

Measuring Health Information Dissemination and Identifying Target Interest Communities on Twitter: Methods Development and Case Study of the @SafetyMD Network.

PubMed

Kandadai, Venk; Yang, Haodong; Jiang, Ling; Yang, Christopher C; Fleisher, Linda; Winston, Flaura Koplin

2016-05-05

Little is known about the ability of individual stakeholder groups to achieve health information dissemination goals through Twitter. This study aimed to develop and apply methods for the systematic evaluation and optimization of health information dissemination by stakeholders through Twitter. Tweet content from 1790 followers of @SafetyMD (July-November 2012) was examined. User emphasis, a new indicator of Twitter information dissemination, was defined and applied to retweets across two levels of retweeters originating from @SafetyMD. User interest clusters were identified based on principal component analysis (PCA) and hierarchical cluster analysis (HCA) of a random sample of 170 followers. User emphasis of keywords remained across levels but decreased by 9.5 percentage points. PCA and HCA identified 12 statistically unique clusters of followers within the @SafetyMD Twitter network. This study is one of the first to develop methods for use by stakeholders to evaluate and optimize their use of Twitter to disseminate health information. Our new methods provide preliminary evidence that individual stakeholders can evaluate the effectiveness of health information dissemination and create content-specific clusters for more specific targeted messaging.

Late Talkers: A Population-Based Study of Risk Factors and School Readiness Consequences

ERIC Educational Resources Information Center

Hammer, Carol Scheffner; Morgan, Paul; Farkas, George; Hillemeier, Marianne; Bitetti, Dana; Maczuga, Steve

2017-01-01

Purpose: This study was designed to (a) identify sociodemographic, pregnancy and birth, family health, and parenting and child care risk factors for being a late talker at 24 months of age; (b) determine whether late talkers continue to have low vocabulary at 48 months; and (c) investigate whether being a late talker plays a unique role in…

Psychosocial Differences Between Whites and African Americans Living With HIV/AIDS in Rural Areas of 13 U.S. States

ERIC Educational Resources Information Center

Davantes Heckman, Bernadette

2006-01-01

Context: Acquired immunodeficiency syndrome (AIDS) prevalence rates are increasing rapidly in rural areas of the United States. As rural African Americans are increasingly affected by human immunodeficiency virus (HIV), it is important to identify psychosocial factors unique to this group so that AIDS mental health interventions can be culturally…

Prevalence of Disordered Eating and Pathogenic Weight Control Behaviors among NCAA Division I Female Collegiate Gymnasts and Swimmers

ERIC Educational Resources Information Center

Anderson, Carlin; Petrie, Trent A.

2012-01-01

Eating disorders and related weight control behaviors, such as excessive exercising and restrictive eating, represent serious health problems for girls and women in the United States and other industrialized nations. Female athletes, in particular, have been identified as a subgroup to study because of the unique weight, performance, and body…

What Social Workers in Health Care Should Know about Lupus: A Structural Equation Model

ERIC Educational Resources Information Center

Auerbach, Charles; Beckerman, Nancy L.

2011-01-01

This article reports on findings from a cross-sectional study (N = 378) of patients living with systemic lupus erythematosus (SLE). The purpose of this study was to identify and clarify the unique psychosocial challenges for those living with lupus. The specific analysis will help to develop a model to determine how different factors influence SLE…

Why aren’t they happy? An analysis of end-user satisfaction with Electronic health records

PubMed Central

Unni, Prasad; Staes, Catherine; Weeks, Howard; Kramer, Heidi; Borbolla, Damion; Slager, Stacey; Taft, Teresa; Chidambaram, Valliammai; Weir, Charlene

2016-01-01

Introduction. Implementations of electronic health records (EHR) have been met with mixed outcome reviews. Complaints about these systems have led to many attempts to have useful measures of end-user satisfaction. However, most user satisfaction assessments do not focus on high-level reasoning, despite the complaints of many physicians. Our study attempts to identify some of these determinants. Method. We developed a user satisfaction survey instrument, based on pre-identified and important clinical and non-clinical clinician tasks. We surveyed a sample of in-patient physicians and focused on using exploratory factor analyses to identify underlying high-level cognitive tasks. We used the results to create unique, orthogonal variables representative of latent structure predictive of user satisfaction. Results. Our findings identified 3 latent high-level tasks that were associated with end-user satisfaction: a) High- level clinical reasoning b) Communicate/coordinate care and c) Follow the rules/compliance. Conclusion: We were able to successfully identify latent variables associated with satisfaction. Identification of communicability and high-level clinical reasoning as important factors determining user satisfaction can lead to development and design of more usable electronic health records with higher user satisfaction. PMID:28269962

Community strengthening and mental health system linking after flooding in two informal human settlements in Peru: a model for small-scale disaster response.

PubMed

Contreras, C; Aguilar, M; Eappen, B; Guzmán, C; Carrasco, P; Millones, A K; Galea, J T

2018-01-01

Mental health is an important factor in responding to natural disasters. Observations of unmet mental health needs motivated the subsequent development of a community-based mental health intervention following one such disaster affecting Peru in 2017. Two informal human settlements on the outskirts of Lima were selected for a mental health intervention that included: (1) screening for depression and domestic violence, (2) children's activities to strengthen social and emotional skills and diminish stress, (3) participatory theater activities to support conflict resolution and community resilience, and (4) community health worker (CHW) accompaniment to government health services. A total of 129 people were screened across both conditions, of whom 12/116 (10%) presented with depression and 21/58 (36%) reported domestic violence. 27 unique individuals were identified with at least one problem. Thirteen people (48%) initially accepted CHW accompaniment to government-provided services. This intervention provides a model for a small-scale response to disasters that can effectively and acceptably identify individuals in need of mental health services and link them to a health system that may otherwise remain inaccessible.

An Approach to Developing Local Climate Change Environmental Public Health Indicators in a Rural District

PubMed Central

2017-01-01

Climate change represents a significant and growing threat to population health. Rural areas face unique challenges, such as high rates of vulnerable populations; economic uncertainty due to their reliance on industries that are vulnerable to climate change; less resilient infrastructure; and lower levels of access to community and emergency services than urban areas. This article fills a gap in public health practice by developing climate and health environmental public health indicators for a local public health department in a rural area. We adapted the National Environmental Public Health Tracking Network's framework for climate and health indicators to a seven-county health department in Western Kentucky. Using a three-step review process, we identified primary climate-related environmental public health hazards for the region (extreme heat, drought, and flooding) and a suite of related exposure, health outcome, population vulnerability, and environmental vulnerability indicators. Indicators that performed more poorly at the county level than at the state and national level were defined as “high vulnerability.” Six to eight high vulnerability indicators were identified for each county. The local health department plans to use the results to enhance three key areas of existing services: epidemiology, public health preparedness, and community health assessment. PMID:28352286

Patient-centered medical homes for patients with disabilities.

PubMed

Hernandez, Brigida; Damiani, Marco; Wang, T Arthur; Driscoll, Carolyn; Dellabella, Peter; LePera, Nicole; Mentari, Michael

2015-01-01

The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.

Environmental Health and Safety Hazards Experienced by Home Health Care Providers: A Room-by-Room Analysis.

PubMed

Polivka, Barbara J; Wills, Celia E; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2015-11-01

The number of personnel providing in-home health care services is increasing substantially. The unique configuration of environmental hazards in individual client homes has a significant impact on the safety and health of home health care providers (HHPs). This mixed-methods study used data from a standardized questionnaire, focus groups, and individual interviews to explore environmental health and safety hazards encountered by HHPs in client homes. The participant sample (N = 68) included nurses, aides, therapists, and owners/managers from a variety of geographic locations. The most often-reported hazards were trip/slip/lift hazards, biohazards, and hazards from poor air quality, allergens, pests and rodents, and fire and burns. Frequency of identified key hazards varied by room, that is, kitchen (e.g., throw rugs, water on floor), bathroom (e.g., tight spaces for client handling), bedroom (e.g., bed too low), living room (e.g., animal waste), and hallway (e.g., clutter). Findings indicate the need for broader training to enable HHPs to identify and address hazards they encounter in client homes. © 2015 The Author(s).

Environmental Health and Safety Hazards Experienced by Home Health Care Providers

PubMed Central

Polivka, Barbara J.; Wills, Celia E.; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

2015-01-01

The number of personnel providing in-home health care services is increasing substantially. The unique configuration of environmental hazards in individual client homes has a significant impact on the safety and health of home health care providers (HHPs). This mixed-methods study used data from a standardized questionnaire, focus groups, and individual interviews to explore environmental health and safety hazards encountered by HHPs in client homes. The participant sample (N = 68) included nurses, aides, therapists, and owners/managers from a variety of geographic locations. The most often-reported hazards were trip/slip/lift hazards, biohazards, and hazards from poor air quality, allergens, pests and rodents, and fire and burns. Frequency of identified key hazards varied by room, that is, kitchen (e.g., throw rugs, water on floor), bathroom (e.g., tight spaces for client handling), bedroom (e.g., bed too low), living room (e.g., animal waste), and hallway (e.g., clutter). Findings indicate the need for broader training to enable HHPs to identify and address hazards they encounter in client homes. PMID:26268486

Becoming an Approved Mental Health Professional: an analysis of the factors that influence individuals to become Approved Mental Health Professionals.

PubMed

Watson, David

2016-08-01

In England and Wales, the Approved Mental Health Professional (AMHP) has final responsibility for applying under the Mental Health Act 1983 to admit an individual compulsorily and convey them to psychiatric hospital. The AMHP role is challenging and legally accountable and unique to the UK context. To analyse the motivation of individuals to become AMHPs, and identify factors which may affect motivation. Semi-structured interviews were conducted with 12 AMHPs from local authorities across Southern England. Ten participants were social workers, one was qualified as both a nurse and social worker, and one was a mental health nurse. Participants identify career progression and professional development as significant as well as the status and independence of the role and enhanced job security. Social work participants value the Mental Health Act assessment as a contained piece of work, with a high degree of professional discretion. AMHPs are motivated by an increase in professional status and job security, but also exercising independent judgment and authority in a time-limited intervention is emotionally and professionally rewarding.

Commercial products that convey personal health information in emergencies.

PubMed

Potini, Vishnu C; Weerasuriya, Dilani N; Lowery-North, Douglas W; Kellermann, Arthur L

2011-12-01

Describe commercially available products and services designed to convey personal health information in emergencies. The search engine Google®, supplemented by print ads, was used to identify companies and organizations that offer relevant products and services to the general market. Disease-specific, health system, and health plan-specific offerings were excluded. Vendor web sites were the primary sources of information, supplemented by telephone and e-mail queries to sales representatives. Perfect inter-rater agreement was achieved. Thirty-nine unique vendors were identified. Eight sell engraved jewelry. Three offer an embossed card or pamphlet. Twelve supply USB drives with various features. Eleven support password-protected web sites. Five maintain national call centers. Available media differed markedly with respect to capacity and accessibility. Quoted prices ranged from a one-time expenditure of $3.50 to an annual fee of $200. Associated features and annual fees varied widely. A wide range of products and services exist to help patients convey personal health information. Health care providers should be familiar with their features, so they can access the information in a disaster or emergency.

Public Health Emergency Planning for Children in Chemical, Biological, Radiological, and Nuclear (CBRN) Disasters

PubMed Central

Bartenfeld, Michael T.; Peacock, Georgina; Griese, Stephanie E.

2015-01-01

Children represent nearly a quarter of the US population, but their unique needs in chemical, biological, radiological, and nuclear (CBRN) emergencies may not be well understood by public health and emergency management personnel or even clinicians. Children are different from adults physically, developmentally, and socially. These characteristics have implications for providing care in CBRN disasters, making resulting illness in children challenging to prevent, identify, and treat. This article discusses these distinct physical, developmental, and social traits and characteristics of children in the context of the science behind exposure to, health effects from, and treatment for the threat agents potentially present in CBRN incidents. PMID:25014894

Community rating and sustainable individual health insurance markets in New Jersey.

PubMed

Monheit, Alan C; Cantor, Joel C; Koller, Margaret; Fox, Kimberley S

2004-01-01

The New Jersey Individual Health Coverage Program (IHCP) was implemented in 1993; key provisions included pure community rating and guaranteed issue/renewal of coverage. Despite positive early evaluations, the IHCP appears to be heading for collapse. Using unique administrative and survey data, we examined trends in IHCP enrollment and premiums. We found the stability of the IHCP to be fragile in light of improving opportunities for job-related health insurance. We also found that it is retaining high-risk enrollees. Institutional realities and the difficulty of identifying a control group preclude attributing causality to the plan's pure community rating and open enrollment provisions.

HNET - A National Computerized Health Network

PubMed Central

Casey, Mark; Hamilton, Richard

1988-01-01

The HNET system demonstrated conceptually and technically a national text (and limited bit mapped graphics) computer network for use between innovative members of the health care industry. The HNET configuration of a leased high speed national packet switching network connecting any number of mainframe, mini, and micro computers was unique in it's relatively low capital costs and freedom from obsolescence. With multiple simultaneous conferences, databases, bulletin boards, calendars, and advanced electronic mail and surveys, it is marketable to innovative hospitals, clinics, physicians, health care associations and societies, nurses, multisite research projects libraries, etc.. Electronic publishing and education capabilities along with integrated voice and video transmission are identified as future enhancements.

Comparing the effectiveness of using generic and specific search terms in electronic databases to identify health outcomes for a systematic review: a prospective comparative study of literature search methods

PubMed Central

MacLean, Alice; Sweeting, Helen; Hunt, Kate

2012-01-01

Objective To compare the effectiveness of systematic review literature searches that use either generic or specific terms for health outcomes. Design Prospective comparative study of two electronic literature search strategies. The ‘generic’ search included general terms for health such as ‘adolescent health’, ‘health status’, ‘morbidity’, etc. The ‘specific’ search focused on terms for a range of specific illnesses, such as ‘headache’, ‘epilepsy’, ‘diabetes mellitus’, etc. Data sources The authors searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Education Resources Information Center for studies published in English between 1992 and April 2010. Main outcome measures Number and proportion of studies included in the systematic review that were identified from each search. Results The two searches tended to identify different studies. Of 41 studies included in the final review, only three (7%) were identified by both search strategies, 21 (51%) were identified by the generic search only and 17 (41%) were identified by the specific search only. 5 of the 41 studies were also identified through manual searching methods. Studies identified by the two ELS differed in terms of reported health outcomes, while each ELS uniquely identified some of the review's higher quality studies. Conclusions Electronic literature searches (ELS) are a vital stage in conducting systematic reviews and therefore have an important role in attempts to inform and improve policy and practice with the best available evidence. While the use of both generic and specific health terms is conventional for many reviewers and information scientists, there are also reviews that rely solely on either generic or specific terms. Based on the findings, reliance on only the generic or specific approach could increase the risk of systematic reviews missing important evidence and, consequently, misinforming decision makers. However, future research should test the generalisability of these findings. PMID:22734117

Young Men, Help-Seeking, and Mental Health Services: Exploring Barriers and Solutions.

PubMed

Lynch, Louise; Long, Maggie; Moorhead, Anne

2018-01-01

International research has identified young men as reluctant to seek help for mental health problems. This research explored barriers and solutions to professional help seeking for mental health problems among young men living in the North West of Ireland. A qualitative approach, using two focus groups with six participants each and five face-to-face interviews, was conducted with men aged 18 to 24 years (total N = 17). Data were analyzed using thematic analysis. Seven key themes of barriers to professional help seeking were identified: "acceptance from peers," "personal challenges," "cultural and environmental influences," "self-medicating with alcohol," "perspectives around seeking professional help," "fear of homophobic responses," and "traditional masculine ideals." Five key themes of solutions to these barriers included "tailored mental health advertising," "integrating mental health into formal education," "education through semiformal support services," "accessible mental health care," and "making new meaning." Interesting findings on barriers include fear of psychiatric medication, fear of homophobic responses from professionals, the legacy of Catholic attitudes, and the genuine need for care. This study offers an in-depth exploration of how young men experience barriers and uniquely offers solutions identified by participants themselves. Youth work settings were identified as a resource for engaging young men in mental health work. Young men can be encouraged to seek help if services and professionals actively address barriers, combining advertising, services, and education, with particular attention and respect to how and when young men seek help and with whom they want to share their problems.

The NIH Cognitive and Emotional Health Project. Report of the Critical Evaluation Study Committee.

PubMed

Hendrie, Hugh C; Albert, Marilyn S; Butters, Meryl A; Gao, Sujuan; Knopman, David S; Launer, Lenore J; Yaffe, Kristine; Cuthbert, Bruce N; Edwards, Emmeline; Wagster, Molly V

2006-01-01

The Cognitive and Emotional Health Project (CEHP) seeks to identify the demographic, social, and biological determinants of cognitive and emotional health in the older adult. As part of the CEHP, a critical evaluation study committee was formed to assess the state of epidemiological research on demographic, social, and biological determinants of cognitive and emotional health. Criteria for inclusion in the survey were large cohort studies, longitudinal in design, participants predominantly 65 years or older, with measurements of both cognition and emotion, and information on a wide variety of demographic, psychosocial, and biological factors. North American and European studies, which met these criteria, were selected for the review. Outcome measures included cognition, cognitive decline, and cognitive function. For emotion, symptoms included depression and anxiety, positive and negative affect, subjective well being, mastery, and resilience. Ninety-six papers were identified that addressed cognitive and emotional outcomes. A large variety of risk factors were consistently identified with cognitive outcomes, particularly those previously associated with increased risk of cardiovascular disease. There was considerable overlap between risk factors for cognitive and emotional outcomes. This review identifies a large number of lifestyle and health behaviors that alter the risk for maintenance of cognitive and emotional health. Large longitudinal cohort studies are a unique source to explore factors associated with cognitive and emotional health. Secondary analyses of these studies should be encouraged as should the development of standardized questionnaires to measure cognitive and emotional health. Future research in this field should study cognitive and emotional health simultaneously.

Suspected meningococcal meningitis on an aircraft carrier.

PubMed

Farr, Wesley; Gonzalez, Michele J; Garbauskas, Heather; Zinderman, Craig E; LaMar, James E

2004-09-01

A suspected case of meningococcal meningitis was diagnosed in a 24-year-old sailor onboard an aircraft carrier at sea in 2003. He was immediately confined to the ship's hospital ward under respiratory isolation precautions and was treated with intravenously administered antibiotics. His illness resolved without sequelae. A total of 99 close contacts from the ship were identified and given antibiotic prophylaxis, with directly observed therapy. British public health authorities were contacted to trace and treat persons identified as close contacts during a port call a few days before presentation. Managing a communicable disease such as meningococcal meningitis in the austere shipboard environment represents a unique challenge to military medical personnel. Successful management is possible through prompt treatment, respiratory isolation, and open communication between primary health care providers and public health officials. The identification of shipboard close contacts and other infection control procedures used by the ship's medical department are reviewed.

Research using qualitative, quantitative or mixed methods and choice based on the research.

PubMed

McCusker, K; Gunaydin, S

2015-10-01

Research is fundamental to the advancement of medicine and critical to identifying the most optimal therapies unique to particular societies. This is easily observed through the dynamics associated with pharmacology, surgical technique and the medical equipment used today versus short years ago. Advancements in knowledge synthesis and reporting guidelines enhance the quality, scope and applicability of results; thus, improving health science and clinical practice and advancing health policy. While advancements are critical to the progression of optimal health care, the high cost associated with these endeavors cannot be ignored. Research fundamentally needs to be evaluated to identify the most efficient methods of evaluation. The primary objective of this paper is to look at a specific research methodology when applied to the area of clinical research, especially extracorporeal circulation and its prognosis for the future. © The Author(s) 2014.

Universal structures of normal and pathological heart rate variability.

PubMed

Gañán-Calvo, Alfonso M; Fajardo-López, Juan

2016-02-25

The circulatory system of living organisms is an autonomous mechanical system softly tuned with the respiratory system, and both developed by evolution as a response to the complex oxygen demand patterns associated with motion. Circulatory health is rooted in adaptability, which entails an inherent variability. Here, we show that a generalized N-dimensional normalized graph representing heart rate variability reveals two universal arrhythmic patterns as specific signatures of health one reflects cardiac adaptability, and the other the cardiac-respiratory rate tuning. In addition, we identify at least three universal arrhythmic profiles whose presences raise in proportional detriment of the two healthy ones in pathological conditions (myocardial infarction; heart failure; and recovery from sudden death). The presence of the identified universal arrhythmic structures together with the position of the centre of mass of the heart rate variability graph provide a unique quantitative assessment of the health-pathology gradient.

Characteristics of food industry web sites and "advergames" targeting children.

PubMed

Culp, Jennifer; Bell, Robert A; Cassady, Diana

2010-01-01

To assess the content of food industry Web sites targeting children by describing strategies used to prolong their visits and foster brand loyalty; and to document health-promoting messages on these Web sites. A content analysis was conducted of Web sites advertised on 2 children's networks, Cartoon Network and Nickelodeon. A total of 290 Web pages and 247 unique games on 19 Internet sites were examined. Games, found on 81% of Web sites, were the most predominant promotion strategy used. All games had at least 1 brand identifier, with logos being most frequently used. On average Web sites contained 1 "healthful" message for every 45 exposures to brand identifiers. Food companies use Web sites to extend their television advertising to promote brand loyalty among children. These sites almost exclusively promoted food items high in sugar and fat. Health professionals need to monitor food industry marketing practices used in "new media." Published by Elsevier Inc.

Priorities of legislatively active veteran services organizations: a content analysis and review for health promotion initiatives.

PubMed

Jahnke, Sara A; Haddock, Christopher K; Carlos Poston, Walker S; Jitnarin, Nattinee

2014-11-01

Military and Veterans Service Organizations (MVSOs) have a unique opportunity to influence legislation and advocate for the interests of their members. However, little is known about what legislative priorities MVSOs see as important. Understanding the legislative priorities of MVSOs can inform efforts by health scientists to promote policy and laws designed to improve the health of our nation's veterans. Using a mixed methods approach, we conducted a thematic analysis of legislative priorities MVSOs promote with their legislative agendas. Most commonly, MVSOs addressed issues related to disability evaluations and ratings with the Veterans Administration and access to Veterans Administration services. Other common themes identified as priorities include benefits such as retirement, education, housing assistance for veterans, and TRICARE benefits. Findings highlight the broad range of topics MVSOs identify as legislative priorities as well as some health issues that receive relatively limited attention. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Promoting culturally competent care for gay youth.

PubMed

Bakker, Leslie J; Cavender, Angela

2003-04-01

Gay youth and those questioning their sexual identity have been referred to as "hidden," "invisible," "stigmatized," and "marginalized." As a result, the unique safety and health needs of this subculture have been overlooked, or worse, ignored, placing these youth at risk. Because school nurses have been identifying at-risk populations of students and developing programs to promote youth and family health for years, they should be prepared to provide health care for the subculture of gay youth. However, nurses are saying they do not have the knowledge or skills needed to identify and address the needs of this group. Providing school nursing care for gay youth requires the school nurse to be culturally competent. School nurses need to be aware of, sensitive to, and knowledgeable about the subculture. They must also possess communication skills required to relate appropriately to this group. This article presents information and nursing strategies that will promote the safety and health of gay youth while enhancing the school nurse's cultural competence.

Nursing students' reflections on the learning experience of a unique mental health clinical placement.

PubMed

Patterson, Christopher; Moxham, Lorna; Brighton, Renee; Taylor, Ellie; Sumskis, Susan; Perlman, Dana; Heffernan, Tim; Hadfield, Louise

2016-11-01

There exists a need for innovative thinking to identify new clinical placement opportunities for nursing students. Recovery-based clinical placements for mental health nurse students remain unique and require investigation. To examine the learning experience of Bachelor of Nursing students who undertook an innovative mental health clinical placement known as Recovery Camp. This study incorporated qualitative analysis of written reflections. Using Braun and Clarke's (2006) six phases of thematic analysis the corpus of student reflections were reviewed by three members of the research team independent to each other. Four themes emerged. The theme of Pre-placement Expectations incorporates participant foci on pre-conceptions of Recovery Camp. The theme of Student Learning incorporates the ways in which participants recognised the experience of Recovery Camp influenced learning. Reflections themed under the title Placement Setting include discussion of the Recovery Camp as a clinical placement. The theme of Future Practice incorporates students' reflections on how they plan to practice as nurses as a result the learning experiences of Recovery Camp. An immersive clinical placement such as Recovery Camp can influence students' perceptions of people with mental illness, have a positive impact on student learning and influence students' decisions about future practice. The learning experience of nursing students whom attend unique, recovery-orientated clinical placements can be both positive and educative. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health Insurance and Health Status: Exploring the Causal Effect from a Policy Intervention.

PubMed

Pan, Jay; Lei, Xiaoyan; Liu, Gordon G

2016-11-01

Whether health insurance matters for health has long been a central issue for debate when assessing the full value of health insurance coverage in both developed and developing countries. In 2007, the government-led Urban Resident Basic Medical Insurance (URBMI) program was piloted in China, followed by a nationwide implementation in 2009. Different premium subsidies by government across cities and groups provide a unique opportunity to employ the instrumental variables estimation approach to identify the causal effects of health insurance on health. Using a national panel survey of the URBMI, we find that URBMI beneficiaries experience statistically better health than the uninsured. Furthermore, the insurance health benefit appears to be stronger for groups with disadvantaged education and income than for their counterparts. In addition, the insured receive more and better inpatient care, without paying more for services. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

"Recognize Our Humanity": Immigrant Youth Voices on Health Care in Arizona's Restrictive Political Environment.

PubMed

Gómez, Sofía; Castañeda, Heide

2018-02-01

The "DACAmented Voices in Healthcare" project examined the intersection of restrictive immigration policies and health care via photovoice, a participatory action research approach, with immigrant youth living in Arizona, who were recipients of the Deferred Action for Childhood Arrivals (DACA) program. These "DACAmented" youth took part in nine photovoice sessions exploring their health care experiences and accessibility to care using documentary photography and narratives. They poignantly illustrated their experiences through images identifying their main health concerns and strengths, facilitating the development of health policy recommendations. This article illustrates the thematic findings and discusses policy recommendations and lessons learned from presentations to policy makers and health care providers. Findings suggest that immigrant youth are knowledgeable of their family's health care needs and hold a unique and important position within mixed-status households. Health care providers can benefit from the proposed recommendations by building bridges to care to address health equity in immigrant communities.

The role of perceived well-being in the family, school and peer context in adolescents' subjective health complaints: evidence from a Greek cross-sectional study.

PubMed

Petanidou, Dimitra; Daskagianni, Evangelie; Dimitrakaki, Christine; Kolaitis, Gerasimos; Tountas, Yannis

2013-11-28

During adolescence children are usually confronted with an expanding social arena. Apart from families, schools and neighbourhoods, peers, classmates, teachers, and other adult figures gain increasing importance for adolescent socio-emotional adjustment. The aim of the present study was to investigate the extent to which Greek adolescents' perceived well-being in three main social contexts (family, school and peers) predicted self-reported Subjective Health Complaints. Questionnaires were administered to a Greek nation-wide, random, school-based sample of children aged 12-18 years in 2003. Data from 1.087 adolescents were analyzed. A hierarchical regression model with Subjective Health Complaints as the outcome variable was employed in order to i) control for the effects of previously well-established demographic factors (sex, age and subjective economic status) and ii) to identify the unique proportion of variance attributed to each context. Bivariate correlations and multicollinearity were also explored. As hypothesized, adolescents' perceived well-being in each of the three social contexts appeared to hold unique proportions of variance in self-reported Subjective Health Complaints, after controlling for the effects of sex, age and subjective economic status. In addition, our final model confirmed that the explained variance in SHC was accumulated from each social context studied. The regression models were statistically significant and explained a total of approximately 24% of the variance in Subjective Health Complaints. Our study delineated the unique and cumulative contributions of adolescents' perceived well-being in the family, school and peer setting in the explanation of Subjective Health Complaints. Apart from families, schools, teachers and peers appear to have a salient role in adolescent psychosomatic adjustment. A thorough understanding of the relationship between adolescents' Subjective Health Complaints and perceived well-being in their social contexts could not only lead to more effective tailored initiatives, but also to promote a multi- and inter-disciplinary culture in adolescent psychosomatic health.

The role of perceived well-being in the family, school and peer context in adolescents’ subjective health complaints: evidence from a Greek cross-sectional study

PubMed Central

2013-01-01

Background During adolescence children are usually confronted with an expanding social arena. Apart from families, schools and neighbourhoods, peers, classmates, teachers, and other adult figures gain increasing importance for adolescent socio-emotional adjustment. The aim of the present study was to investigate the extent to which Greek adolescents’ perceived well-being in three main social contexts (family, school and peers) predicted self-reported Subjective Health Complaints. Methods Questionnaires were administered to a Greek nation-wide, random, school-based sample of children aged 12–18 years in 2003. Data from 1.087 adolescents were analyzed. A hierarchical regression model with Subjective Health Complaints as the outcome variable was employed in order to i) control for the effects of previously well-established demographic factors (sex, age and subjective economic status) and ii) to identify the unique proportion of variance attributed to each context. Bivariate correlations and multicollinearity were also explored. Results As hypothesized, adolescents’ perceived well-being in each of the three social contexts appeared to hold unique proportions of variance in self-reported Subjective Health Complaints, after controlling for the effects of sex, age and subjective economic status. In addition, our final model confirmed that the explained variance in SHC was accumulated from each social context studied. The regression models were statistically significant and explained a total of approximately 24% of the variance in Subjective Health Complaints. Conclusions Our study delineated the unique and cumulative contributions of adolescents’ perceived well-being in the family, school and peer setting in the explanation of Subjective Health Complaints. Apart from families, schools, teachers and peers appear to have a salient role in adolescent psychosomatic adjustment. A thorough understanding of the relationship between adolescents’ Subjective Health Complaints and perceived well-being in their social contexts could not only lead to more effective tailored initiatives, but also to promote a multi- and inter-disciplinary culture in adolescent psychosomatic health. PMID:24283390

Clinical Immersion: An Approach for Fostering Cross-disciplinary Communication and Innovation in Nursing and Engineering Students.

PubMed

Geist, Melissa J; Sanders, Robby; Harris, Kevin; Arce-Trigatti, Andrea; Hitchcock-Cass, Cary

2018-05-24

A faculty team from nursing and chemical engineering developed a course that brought together students from each discipline for cross-disciplinary, team-based clinical immersion and collaboration. Health care processes and devices are rapidly changing, and nurses are uniquely positioned to be bedside innovators to improve patient care delivery. During each clinical immersion, the student teams rotated through various hospital units where they identified problems and worked together in the university's makerspace (iMaker Space) to design and build prototypes to improve health outcomes. Data from the Critical thinking Assessment Test provided evidence of gains in critical-thinking and problem-solving skills, while the problems identified in the clinical setting and prototypes developed demonstrated the impact of bringing nursing and engineering students together to design innovations. When challenged to identify authentic problems during their clinical immersion, the teams of nursing and engineering students proposed creative solutions and developed commercially viable prototypes.

Patient Electronic Health Records as a Means to Approach Genetic Research in Gastroenterology

PubMed Central

Ananthakrishnan, Ashwin N; Lieberman, David

2015-01-01

Electronic health records (EHR) are being increasingly utilized and form a unique source of extensive data gathered during routine clinical care. Through use of codified and free text concepts identified using clinical informatics tools, disease labels can be assigned with a high degree of accuracy. Analysis linking such EHR-assigned disease labels to a biospecimen repository has demonstrated that genetic associations identified in prospective cohorts can be replicated with adequate statistical power, and novel phenotypic associations identified. In addition, genetic discovery research can be performed utilizing clinical, laboratory, and procedure data obtained during care. Challenges with such research include the need to tackle variability in quality and quantity of EHR data and importance of maintaining patient privacy and data security. With appropriate safeguards, this novel and emerging field of research offers considerable promise and potential to further scientific research in gastroenterology efficiently, cost-effectively, and with engagement of patients and communities. PMID:26073373

Monitoring the Internet for emerging psychoactive substances available to Australia.

PubMed

Bruno, Raimondo; Poesiat, Rosalie; Matthews, Allison Jane

2013-09-01

Novel psychoactive substances are increasingly available, both in traditional storefronts and via the Internet. While some use of such substances has been captured in Australian consumer surveys and wastewater analyses, there is little information about the products that are available to Australia via the Internet. Systematic monthly Internet monitoring for emerging psychoactive substances was conducted between July 2011 and July 2012. Webstores identified through searches were examined to determine if they sold stimulant or psychedelic emerging psychoactive substances to Australia. Internet search numbers for these products were examined over time using commercial tools. In 12 months, 43 unique webstores were identified selling to Australia, averaging two new webstores per month; however, two-fifths had closed within six months. Over 200 unique chemically unspecified products sold by purported effect (e.g. 'charge') were identified over 12 months, averaging 10 new products per month. Almost half of these products had disappeared from the market within six months. Eighty-six unique chemically specified products (e.g. methylenedioxypyrovalerone) were identified over 12 months, averaging four new novel substances per month. Once released, these products typically remained available, with almost 90% still available for purchase over a 6-month period. Almost 40 000 searches for these products emanated from Australia per month. This market is fast paced as retailers strive to beat both regulatory processes and competitors. Ongoing attention to these markets, incorporating surveillance of both Internet and traditional storefronts, is crucial as several of the substances identified have demonstrated potential for health and neurological harm. © 2013 Australasian Professional Society on Alcohol and other Drugs.

Early Social-Emotional Functioning and Public Health: The Relationship Between Kindergarten Social Competence and Future Wellness.

PubMed

Jones, Damon E; Greenberg, Mark; Crowley, Max

2015-11-01

We examined whether kindergarten teachers' ratings of children's prosocial skills, an indicator of noncognitive ability at school entry, predict key adolescent and adult outcomes. Our goal was to determine unique associations over and above other important child, family, and contextual characteristics. Data came from the Fast Track study of low-socioeconomic status neighborhoods in 3 cities and 1 rural setting. We assessed associations between measured outcomes in kindergarten and outcomes 13 to 19 years later (1991-2000). Models included numerous control variables representing characteristics of the child, family, and context, enabling us to explore the unique contributions among predictors. We found statistically significant associations between measured social-emotional skills in kindergarten and key young adult outcomes across multiple domains of education, employment, criminal activity, substance use, and mental health. A kindergarten measure of social-emotional skills may be useful for assessing whether children are at risk for deficits in noncognitive skills later in life and, thus, help identify those in need of early intervention. These results demonstrate the relevance of noncognitive skills in development for personal and public health outcomes.

Social network types among older Korean adults: Associations with subjective health.

PubMed

Sohn, Sung Yun; Joo, Won-Tak; Kim, Woo Jung; Kim, Se Joo; Youm, Yoosik; Kim, Hyeon Chang; Park, Yeong-Ran; Lee, Eun

2017-01-01

With population aging now a global phenomenon, the health of older adults is becoming an increasingly important issue. Because the Korean population is aging at an unprecedented rate, preparing for public health problems associated with old age is particularly salient in this country. As the physical and mental health of older adults is related to their social relationships, investigating the social networks of older adults and their relationship to health status is important for establishing public health policies. The aims of this study were to identify social network types among older adults in South Korea and to examine the relationship of these social network types with self-rated health and depression. Data from the Korean Social Life, Health, and Aging Project were analyzed. Model-based clustering using finite normal mixture modeling was conducted to identify the social network types based on ten criterion variables of social relationships and activities: marital status, number of children, number of close relatives, number of friends, frequency of attendance at religious services, attendance at organized group meetings, in-degree centrality, out-degree centrality, closeness centrality, and betweenness centrality. Multivariate regression analysis was conducted to examine associations between the identified social network types and self-rated health and depression. The model-based clustering analysis revealed that social networks clustered into five types: diverse, family, congregant, congregant-restricted, and restricted. Diverse or family social network types were significantly associated with more favorable subjective mental health, whereas the restricted network type was significantly associated with poorer ratings of mental and physical health. In addition, our analysis identified unique social network types related to religious activities. In summary, we developed a comprehensive social network typology for older Korean adults. Copyright © 2016 Elsevier Ltd. All rights reserved.

Advancing oral health policy and advocacy to prevent childhood obesity and reduce children's consumption of sugar-sweetened beverages.

PubMed

Sanghavi, Ankit; Siddiqui, Nadia J

2017-06-01

While a large body of work documents the interconnections between oral health and obesity, less is known about the role that oral health professionals and organizations play to prevent childhood obesity, especially by influencing children's consumption of sugar-sweetened beverages (SSBs). This review identifies efforts by oral health professionals and organizations to influence such policy and advocacy, while informing future opportunities to leverage and expand on existing efforts. A scoping review of peer-reviewed literature and a web-based review of oral health policy and advocacy initiatives addressing prevention of obesity and reducing children's consumption of SSBs were conducted. Of 30 unique references identified, four peer-reviewed and seven non-peer-reviewed references met selection criteria. Qualitative and quantitative data were extracted using a priori determined headings. Findings suggest a strong role for oral health professionals in preventing childhood obesity and reducing children's consumption of SSBs; however, only a few national, state, and local oral-health-advocacy and -policy efforts were identified, such as policy statements by national associations, state and local education campaigns, and clinical guidelines. Evidence was limited on the role of oral health professionals in influencing broader communitywide advocacy and policy efforts such as soda taxation and limiting SSB consumption in schools. This review provides an emerging evidence base to support growing recognition among oral health professionals of their dual role in preventing childhood obesity and dental caries by targeting SSB consumption. It also identifies opportunities for oral health professionals to build on initial efforts to more proactively influence future policy and advocacy. © 2017 American Association of Public Health Dentistry.

Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction.

PubMed

New, Peter Wayne; Eriks-Hoogland, Inge; Scivoletto, Giorgio; Reeves, Ronald K; Townson, Andrea; Marshall, Ruth; Rathore, Farooq A

2017-01-01

Background: Non-traumatic spinal cord dysfunction (SCDys) is caused by a large range of heterogeneous etiologies. Although most aspects of rehabilitation for traumatic spinal cord injury and SCDys are the same, people with SCDys have some unique rehabilitation issues. Purpose: This article presents an overview of important clinical rehabilitation principles unique to SCDys. Methods: Electronic literature search conducted (January 2017) using MEDLINE and Embase (1990-2016) databases for publications regarding SCDys. The focus of the literature search was on identifying publications that present suggestions regarding the clinical rehabilitation of SCDys. Results: The electronic search of MEDLINE and Embase identified no relevant publications, and the publications included were from the authors' libraries. A number of important clinical rehabilitation principles unique to people with SCDys were identified, including classification issues, general rehabilitation issues, etiology-specific issues, and a role for the rehabilitation physician as a diagnostic clinician. The classification issues were regarding the etiology of SCDys and the International Standards for Neurological Classification of Spinal Cord Injury. The general rehabilitation issues were predicting survival, improvement, and rehabilitation outcomes; admission to spinal rehabilitation units, including selection decision issues; participation in rehabilitation; and secondary health conditions. The etiology-specific issues were for SCDys due to spinal cord degeneration, tumors, and infections. Conclusions: Although there are special considerations regarding the rehabilitation of people with SCDys, such as the potential for progression of the underlying condition, functional improvement is typically significant with adequate planning of rehabilitation programs and special attention regarding the clinical condition of patients with SCDys.

Women's Health

MedlinePlus

Women have unique health issues. And some of the health issues that affect both men and women can affect women differently. Unique issues ... and men also have many of the same health problems. But these problems can affect women differently. ...

Development of the Tongan American Health Professionals Association: Sharing, Mentoring and Networking for Community Health.

PubMed

Tui'one, Vanessa; Tulua-Tata, Alisi; Hui, Brian; Tisnado, Diana M

Tongan-Americans face severe disparities in health including diabetes, cardiovascular disease, and cancer. Educational disparities also affect health opportunities and well-being, influencing health status and community capacity to address disparities. Few resources have been identified within the Tongan-American community to address these concerns. The Tongan American Health Professionals Association (TAHPA) was conceived to identify and develop health and health career resources for the Tongan community. Through TAHPA, the Tongan-American community is utilizing a community-empowerment approach to address disparities and well-being. TAHPA was formed in 2008 through the leadership of individuals with a vision of a healthier Tongan-American community. TAHPA's purpose was to inspire and empower the Tongan-American community by developing an organization of Tongan-American health care professionals and pre-professionals, celebrating their accomplishments, and providing resources and support for educational and career development. Founders gathered in small work groups in community settings to discuss health concerns, well-being and solutions. Key community members facilitated the process to establish goals and objectives. To date, 40 Tongan health professionals and pre-professionals have become members. TAHPA's vision and outreach processes have been developed. TAHPA's uniqueness and strength is that it is rooted in the community, created by the community to serve the community.

Dissemination, Implementation, and Improvement Science Research in Population Health: Opportunities for Public Health and CTSAs

PubMed Central

Gase, Lauren N.; Inkelas, Moira

2015-01-01

Abstract Importance The complex, dynamic nature of health systems requires dissemination, implementation, and improvement (DII) sciences to effectively translate emerging knowledge into practice. Although they hold great promise for informing multisector policies and system‐level changes, these methods are often not strategically used by public health. Objectives and Methods More than 120 stakeholders from Southern California, including the community, federal and local government, university, and health services were convened to identify key priorities and opportunities for public health departments and Clinical and Translational Science Awards programs (CTSAs) to advance DII sciences in population health. Main Outcomes Participants identified challenges (mismatch of practice realities with narrowly focused research questions; lack of iterative learning) and solutions (using methods that fit the dynamic nature of the real world; aligning theories of change across sectors) for applying DII science research to public health problems. Pragmatic steps that public health and CTSAs can take to facilitate DII science research include: employing appropriate study designs; training scientists and practicing professionals in these methods; securing resources to advance this work; and supporting team science to solve complex‐systems issues. Conclusions Public health and CTSAs represent a unique model of practice for advancing DII research in population health. The partnership can inform policy and program development in local communities. PMID:26243323

Dissemination, Implementation, and Improvement Science Research in Population Health: Opportunities for Public Health and CTSAs.

PubMed

Kuo, Tony; Gase, Lauren N; Inkelas, Moira

2015-12-01

The complex, dynamic nature of health systems requires dissemination, implementation, and improvement (DII) sciences to effectively translate emerging knowledge into practice. Although they hold great promise for informing multisector policies and system-level changes, these methods are often not strategically used by public health. More than 120 stakeholders from Southern California, including the community, federal and local government, university, and health services were convened to identify key priorities and opportunities for public health departments and Clinical and Translational Science Awards programs (CTSAs) to advance DII sciences in population health. Participants identified challenges (mismatch of practice realities with narrowly focused research questions; lack of iterative learning) and solutions (using methods that fit the dynamic nature of the real world; aligning theories of change across sectors) for applying DII science research to public health problems. Pragmatic steps that public health and CTSAs can take to facilitate DII science research include: employing appropriate study designs; training scientists and practicing professionals in these methods; securing resources to advance this work; and supporting team science to solve complex-systems issues. Public health and CTSAs represent a unique model of practice for advancing DII research in population health. The partnership can inform policy and program development in local communities. © 2015 Wiley Periodicals, Inc.

Priorities for Investments in Children and Families in Caddo and Bossier Parishes: Application of a Unique Framework for Identifying Priorities. Technical Report

ERIC Educational Resources Information Center

Kilburn, M. Rebecca; Maloney, Shannon I.

2010-01-01

After an initial inventory of community indicators in its 2008 Shreveport-Bossier City "Community Counts" annual report, the Community Foundation of Shreveport-Bossier decided to focus existing funding related to children and families on the areas of education, health, and poverty, as well as develop new funds in these areas. These focal…

EPIRUS-NET: A Wireless Health Telematics Network in Greece

DTIC Science & Technology

2001-10-25

has also to be made. The system is represented of three basic layers: the database layer, the middleware and the Hospital Daily Progress Anamnesis ... Anamnesis . The Encounter entry is uniquely identified by the incremental ID, IID, attribute. Each encounter entry is associated with a clinical...the main entities of the system (Hospital, Patient, Anamnesis , Encounter, Clinical Examination, Daily Progress, Examination, Release Ticket), along

The role of indigenous health workers in promoting oral health during pregnancy: a scoping review.

PubMed

Villarosa, Ariana C; Villarosa, Amy R; Salamonson, Yenna; Ramjan, Lucie M; Sousa, Mariana S; Srinivas, Ravi; Jones, Nathan; George, Ajesh

2018-03-20

Early childhood caries is the most common chronic childhood disease worldwide. Australian Aboriginal and Torres Strait Islander children are twice more likely to develop dental decay, and contributing factors include poor maternal oral health and underutilisation of dental services. Globally, Indigenous health workers are in a unique position to deliver culturally competent oral healthcare because they have a contextual understanding of the needs of the community. This scoping review aimed to identify the role of Indigenous health workers in promoting maternal oral health globally. A systematic search was undertaken of six electronic databases for relevant published literature and grey literature, and expanded to include non-dental health professionals and other Indigenous populations across the lifespan when limited studies were identified. Twenty-two papers met the inclusion criteria, focussing on the role of Indigenous health workers in maternal oral healthcare, types of oral health training programs and screening tools to evaluate program effectiveness. There was a paucity of peer-reviewed evidence on the role of Indigenous health workers in promoting maternal oral health, with most studies focusing on other non-dental health professionals. Nevertheless, there were reports of Indigenous health workers supporting oral health in early childhood. Although some oral health screening tools and training programs were identified for non-dental health professionals during the antenatal period, no specific screening tool has been developed for use by Indigenous health workers. While the role of health workers from Indigenous communities in promoting maternal oral health is yet to be clearly defined, they have the potential to play a crucial role in 'driving' screening and education of maternal oral health especially when there is adequate organisational support, warranting further research.

Dietary pattern classifications with nutrient intake and health-risk factors in Korean men.

PubMed

Lee, Ji Eun; Kim, Jung-Hyun; Son, Say Jin; Ahn, Younjhin; Lee, Juyoung; Park, Chan; Lee, Lilha; Erickson, Kent L; Jung, In-Kyung

2011-01-01

This study was performed to identify dietary patterns in Korean men and to determine the associations among dietary patterns, nutrient intake, and health-risk factors. Using baseline data from the Korean Health and Genome Study, dietary patterns were identified using factor analysis of data from a validated food-frequency questionnaire, and associations between these dietary patterns and health-risk factors were analyzed. Three dietary patterns were identified: 1) the "animal-food" pattern (greater intake of meats, fish, and dairy products), 2) the "rice-vegetable" pattern (greater intake of rice, tofu, kimchi, soybean paste, vegetables, and seaweed), and 3) the "noodle-bread" pattern (greater intake of instant noodles, Chinese noodles, and bread). The animal-food pattern (preferred by younger people with higher income and education levels) had a positive correlation with obesity and hypercholesterolemia, whereas the rice-vegetable pattern (preferred by older people with lower income and educational levels) was positively associated with hypertension. The noodle-bread pattern (also preferred by younger people with higher income and education levels) had a positive association with abdominal obesity and hypercholesterolemia. This study identifies three unique dietary patterns in Korean men, which are independently associated with certain health-risk factors. The rice-vegetable dietary pattern, modified for a low sodium intake, might be a healthy dietary pattern for Korean men. Copyright © 2011 Elsevier Inc. All rights reserved.

Identifying indigenous peoples for health research in a global context: a review of perspectives and challenges.

PubMed

Bartlett, Judith G; Madariaga-Vignudo, Lucia; O'Neil, John D; Kuhnlein, Harriet V

2007-09-01

Identifying Indigenous Peoples globally is complex and contested despite there being an estimated 370 million living in 70 countries. The specific context and use of locally relevant and clear definitions or characterizations of Indigenous Peoples is important for recognizing unique health risks Indigenous Peoples face, for understanding local Indigenous health aspirations and for reflecting on the need for culturally disaggregated data to plan meaningful research and health improvement programs. This paper explores perspectives on defining Indigenous Peoples and reflects on challenges in identifying Indigenous Peoples. Literature reviews and Internet searches were conducted, and some key experts were consulted. Pragmatic and political definitions by international institutions, including the United Nations, are presented as well as characterizations of Indigenous Peoples by governments and academic researchers. Assertions that Indigenous Peoples have about definitions of indigeneity are often related to maintenance of cultural integrity and sustainability of lifestyles. Described here are existing definitions and interests served by defining (or leaving undefined) such definitions, why there is no unified definition and implications of "too restrictive" a definition. Selected indigenous identities and dynamics are presented for North America, the Arctic, Australia and New Zealand, Latin America and the Caribbean, Asia and Africa. While health researchers need to understand the Indigenous Peoples with whom they work, ultimately, indigenous groups themselves best define how they wish to be viewed and identified for research purposes.

mHealth Education Applications Along the Cancer Continuum.

PubMed

Davis, Sharon Watkins; Oakley-Girvan, Ingrid

2015-06-01

The majority of adults worldwide own a mobile phone, including those in under-resourced communities. Mobile health (mhealth) education technologies present a promising mechanism for improving cancer prevention, treatment, and follow-up. The purpose of this study was to summarize the literature related to mobile phone (mhealth) applications for patient education specific to cancer and identify current recommendations from randomized studies. In particular, we were interested in identifying mobile phone applications along the cancer continuum, from cancer prevention to survivorship. The authors identified 28 articles reporting on mobile applications for patients related to cancer. Articles were identified in all categories along the cancer continuum, including health professional involvement in application development. Of these, six involved direct patient education, and eight focused on improving patient/professional communication and patient self-management. However, only six of the studies were randomized interventions. The potential for mobile applications to help overcome the "health care gap" has not yet been realized in the studies from the USA that were reviewed for this paper. However, early recommendations are emerging that support the use of mHealth communications to change behaviors for cancer prevention, early detection, and symptom management and improved patient-provider communication. Recommendations include short messages, use of multiple modalities as patient characteristics dictate comfort with mHealth communication, and the inclusion of patients and health professionals to develop and test applications. Tailoring mHealth to particular cultures, languages, and ethnic groups may also represent a unique possibility to provide accessible information and education at minimal cost for under-resourced communities and individuals.

Self-Identified Sexual Orientation and Sexual Risk Behavior Among HIV-Infected Latino Males.

PubMed

Champion, Jane Dimmitt; Szlachta, Alaina

2016-01-01

The HIV testing, disclosure, and sexual practices of ethnic minority men suggest that addressing sexual risk behavior and the underlying reasons for not receiving HIV testing or disclosing HIV-infection status-unique to differing populations-would improve public health interventions. Descriptive behaviors and underlying perspectives reported in our study suggest that public health interventions for HIV-infected Latino men who self-identify as heterosexual should explicitly identify substance use, needle sharing, and unprotected sex to current partners as behaviors placing both oneself and one's partners at high risk for contracting HIV. However, diversity of sexual behavior among gay, straight, and bisexual HIV-infected Latino men in our study ultimately suggested that clinicians should not rely on simplistic conceptions of sexuality in assessment of self-care needs. Care in presentation and discussion of self-identified sexual preference and sexual behavior is indicated, as these do not determine actual sexual orientation or behavior and vice versa. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Community health workers and the Patient Protection and Affordable Care Act: an opportunity for a research, advocacy, and policy agenda.

PubMed

Shah, Megha K; Heisler, Michele; Davis, Matthew M

2014-02-01

Community health workers (CHWs), who have been shown to be effective in multiple roles in the provision of culturally appropriate health care in a variety of settings, have the potential to be important members of an interdisciplinary health care team. Recent efforts have started to explore how best to integrate CHWs into the health system. However, to date, there has been limited policy guidance, support, or evidence on how best to achieve this on a larger scale. The Patient Protection and Affordable Care Act (ACA), through several provisions, provides a unique opportunity to create a unified framework for workforce integration and wider utilization of CHWs. This review identifies four major opportunities to further the research, advocacy, and policy agenda for CHWs.

Commentary: Medicaid reform issues affecting the Indian health care system.

PubMed Central

Wellever, A; Hill, G; Casey, M

1998-01-01

Substantial numbers of Indian people rely on Medicaid for their primary health insurance coverage. When state Medicaid programs enroll Indians in managed care programs, several unintended consequences may ensue. This paper identifies some of the perverse consequences of Medicaid reform for Indians and the Indian health care system and suggests strategies for overcoming them. It discusses the desire of Indian people to receive culturally appropriate services, the need to maintain or improve Indian health care system funding, and the duty of state governments to respect tribal sovereignty. Because of their relatively small numbers, Indians may be treated differently under Medicaid managed care systems without significantly endangering anticipated program savings. Failure of Medicaid programs to recognize the uniqueness of Indian people, however, may severely weaken the Indian health care system. PMID:9491006

Achieving appropriate design for developing world heath care: the case of a low-cost autoclave for primary health clinics.

PubMed

Cho, Hallie S; Tao, Gregory D; Winter, Amos

2012-01-01

In developing world health clinics, incidence of surgical site infection is 2 to 10 times higher than in developed world hospitals. This paper identifies lack of availability of appropriately designed, low-cost autoclaves in developing world health clinics as a major contributing factor to the dramatic gap in surgical site infection rates. The paper describes the process of developing a low-cost autoclave that addresses the unique challenges faced by developing world primary health clinics and discusses how appropriateness of design was determined. The resulting pressure cooker-based autoclave design was fabricated and tested against the CDC specifications. Twelve partnering clinics in Nepal trialed these autoclaves from July until December 2012.

Model-driven meta-analyses for informing health care: a diabetes meta-analysis as an exemplar.

PubMed

Brown, Sharon A; Becker, Betsy Jane; García, Alexandra A; Brown, Adama; Ramírez, Gilbert

2015-04-01

A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points. © The Author(s) 2014.

MODEL-DRIVEN META-ANALYSES FOR INFORMING HEALTH CARE: A DIABETES META-ANALYSIS AS AN EXEMPLAR

PubMed Central

Brown, Sharon A.; Becker, Betsy Jane; García, Alexandra A.; Brown, Adama; Ramírez, Gilbert

2015-01-01

A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points. PMID:25142707

How Have States Used Executive Orders to Address Public Health?

PubMed

Gakh, Maxim; Callahan, Karen; Goodie, Aaliyah; Rutkow, Lainie

2018-06-07

Gubernatorial executive orders (GEOs) are important, yet poorly understood, public health tools. We analyzed health-related GEOs nationwide using a modified legal mapping approach. We searched Westlaw's Netscan Executive Orders database for orders issued between 2008 and 2014. Search terms were generated from the Healthy People 2020 Leading Health Indicators (LHIs). GEOs were screened with data abstracted and analyzed on the basis of LHIs, states, years, and characteristics identified in previous literature. We found differences in GEOs issued per LHI. Of the 303 unique orders, they ranged from 32 to 53 issued per year and 0 to 45 issued per state. Most GEOs managed governmental public health functions, required collaboration, and mandated studying problems. Fewer directly addressed health equity, chronic disease, and resource deployment. Gubernatorial authority and political and institutional factors appear relevant to GEO issuance. GEOs offer means to institute public health policies and should be considered by public health professionals.

Perceptions of mental health among recently immigrated Mexican adolescents.

PubMed

Garcia, Carolyn M; Saewyc, Elizabeth M

2007-01-01

Rates of anxiety, depression, and suicidal ideation are high among Latino adolescents in the U.S., many of whom are immigrants. Immigration during adolescence creates risk factors for mental health problems. The purpose of this study was to explore the health-related perceptions of Mexican-origin immigrant adolescents to inform the design of culturally and developmentally appropriate mental health services. This focused ethnography was guided by Bronfenbrenner's ecological framework and symbolic interactionism. Fourteen adolescents were recruited from two non-health-based community settings. Data from one-to-one semi-structured interviews and a visual narrative project were coded and analyzed inductively. Three thematic patterns were identified: "mentally healthy," "mentally unhealthy," and "health promotion." Increased awareness of cultural influences and immigration on Latino adolescents' mental health is needed. Mental health nurses are in a unique position to educate and to influence accessibility of services.

Applying e-health to case management.

PubMed

Adams, J M

2000-01-01

The healthcare industry is only beginning to understand e-health. E-health can be defined as the use of technology to directly improve healthcare delivery-affording patients the opportunity to participate in their own healthcare management, provider, and institution. The market is changing rapidly, and innovations, partnerships, and mergers are taking place daily. For healthcare institutions, setting a long-term, yet adaptable e-health strategy is of vital importance for the continued success of the organization. For clinicians, an understanding of and familiarity with technologies can significantly improve workflow, organization, and patient interaction. For the patient, technology can be leveraged as a means to take initiative and responsibility for his/her own health. This article defines e-health and explains the implications and benefits of e-health to nurses and their patients. The article also identifies unique opportunities e-health/e-commerce can provide case managers in promoting patient connectivity, care management, and economy in cost of care.

Learner : preceptor ratios for practice-based learning across health disciplines: a systematic review.

PubMed

Loewen, Peter; Legal, Michael; Gamble, Allison; Shah, Kieran; Tkachuk, Stacey; Zed, Peter

2017-02-01

Practice-based learning is a cornerstone of developing clinical and professional competence in health disciplines. Practice-based learning systems have many interacting components, but a key facet is the number of learners per preceptor. Different learner : preceptor ratios may have unique benefits and pose unique challenges for participants. This is the first comprehensive systematic review of the topic. Our research questions were: What are the benefits and challenges of each learner : preceptor ratio in practice-based learning from the perspectives of the learners, preceptors, patients and stakeholder organisations (i.e. the placing and health care delivery organisations)? Are any ratios superior to others with respect to these characteristics and perspectives? Qualitative systematic review of published English-language literature since literature database inception, including multiple health disciplines. Seventy-three articles were included in this review. Eight learner : preceptor ratio arrangements were identified involving nursing, physiotherapy, occupational therapy, pharmacy, dietetics, speech and language therapy, and medicine. Each arrangement offers unique benefits and challenges from the perspectives of learners, preceptors, programmes and health care delivery organisations. Patient perspectives were absent. Despite important advantages of each ratio for learners, preceptors and organisations, some of which may be profession specific, the 2 : 1 and 2+ : 2+ learner : preceptor ratios appear to be most likely to successfully balance the needs of all stakeholders. Regardless of the learner : preceptor ratio chosen for its expected benefits, our results illuminate challenges that can be anticipated and managed. Patient perspectives should be incorporated into future studies of learner : preceptor ratios. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Developing a gender-based approach to chronic conditions and women's health: a qualitative investigation of community-dwelling women and service provider perspectives.

PubMed

DiGiacomo, Michelle; Green, Anna; Rodrigues, Emma; Mulligan, Kathryn; Davidson, Patricia M

2015-11-21

Chronic conditions contribute to over 70 % of Australia's total disease burden, and this is set to increase to 80 % by 2020. Women's greater longevity means that they are more likely than men to live with disability and have unique health concerns related to their gender based roles in society. Cultural and social issues can impact on women's health and are important to consider in health services planning and research. In this study, we aimed to identify barriers and facilitators to providing a gender-based approach to chronic conditions and women's health in an eastern metropolitan region of Australia. Focus groups were used to engage both community-dwelling women who had chronic conditions and relevant professional stakeholders in the target area. Recorded proceedings underwent thematic analysis. Five focus groups were conducted with professional stakeholders and women community members in February and March 2014. Resultant themes included: women's disempowerment through interactions with health systems; social and economic constraints and caregiving roles act to exclude women from participating in self-care and society; and empowerment can be achieved through integrated models of care that facilitate voice and enable communication and engagement. This study underscores the importance of including perspectives of sex and gender in health care services planning. Tailoring services to socio-demographic and cultural groups is critical in promoting access to health care services. Unique epidemiological trends, particularly the ageing of women and new migrant groups, require particular attention.

Comparing demographic, health status and psychosocial strategies of audience segmentation to promote physical activity.

PubMed

Boslaugh, Sarah E; Kreuter, Matthew W; Nicholson, Robert A; Naleid, Kimberly

2005-08-01

The goal of audience segmentation is to identify population subgroups that are homogeneous with respect to certain variables associated with a given outcome or behavior. When such groups are identified and understood, targeted intervention strategies can be developed to address their unique characteristics and needs. This study compares the results of audience segmentation for physical activity that is based on either demographic, health status or psychosocial variables alone, or a combination of all three types of variables. Participants were 1090 African-American and White adults from two public health centers in St Louis, MO. Using a classification-tree algorithm to form homogeneous groups, analyses showed that more segments with greater variability in physical activity were created using psychosocial versus health status or demographic variables and that a combination of the three outperformed any individual set of variables. Simple segmentation strategies such as those relying on demographic variables alone provided little improvement over no segmentation at all. Audience segmentation appears to yield more homogeneous subgroups when psychosocial and health status factors are combined with demographic variables.

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

PubMed

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

2016-02-01

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

"When you walk in the rain, you get wet": a qualitative study of Ghanaian immigrants' perspective on the epidemiological paradox.

PubMed

Kaplan, Sue A; Ahmed, Ramatu; Musah, Adam

2015-02-01

This study sought to understand the perceptions of Ghanaian immigrants of the health status and health trajectory of their community. We conducted focus groups and interviews with 63 primarily Ghanaian immigrants living in New York City. Nearly all participants observed that Ghanaians are generally healthy when they arrive in the US, but that their health declines over time. Participants identified four causes of this perceived deterioration: changes in health behaviors, increased stress, environmental exposures, and barriers to health care. Participants see themselves as being at risk for many health problems resulting from changes in lifestyle that follow immigration. Although some vulnerabilities are unique to their experience as immigrants, many of the risk factors they described are the same as those that affect other residents in the communities in which they live.

40 CFR 174.529 - Bacillus thuringiensis modified Cry1Ab protein as identified under OECD Unique Identifier SYN...

Code of Federal Regulations, 2011 CFR

2011-07-01

... protein as identified under OECD Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement... Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement of a tolerance. Residues of... exempt from the requirement of a tolerance when used as a plant-incorporated protectant in cotton; cotton...

40 CFR 174.529 - Bacillus thuringiensis modified Cry1Ab protein as identified under OECD Unique Identifier SYN...

Code of Federal Regulations, 2013 CFR

2013-07-01

... protein as identified under OECD Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement... Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement of a tolerance. Residues of... exempt from the requirement of a tolerance when used as a plant-incorporated protectant in cotton; cotton...

40 CFR 174.529 - Bacillus thuringiensis modified Cry1Ab protein as identified under OECD Unique Identifier SYN...

Code of Federal Regulations, 2014 CFR

2014-07-01

... protein as identified under OECD Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement... Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement of a tolerance. Residues of... exempt from the requirement of a tolerance when used as a plant-incorporated protectant in cotton; cotton...

40 CFR 174.529 - Bacillus thuringiensis modified Cry1Ab protein as identified under OECD Unique Identifier SYN...

Code of Federal Regulations, 2012 CFR

2012-07-01

... protein as identified under OECD Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement... Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement of a tolerance. Residues of... exempt from the requirement of a tolerance when used as a plant-incorporated protectant in cotton; cotton...

40 CFR 174.529 - Bacillus thuringiensis modified Cry1Ab protein as identified under OECD Unique Identifier SYN...

Code of Federal Regulations, 2010 CFR

2010-07-01

... protein as identified under OECD Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement... Unique Identifier SYN-IR67B-1 in cotton; exemption from the requirement of a tolerance. Residues of... exempt from the requirement of a tolerance when used as a plant-incorporated protectant in cotton; cotton...

Constructing the informatics and information technology foundations of a medical device evaluation system: a report from the FDA unique device identifier demonstration.

PubMed

Drozda, Joseph P; Roach, James; Forsyth, Thomas; Helmering, Paul; Dummitt, Benjamin; Tcheng, James E

2018-02-01

The US Food and Drug Administration (FDA) has recognized the need to improve the tracking of medical device safety and performance, with implementation of Unique Device Identifiers (UDIs) in electronic health information as a key strategy. The FDA funded a demonstration by Mercy Health wherein prototype UDIs were incorporated into its electronic information systems. This report describes the demonstration's informatics architecture. Prototype UDIs for coronary stents were created and implemented across a series of information systems, resulting in UDI-associated data flow from manufacture through point of use to long-term follow-up, with barcode scanning linking clinical data with UDI-associated device attributes. A reference database containing device attributes and the UDI Research and Surveillance Database (UDIR) containing the linked clinical and device information were created, enabling longitudinal assessment of device performance. The demonstration included many stakeholders: multiple Mercy departments, manufacturers, health system partners, the FDA, professional societies, the National Cardiovascular Data Registry, and information system vendors. The resulting system of systems is described in detail, including entities, functions, linkage between the UDIR and proprietary systems using UDIs as the index key, data flow, roles and responsibilities of actors, and the UDIR data model. The demonstration provided proof of concept that UDIs can be incorporated into provider and enterprise electronic information systems and used as the index key to combine device and clinical data in a database useful for device evaluation. Keys to success and challenges to achieving this goal were identified. Fundamental informatics principles were central to accomplishing the system of systems model. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Building company health promotion capacity: a unique collaboration between Cargill and the Centers for Disease Control and Prevention.

PubMed

Lang, Jason E; Hersey, James C; Isenberg, Karen L; Lynch, Christina M; Majestic, Elizabeth

2009-04-01

The US Centers for Disease Control and Prevention (CDC) helps protect the health and safety of all people. The workplace can be used to reach millions of workers and their families with programs, policies, and benefits that promote health. We describe a CDC-led project to build Cargill's workplace health promotion capacity and identify the importance of a company liaison in the public-private relationship. The project goals were to engage diverse Cargill personnel, conduct a workplace health assessment, aid in the development of a workplace health program action plan, and develop Cargill's internal capacity using knowledge and skill-building. CDC partnered with Cargill on a workplace health promotion project to build Cargill's capacity. A multicomponent assessment was conducted to determine priority employee health issues, stakeholder meetings were held to engage and educate Cargill management and employees, and technical assistance was provided regularly between CDC and Cargill. Identifying a company liaison to work with an external assessment team is critical to building capacity for a successful workplace health project. This relationship creates an understanding of company culture and operations, facilitates access to key stakeholders and data, and provides opportunities to enhance capacity and sustainability. Employers undertaking workplace health promotion projects should identify a senior-level person to serve as the company health leader or liaison and who can devote the time necessary to build trusting relationships with partners to ensure project success. This person is valuable in facilitating communications, data collection, logistical support, troubleshooting, and influencing employer workplace health practices.

76 FR 39234 - Federal Acquisition Regulation; Unique Procurement Instrument Identifier

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

...-AL70 Federal Acquisition Regulation; Unique Procurement Instrument Identifier AGENCIES: Department of... Acquisition Regulation (FAR) to standardize use of unique Procurement Instrument Identifiers (PIID) throughout... Acquisition Council and the Defense Acquisition Regulations Council (the Councils) reviewed the public...

A scoping review of skills and tools oral health professionals need to engage children and parents in dietary changes to prevent childhood obesity and consumption of sugar-sweetened beverages.

PubMed

Mallonee, Lisa F; Boyd, Linda D; Stegeman, Cynthia

2017-06-01

Increased consumption of sugar-sweetened beverages (SSBs) has been linked to obesity. Obesity now affects one in six children in the United States. The purpose of this scoping review is to identify and review published studies that discuss skills and tools oral health professionals can use with children (under age 12) and their parents to encourage dietary changes to aid in preventing childhood obesity and reducing consumption of SSBs. Key search terms were identified and used to examine selected databases via PubMed, EMBASE, CINAHL, and Cochrane Database of Systematic Reviews. A total of 637 records were identified. After duplicates were removed and records were screened for eligibility, 33 remained. Six met established inclusion/exclusion criteria and were included in the review. Only two full-text articles included dental-office-based weight interventions. Patient response to education on healthy habits and weight maintenance in the dental setting was favorable. Literature supports oral health professionals expanding their role in health care delivery by offering nutrition and physical activity recommendations to prevent and/or reduce chronic disease. Active listening and motivational interviewing were techniques identified to promote beneficial lifestyle changes. There is limited research on behavior modification tools and skills that have been effectively implemented in the dental setting to decrease risk of obesity. Oral health professionals are uniquely positioned to address consumption of SSBs and promote positive dietary habits for improved weight management. Future studies are needed to identify effective techniques that techniques that oral health professionals can integrate into preventive patient care. © 2017 American Association of Public Health Dentistry.

The evolution of health administration education for public health: responding to a changing environment.

PubMed

Kilpatrick, K E; Romani, J H

1995-01-01

Health administration education in schools of public health has undergone a steady but remarkable evolution over the last five decades. What was once taught was simply an enumeration of statutory requirements and programs managed by public health agencies. This changed dramatically in the 1960s with the incorporation of both theoretical concepts and skills from the fields of public administration and business administration. In the 1990s, the differentiation between training required for public health administration and for health services administration has become increasingly blurred as institutional responsibility for the health of defined populations has necessitated the adoption of the community epidemiology perspective, long the centerpiece of public health programs, by all health services administration programs. The future challenge for programs located in schools of public health is to identify the unique characteristics of public health practice and to prepare graduates to assure that core public health functions are met adequately in the communities in which they will serve.

Comparison of two heuristic evaluation methods for evaluating the usability of health information systems.

PubMed

Khajouei, Reza; Hajesmaeel Gohari, Sadrieh; Mirzaee, Moghaddameh

2018-04-01

In addition to following the usual Heuristic Evaluation (HE) method, the usability of health information systems can also be evaluated using a checklist. The objective of this study is to compare the performance of these two methods in identifying usability problems of health information systems. Eight evaluators independently evaluated different parts of a Medical Records Information System using two methods of HE (usual and with a checklist). The two methods were compared in terms of the number of problems identified, problem type, and the severity of identified problems. In all, 192 usability problems were identified by two methods in the Medical Records Information System. This was significantly higher than the number of usability problems identified by the checklist and usual method (148 and 92, respectively) (p < 0.0001). After removing the duplicates, the difference between the number of unique usability problems identified by the checklist method (n = 100) and usual method (n = 44) was significant (p < 0.0001). Differences between the mean severity of the real usability problems (1.83) and those identified by only one of the methods (usual = 2.05, checklist = 1.74) were significant (p = 0.001). This study revealed the potential of the two HE methods for identifying usability problems of health information systems. The results demonstrated that the checklist method had significantly better performance in terms of the number of identified usability problems; however, the performance of the usual method for identifying problems of higher severity was significantly better. Although the checklist method can be more efficient for less experienced evaluators, wherever usability is critical, the checklist should be used with caution in usability evaluations. Copyright © 2018 Elsevier Inc. All rights reserved.

Systematic review of women veterans' mental health.

PubMed

Runnals, Jennifer J; Garovoy, Natara; McCutcheon, Susan J; Robbins, Allison T; Mann-Wrobel, Monica C; Elliott, Alyssa

2014-01-01

Given recent, rapid growth in the field of women veterans' mental health, the goal of this review was to update the status of women veterans' mental health research and to identify current themes in this literature. The scope of this review included women veterans' unique mental health needs, as well as gender differences in veterans' mental health needs. Database searches were conducted for relevant articles published between January 2008 and July 2011. Searches were supplemented with bibliographic reviews and consultation with subject matter experts. The database search yielded 375 titles; 32 met inclusion/exclusion criteria. The women veterans' mental health literature crosses over several domains, including prevalence, risk factors, health care utilization, treatment preferences, and access barriers. Studies were generally cross-sectional, descriptive, mixed-gender, and examined Department of Veterans Affairs (VA) health care users from all service eras. Results indicate higher rates of specific disorders (e.g., depression) and comorbidities, with differing risk factors and associated medical and functional impairment for female compared with male veterans. Although satisfaction with VA health care is generally high, unique barriers to care and indices of treatment satisfaction exist for women. There is a breadth of descriptive knowledge in many content areas of women veterans' mental health; however, the research base examining interventional and longitudinal designs is less developed. Understudied content areas and targets for future research and development include certain psychiatric disorders (e.g., schizophrenia), the effects of deployment on woman veterans' families, and strategies to address treatment access, attrition, and provision of gender-sensitive care. Published by Elsevier Inc.

The Design and Implementation of the 2016 National Survey of Children's Health.

PubMed

Ghandour, Reem M; Jones, Jessica R; Lebrun-Harris, Lydie A; Minnaert, Jessica; Blumberg, Stephen J; Fields, Jason; Bethell, Christina; Kogan, Michael D

2018-05-09

Introduction Since 2001, the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children's Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health care. Between 2012 and 2015, HRSA MCHB redesigned the surveys, combining content into a single survey, and shifting from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. Methods The U.S. Census Bureau fielded the redesigned NSCH using a random sample of addresses drawn from the Census Master Address File, supplemented with a unique administrative flag to identify households most likely to include children. Data were collected June 2016-February 2017 using a multi-mode design, encouraging web-based responses while allowing for paper mail-in responses. A parent/caregiver knowledgeable about the child's health completed an age-appropriate questionnaire. Experiments on incentives, branding, and contact strategies were conducted. Results Data were released in September 2017. The final sample size was 50,212 children; the overall weighted response rate was 40.7%. Comparison of 2016 estimates to those from previous survey iterations are not appropriate due to sampling and mode changes. Discussion The NSCH remains an invaluable data source for key measures of child health and attendant health care system, family, and community factors. The redesigned survey extended the utility of this resource while seeking a balance between previous strengths and innovations now possible.

Preventing HIV Among U.S. Women of Color With Severe Mental Illness: Perceptions of Mental Health Care Providers Working in Urban Community Clinics

PubMed Central

Agénor, Madina; Collins, Pamela Y.

2013-01-01

Given their knowledge of the behavioral issues related to psychiatric illness, mental health care providers are in a unique position to help prevent HIV among women with severe mental illness (SMI). We conducted in-depth interviews with providers at two New York City community clinics. We identified three major, interrelated themes pertaining to HIV prevention among women of color with SMI. Interventions that address the barriers that clinicians face in discussing sex, sexuality, and HIV with patients and train providers in the cultural considerations of cross-cultural mental health care are needed to help prevent HIV among women of color with SMI. PMID:23394326

Preventing HIV among U.S. women of color with severe mental illness: perceptions of mental health care providers working in urban community clinics.

PubMed

Agénor, Madina; Collins, Pamela Y

2013-01-01

Given their knowledge of the behavioral issues related to psychiatric illness, mental health care providers are in a unique position to help prevent HIV among women with severe mental illness (SMI). We conducted in-depth interviews with providers at two New York City community clinics. We identified three major, interrelated themes pertaining to HIV prevention among women of color with SMI. Interventions that address the barriers that clinicians face in discussing sex, sexuality, and HIV with patients and train providers in the cultural considerations of cross-cultural mental health care are needed to help prevent HIV among women of color with SMI.

Rapid Changes in American Family Life: Consequences for Child Health and Pediatric Practice

PubMed Central

Fiese, Barbara H.; Beardslee, William R.

2013-01-01

Pediatricians are in the unique position of being on the front line of care for children and having access to their families. This article presents both a rationale and the evidence base for identifying the family characteristics and processes that affect child health and suggests approaches that pediatricians can implement to improve the care of children, using data from 3 recent reports of the Institute of Medicine and National Research Council, as well as other recent family research. Evidence regarding the impact on child health of 3 family factors in particular (family composition and living arrangements, family routines, and parental depression) is highlighted, and implications for pediatric practice are described. PMID:23918891

Health Informatics and Technology for Integrated Elderly Care in the Context of Hong Kong: A Case Study.

PubMed

Chau, Cheuk Wing; Leung, Eman

2017-01-01

The aging population creates tremendous pressure to healthcare. To resolve, scholars recognized the solution to this challenge is integrated care. To facilitate integrated care, health information technologies (HIT) is a critical enabler. This paper will first review how technology enhanced integrated care, and review on the existing literatures in system effective use and the three key external factors that enable HIT implementation. Applying Burton-Jones and Volkoff's contextualized theories of effective use of HIT to understand the role of health informatics and technology in the unique context of Hong Kong, we have conducted a case study research to identify the levers for improving HK integration of care through HIT.

Rapid changes in American family life: consequences for child health and pediatric practice.

PubMed

Fiese, Barbara H; Rhodes, Holly G; Beardslee, William R

2013-09-01

Pediatricians are in the unique position of being on the front line of care for children and having access to their families. This article presents both a rationale and the evidence base for identifying the family characteristics and processes that affect child health and suggests approaches that pediatricians can implement to improve the care of children, using data from 3 recent reports of the Institute of Medicine and National Research Council, as well as other recent family research. Evidence regarding the impact on child health of 3 family factors in particular (family composition and living arrangements, family routines, and parental depression) is highlighted, and implications for pediatric practice are described.

Improving pathways to primary health care among LGBTQ populations and health care providers: key findings from Nova Scotia, Canada.

PubMed

Gahagan, Jacqueline; Subirana-Malaret, Montse

2018-06-13

This study explores the perceived barriers to primary health care as identified among a sample of Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) identified individuals and health care providers in Nova Scotia, Canada. These findings, based on a province-wide anonymous online survey, suggest that additional efforts are needed to improve pathways to primary health among LGBTQ populations and in deepening our understanding of how to advance the unique primary health needs of these populations. Data were collected from the LGBTQ community through an online, closed-ended anonymous survey. Inclusion criteria for participation were self-identifying as LGBTQ, offering primary health care to LGBTQ patients, being able to understand English, being 16 years of age or older, and having lived in Nova Scotia for at least one year. A total of 283 LGBTQ respondents completed the online survey which included sociodemographic questions, perceptions of respondents' health status, and their primary health care experiences. In addition, a total of 109 health care providers completed the survey based on their experiences providing care in Nova Scotia, and in particular, their experiences and perceptions regarding LGBTQ access to primary health care and physician-patient interactions. Our results indicate that, in several key areas, the primary health care needs of LGBTQ populations in Nova Scotia are not being met and this may in turn contribute to their poor health outcomes across the life course. A framework of intersectionality and health equity was used to interpret and analyze the survey data. The key findings indicate the need to continue improving pathways to primary health care among LGBTQ populations, specifically in relation to additional training and related supports for health care providers who work with these populations.

Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study.

PubMed

Caspi, A; Begg, D; Dickson, N; Harrington, H; Langley, J; Moffitt, T E; Silva, P A

1997-11-01

In a longitudinal study of a birth cohort, the authors identified youth involved in each of 4 different health-risk behaviors at age 21: alcohol dependence, violent crime, unsafe sex, and dangerous driving habits. At age 18, the Multidimensional Personality Questionnaire (MPQ) was used to assess 10 distinct personality traits. At age 3, observational measures were used to classify children into distinct temperament groups. Results showed that a similar constellation of adolescent personality traits, with developmental origins in childhood, is linked to different health-risk behaviors at 21. Associations between the same personality traits and different health-risk behaviors were not an artifact of the same people engaging in different health-risk behaviors; rather, these associations implicated the same personality type in different but related behaviors. In planning campaigns, health professionals may need to design programs that appeal to the unique psychological makeup of persons most at risk for health-risk behaviors.

Acculturation and Health of Korean American Adults.

PubMed

Shin, Cha-Nam; Lach, Helen W

2014-07-01

Increasing cultural diversity in the United States and significant health disparities among immigrant populations make acculturation an important concept to measure in health research. The purpose of this cross-sectional, descriptive study was to examine acculturation and health of Korean American adults. A convenience sample of 517 Korean American adults in a Midwestern city completed a survey in either English or Korean. All four groups of Berry's acculturation model were identified using cluster analysis with Lee's Acculturation Scale. Assimilation, integration, and separation were found in the English survey sample, whereas integration, separation, and marginalization were found in the Korean survey sample. Moreover, the findings revealed that acculturation is a bidimensional process, and the unique nature of samples may determine acculturation groups. Physical health and mental health were significantly related to acculturation in the English survey sample. However, there was not a significant relationship between health and acculturation in the Korean survey sample. © The Author(s) 2014.

The disease of corruption: views on how to fight corruption to advance 21st century global health goals.

PubMed

Mackey, Tim K; Kohler, Jillian Clare; Savedoff, William D; Vogl, Frank; Lewis, Maureen; Sale, James; Michaud, Joshua; Vian, Taryn

2016-09-29

Corruption has been described as a disease. When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle, despite its enormous costs, which have been estimated in the billions of dollars. In this forum article, we asked anti-corruption experts to identify key priority areas that urgently need global attention in order to advance the fight against global health corruption. The views shared by this multidisciplinary group of contributors reveal several fundamental challenges and allow us to explore potential solutions to address the unique risks posed by health-related corruption. Collectively, these perspectives also provide a roadmap that can be used in support of global health anti-corruption efforts in the post-2015 development agenda.

Well-being measurement and the WHO health policy Health 2010: systematic review of measurement scales.

PubMed

Lindert, Jutta; Bain, Paul A; Kubzansky, Laura D; Stein, Claudia

2015-08-01

Subjective well-being (SWB) contributes to health and mental health. It is a major objective of the new World Health Organization health policy framework, 'Health 2020'. Various approaches to defining and measuring well-being exist. We aimed to identify, map and analyse the contents of self-reported well-being measurement scales for use with individuals more than 15 years of age to help researchers and politicians choose appropriate measurement tools. We conducted a systematic literature search in PubMed for studies published between 2007 and 2012, with additional hand-searching, to identify empirical studies that investigated well-being using a measurement scale. For each eligible study, we identified the measurement tool and reviewed its components, number of items, administration time, validity, reliability, responsiveness and sensitivity. The literature review identified 60 unique measurement scales. Measurement scales were either multidimensional (n = 33) or unidimensional (n = 14) and assessed multiple domains. The most frequently encountered domains were affects (39 scales), social relations (17 scales), life satisfaction (13 scales), physical health (13 scales), meaning/achievement (9 scales) and spirituality (6 scales). The scales included between 1 and 100 items; the administration time varied from 1 to 15 min. Well-being is a higher order construct. Measures seldom reported testing for gender or cultural sensitivity. The content and format of scales varied considerably. Effective monitoring and comparison of SWB over time and across geographic regions will require further work to refine definitions of SWB. We recommend concurrent evaluation of at least three self-reported SWB measurement scales, including evaluation for gender or cultural sensitivity. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Educational Strategies to Help Students Provide Respectful Sexual and Reproductive Health Care for Lesbian, Gay, Bisexual, and Transgender Persons.

PubMed

Walker, Kelly; Arbour, Megan; Waryold, Justin

2016-11-01

Graduate medical, nursing, and midwifery curricula often have limited amounts of time to focus on issues related to cultural competency in clinical practice, and respectful sexual and reproductive health care for all individuals in particular. Respectful health care that addresses sexual and reproductive concerns is a right for everyone, including those who self-identify as lesbian, gay, bisexual, or transgender (LGBT). LGBT persons have unique reproductive health care needs as well as increased risks for poor health outcomes. Both the World Health Organization and Healthy People 2020 identified the poor health of LGBT persons as an area for improvement. A lack of educational resources as well as few student clinical experiences with an LGBT population may be barriers to providing respectful sexual and reproductive health care to LGBT persons. This article offers didactic educational strategies for midwifery and graduate nursing education programs that may result in reducing barriers to the provision of respectful sexual and reproductive health care for LGBT clients. Specific ideas for implementation are discussed in detail. In addition to what is presented here, other educational strategies and clinical experiences may help to support students for caring for LGBT persons prior to entrance into clinical practice. © 2016 by the American College of Nurse-Midwives.

HIV information needs of parents of young men who have sex with men.

PubMed

Rose, India D; Friedman, Daniela B

2016-12-01

Young men who have sex with men (YMSM) have unique health concerns, including high rates of HIV infection. To prevent HIV, YMSM need credible information from trusted sources, specifically parents. Little is known about what health information resources parents of YMSM need to communicate with their child about HIV prevention. The primary objective of this study was to examine the proxy health information seeking behaviours of parents of YMSM and to identify information resources that parents need to communicate with their YMSM identified child about HIV prevention. Qualitative findings were grouped into four categories: parents' current health information sources; barriers to seeking health information; parents' health information needs; and recommendations for delivery of health information for parents. Ten in-depth interviews were conducted with parents of YMSM. Parents reported consulting physicians and the Internet for HIV/AIDS information. They reported finding limited information targeted towards parents of YMSM and provided suggestions for improving the delivery of health information including training, websites and the local news. Delivery of tailored HIV prevention information to parents may be effective in helping combat HIV among YMSM. Given that YMSM bear the greatest burden for HIV, this study highlights the need to include parents of YMSM in future interventions aimed at reducing YMSM's risk of HIV/AIDS. © 2016 Health Libraries Group.

Types of lay health influencers in tobacco cessation: a qualitative study.

PubMed

Yuan, Nicole P; Wind, Steven; Nichter, Mimi; Nichter, Mark; Castañeda, Heide; Carruth, Lauren; Muramoto, Myra

2010-01-01

To identify types of health influencers in tobacco cessation based on the frequency and characteristics of brief intervention activities. Longitudinal qualitative interviews were completed with 28 individuals posttraining. Four individuals were categorized as Rarely Active, 5 as Active With Family and Friends, 9 as Active in the Workplace, and 10 as Proactive in Multiple Settings. Unique motivators, intervention behaviors, and barriers were documented. Some individuals displayed high levels of self-efficacy necessary for expanding the reach of community-based interventions. Training programs need to address the impact of contextual factors on initiating and sustaining intervention activities.

Implications of the Medicaid Undercount in a High-Penetration Medicaid State

PubMed Central

Goidel, R Kirby; Procopio, Steven; Schwalm, Douglas; Terrell, Dek

2007-01-01

Research Objective This study investigates the impact of misreporting by Medicaid recipients on estimates of the uninsured in Louisiana, and is based on similar work by Call et al. in Minnesota and Klerman, Ringel, and Roth in California. With its unique charity hospital system, culture, and high poverty, Louisiana provides an interesting and unique context for examining Medicaid underreporting. Study Design Results are based on a random sample of 2,985 Medicaid households. Respondents received a standard questionnaire to identify health insurance status, and individual records were matched to Medicaid enrollment data to identify misreporting. Data Sources Data were collected by the Public Policy Research Lab at Louisiana State University using computer-assisted telephone interviewing. Using Medicaid enrollment data to obtain contact information, the Louisiana Health Insurance Survey was administered to 2,985 households containing Medicaid recipients. Matching responses on individuals from these households to Medicaid enrollment data yielded responses for 3,199 individuals. Conclusions Results suggest relatively high rates of underreporting among Medicaid recipients in Louisiana for both children and adults. Given the very high proportion of Medicaid recipients in the population, this may translate up to a 3 percent bias in estimates of uninsured populations. Implications Medicaid bias may be particularly pronounced in areas with high Medicaid enrollments. Misreporting rates and thus the bias in estimates of the uninsured may differ across areas of the United States with important consequences for Medicaid funding. Funding Source Louisiana Department of Health and Hospitals. PMID:17995551

Department of Defense Logistics Roadmap 2008. Volume 1

DTIC Science & Technology

2008-07-01

machine readable identification mark on the Department’s tangible qualifying assets, and establishes the data management protocols needed to...uniquely identify items with a Unique Item Identifier (UII) via machine - readable information (MRI) marking represented by a two-dimensional data...property items with a machine -readable Unique Item Identifier (UII), which is a set of globally unique data elements. The UII is used in functional

Family caregivers of patients with frontotemporal dementia: An integrative review.

PubMed

Caceres, Billy A; Frank, Mayu O; Jun, Jin; Martelly, Melissa T; Sadarangani, Tina; de Sales, Paloma Cesar

2016-03-01

The purpose of this integrative review is to: (1) identify the characteristics of family caregivers of patients with frontotemporal dementia, (2) explore the impact of providing care on family caregivers' health and well-being, and (3) identify coping strategies used by family caregivers. Frontotemporal dementia is thought to be the second most common form of dementia after Alzheimer's disease. Family caregivers of patients with frontotemporal dementia face unique challenges due to its early onset, behavioral symptoms, and slow progression of decline. However, there is a dearth of research evaluating the health and wellbeing of family caregivers of patients with frontotemporal dementia. An integrative review was conducted using the Whittemore and Knafl methodology. An electronic search of the literature was conducted using four electronic databases: PubMed, Embase, CINAHL, and Web of Science. The Crowe Critical Appraisal tool was used to evaluate the quality of the selected articles. Findings of 11 articles informed this integrative review. Family caregivers of patients with frontotemporal dementia identify behavioral disturbances as most troubling. Spouses and female caregivers experience greater caregiver burden, distress, increased rates of depression, as well as decreased sleep related to behavior disturbances. Though less explored, providing care to those with behavioral disturbances may also impact caregiver physical health. Additionally, female caregivers are most likely to employ coping strategies, most commonly, adaptation and reframing. Effective interventions to reduce family caregiver burden are poorly understood but family caregivers suggest education and internet-based support groups are most helpful. Family caregivers of patients with frontotemporal dementia experience significant distress, which impacts their health and wellbeing. It is important for healthcare providers who care for patients with frontotemporal dementia to recognize the unique needs of family caregivers. Future research should focus on examining interventions and strategies to reduce caregiver burden. Copyright © 2015 Elsevier Ltd. All rights reserved.

Health and wellbeing boards: public health decision making bodies or political pawns?

PubMed

Greaves, Z; McCafferty, S

2017-02-01

Health and Wellbeing boards in England are uniquely constituted; embedded in the local authorities with membership drawn from a range of stakeholders and partner organizations. This raises the question of how decision making functions of the boards reflects wider public health decision making, if criteria are applied to decision making, and what prioritization processes, if any, are used. Qualitative research methods were employed and five local boards were approached, interview dyads were conducted with the boards Chair and Director of Public Health across four of these (n = 4). Three questions were addressed: how are decisions made? What are the criteria applied to decision making? And how are criteria then prioritized? A thematic approach was used to analyse data identifying codes and extracting key themes. Equity, effectiveness and consistency with strategies of board and partners were most consistently identified by participants as criteria influencing decisions. Prioritization was described as an engaged and collaborative process, but criteria were not explicitly referenced in the decision making of the boards which instead made unstructured prioritization of population sub-groups or interventions agreed by consensus. Criteria identified are broadly consistent with those used in wider public health practice but additionally incorporated criteria which recognizes the political siting of the boards. The study explored the variety in different board's approaches to prioritization and identified a lack of clarity and rigour in the identification and use of criteria in prioritization processes. Decision making may benefit from the explicit inclusion of criteria in the prioritization process. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

NHash: Randomized N-Gram Hashing for Distributed Generation of Validatable Unique Study Identifiers in Multicenter Research.

PubMed

Zhang, Guo-Qiang; Tao, Shiqiang; Xing, Guangming; Mozes, Jeno; Zonjy, Bilal; Lhatoo, Samden D; Cui, Licong

2015-11-10

A unique study identifier serves as a key for linking research data about a study subject without revealing protected health information in the identifier. While sufficient for single-site and limited-scale studies, the use of common unique study identifiers has several drawbacks for large multicenter studies, where thousands of research participants may be recruited from multiple sites. An important property of study identifiers is error tolerance (or validatable), in that inadvertent editing mistakes during their transmission and use will most likely result in invalid study identifiers. This paper introduces a novel method called "Randomized N-gram Hashing (NHash)," for generating unique study identifiers in a distributed and validatable fashion, in multicenter research. NHash has a unique set of properties: (1) it is a pseudonym serving the purpose of linking research data about a study participant for research purposes; (2) it can be generated automatically in a completely distributed fashion with virtually no risk for identifier collision; (3) it incorporates a set of cryptographic hash functions based on N-grams, with a combination of additional encryption techniques such as a shift cipher; (d) it is validatable (error tolerant) in the sense that inadvertent edit errors will mostly result in invalid identifiers. NHash consists of 2 phases. First, an intermediate string using randomized N-gram hashing is generated. This string consists of a collection of N-gram hashes f1, f2, ..., fk. The input for each function fi has 3 components: a random number r, an integer n, and input data m. The result, fi(r, n, m), is an n-gram of m with a starting position s, which is computed as (r mod |m|), where |m| represents the length of m. The output for Step 1 is the concatenation of the sequence f1(r1, n1, m1), f2(r2, n2, m2), ..., fk(rk, nk, mk). In the second phase, the intermediate string generated in Phase 1 is encrypted using techniques such as shift cipher. The result of the encryption, concatenated with the random number r, is the final NHash study identifier. We performed experiments using a large synthesized dataset comparing NHash with random strings, and demonstrated neglegible probability for collision. We implemented NHash for the Center for SUDEP Research (CSR), a National Institute for Neurological Disorders and Stroke-funded Center Without Walls for Collaborative Research in the Epilepsies. This multicenter collaboration involves 14 institutions across the United States and Europe, bringing together extensive and diverse expertise to understand sudden unexpected death in epilepsy patients (SUDEP). The CSR Data Repository has successfully used NHash to link deidentified multimodal clinical data collected in participating CSR institutions, meeting all desired objectives of NHash.

Sexual Orientation Disparities in Sexually Transmitted Infection Risk Behaviors and Risk Determinants Among Sexually Active Adolescent Males: Results From a School-Based Sample

PubMed Central

Schnarrs, Phillip W.; Rosario, Margaret; Garofalo, Robert; Mustanski, Brian

2014-01-01

Objectives. We examined disparities in risk determinants and risk behaviors for sexually transmitted infections (STIs) between gay-identified, bisexual-identified, and heterosexual-identified young men who have sex with men (YMSM) and heterosexual-identified young men who have sex with women (YMSW) using a school-based sample of US sexually active adolescent males. Methods. We analyzed a pooled data set of Youth Risk Behavior Surveys from 2005 and 2007 that included information on sexual orientation identity, sexual behaviors, and multiple STI risk factors. Results. Bisexual-identified adolescents were more likely to report multiple STI risk behaviors (number of sex partners, concurrent sex partners, and age of sexual debut) compared with heterosexual YMSW as well as heterosexual YMSM and gay-identified respondents. Gay, bisexual, and heterosexual YMSM were significantly more likely to report forced sex compared with heterosexual YMSW. Conclusions. Our results provide evidence that sexual health disparities emerge early in the life course and vary by both sexual orientation identity and sexual behaviors. In particular, they show that bisexual-identified adolescent males exhibit a unique risk profile that warrants targeted sexual health interventions. PMID:24825214

The use of focus groups in the development of the PROMIS Pediatrics Item Bank

PubMed Central

Walsh, Tasanee R.; Irwin, Debra E.; Meier, Andrea; Varni, James W.; DeWalt, Darren A.

2008-01-01

Objective To understand differences in perceptions of patient reported outcome domains between children with asthma and children from the general population. We used this information in the development of patient-reported outcome items for the Patient Reported Outcomes Measurement Information System Pediatrics project. Methods We conducted focus groups composed of ethnically, racially, and geographically diverse youth (8-12, 13-17 years) from the general population and youth with asthma. We performed content analysis to identify important themes. Results We identified five unique and different challenges that may confront youth with asthma as compared to general population youth: 1) They experience more difficulties when participating in physical activities; 2) They may experience anxiety about having an asthma attack at anytime and anywhere; 3) They may experience sleep disturbances and fatigue secondary to their asthma symptoms; 4) Their health condition has a greater effect on their emotional well-being and interpersonal relationships; and 5) Youth with asthma report that asthma often leaves them with insufficient energy to complete their school activities, especially physical activities. Conclusions The results confirm unique experiences for children with asthma across a broad range of health domains and enhance the breadth of all domains when creating an item bank. PMID:18427951

Survey of advertising for nutritional supplements in health and bodybuilding magazines.

PubMed

Philen, R M; Ortiz, D I; Auerbach, S B; Falk, H

1992-08-26

The use of food supplements by the general public is poorly quantified, and little information on this subject is available in the medical literature. We surveyed 12 recent issues of popular health and bodybuilding magazines (1) to quantify the number of advertisements for food supplements, the number of products advertised, and the number and type of ingredients in these products; (2) to identify the purported health benefits of these products; and (3) as a preliminary effort to identify areas for future research. We counted 89 brands, 311 products, and 235 unique ingredients, the most frequent of which were unspecified amino acids; the most frequently promoted health benefit was muscle growth. We also found many unusual or unidentifiable ingredients, and 22.2% of the products had no ingredients listed in their advertisements. Health professionals may not be aware of how popular food supplements are or of a particular supplement's potential effects or side effects. In addition, patients may be reluctant to discuss their use of these products with traditional medical practitioners. We recommend that routine history taking include specific questions about patients' use of food supplements and that any possible adverse effects or side effects be reported to public health authorities.

Opportunities and Challenges for Practical Training in Public Health: Insights from Practicum Coordinators in Ontario.

PubMed

Wegener, Jessica; Petitclerc, Marilyne

2018-06-12

Dietetic educators and practicum coordinators (PC) play critical roles in preparing students for practice. Dietitians have made significant progress in the development of educational curricula, competencies, and other resources to support knowledge and skill attainment in public health. There are identified gaps in the literature concerning practical training in sustainable food systems and public health, creating barriers in knowledge exchange and improvements in practicum programs in Canada. This paper discusses the potential opportunities and challenges associated with the number of placements for practical training in public health based on interviews with PCs in Ontario. The findings are limited to the perspectives of 7 PCs with experience in practical training and are a starting point for ongoing evaluation. Identified opportunities within traditional and "emerging settings" for practical training in public health included: the uniqueness of the experience, the potential for students to learn outside their comfort zones, and greater possibilities for dietitians in new roles and settings. Challenges included the need for significant PC engagement with nondietetic preceptors and a narrow view of dietetic practice among some dietitians. Interprofessional teams, emerging settings, and flexible learning approaches may create and support practical training opportunities in food systems and public health going forward.

Making it work: health care provider perspectives on strategies to increase colorectal cancer screening in federally qualified health centers.

PubMed

Gwede, Clement K; Davis, Stacy N; Quinn, Gwendolyn P; Koskan, Alexis M; Ealey, Jamila; Abdulla, Rania; Vadaparampil, Susan T; Elliott, Gloria; Lopez, Diana; Shibata, David; Roetzheim, Richard G; Meade, Cathy D

2013-12-01

Colorectal cancer screening (CRCS) rates are low among men and women who seek health care at federally qualified health centers (FQHCs). This study explores health care providers' perspectives about their patient's motivators and impediments to CRCS and receptivity to preparatory education. A mixed methods design consisting of in-depth interviews, focus groups, and a short survey is used in this study. The participants of this study are 17 health care providers practicing in FQHCs in the Tampa Bay area. Test-specific patient impediments and motivations were identified including fear of abnormal findings, importance of offering less invasive fecal occult blood tests, and need for patient-centered test-specific educational materials in clinics. Opportunities to improve provider practices were identified including providers' reliance on patients' report of symptoms as a cue to recommend CRCS and overemphasis of clinic-based guaiac stool tests. This study adds to the literature on CRCS test-specific motivators and impediments. Providers offered unique approaches for motivating patients to follow through with recommended CRCS and were receptive to in-clinic patient education. Findings readily inform the design of educational materials and interventions to increase CRCS in FQHCs.

Evidence-based characteristics of nurse-managed health centers for quality and outcomes.

PubMed

Holt, Jeana; Zabler, Bev; Baisch, Mary Jo

2014-01-01

There are approximately 250 nurse-managed health centers (NMHC) in the United States, but there are few consistent descriptions of their functions and even fewer reports of their outcomes. Because NMHCs have been identified as a unique and effectual health care delivery care model (Patient Protection and Affordable Care Act), a description of their characteristics and a framework for outcome evaluation are required for their continued evolution and expansion. This study identifies the principal characteristics of U.S. NMHCs described in the professional literature through an integrative review and classifies these characteristics through a multistage qualitative analysis in relation to Donabedian's structure-process-outcomes model, a well-established model for evaluating quality in health care. This study yielded an evidence-based definition of NMHCs that is more reflective of current NMHC practice across settings and recognizes the full scope of nursing practice that is considered one solution to the health care crisis in the country. Using the results from this study, NMHCs will be able to structure self-evaluations of quality care and compare their quality related to structure, processes, and outcomes with other primary health care delivery systems. Copyright © 2014 Elsevier Inc. All rights reserved.

Generating unique IDs from patient identification data using security models.

PubMed

Mohammed, Emad A; Slack, Jonathan C; Naugler, Christopher T

2016-01-01

The use of electronic health records (EHRs) has continued to increase within healthcare systems in the developed and developing nations. EHRs allow for increased patient safety, grant patients easier access to their medical records, and offer a wealth of data to researchers. However, various bioethical, financial, logistical, and information security considerations must be addressed while transitioning to an EHR system. The need to encrypt private patient information for data sharing is one of the foremost challenges faced by health information technology. We describe the usage of the message digest-5 (MD5) and secure hashing algorithm (SHA) as methods for encrypting electronic medical data. In particular, we present an application of the MD5 and SHA-1 algorithms in encrypting a composite message from private patient information. The results show that the composite message can be used to create a unique one-way encrypted ID per patient record that can be used for data sharing. The described software tool can be used to share patient EMRs between practitioners without revealing patients identifiable data.

Health as Submission and Social Responsibilities: Embodied Experiences of Javanese Women With Type II Diabetes.

PubMed

Pitaloka, Dyah; Hsieh, Elaine

2015-08-01

By examining women's experiences with type II diabetes, we explore how illness can provide resources to construct meanings of everyday life in Javanese culture. We conducted in-depth interviews with 30 female participants in Central Java, Indonesia, and adopted grounded theory for data analysis. We identified four themes that diabetes serves as resources for women in Indonesia to (a) normalize suffering, (b) resist social control, (c) accept fate, and (d) validate faith. We concluded by noting three unique aspects of Javanese women's illness management. First, through the performance of submission, our participants demonstrated spirituality and religiosity as essential elements of health. Second, diabetes empowers individuals in everyday suffering through two divergent processes: embracing submission and resisting control. Finally, diabetes provides opportunities for individuals within a social network to (re)negotiate social responsibilities. In summary, diabetes provides unique resources to empower our participants to obtain voices that they otherwise would not have had. © The Author(s) 2015.

Corporate social marketing: message design to recruit program participants.

PubMed

Black, David R; Blue, Carolyn L; Coster, Daniel C; Chrysler, Lisa M

2002-01-01

To identify variables for a corporate social marketing (SM) health message based on the 4 Ps of SM in order to recruit future participants to an existing national, commercial, self-administered weight-loss program. A systematically evaluated, author-developed, 310-response survey was administered to a random sample of 270 respondents. A previously established research plan was used to empirically identify the audience segments and the "marketing mix" appropriate for the total sample and each segment. Tangible product, pertaining to the unique program features, should be emphasized rather than positive core product and outcome expectation related to use of the program.

UMDNJ school of nursing mobile healthcare project: a component of the New Jersey Children's Health Project.

PubMed

McNeal, Gloria J

2008-01-01

This article describes a mobile ambulatory care nurse-managed center on wheels designed to address the healthcare needs of at-risk inner city residents. A grant-funded initiative, the Project uniquely joins nursing academe with community-based organizations in a partnership that brings healthcare services directly to those communities most in need. In addition to providing healthcare services, the Project serves as a site for faculty practice and community clinical rotations for nursing and medical students. The broad objectives of this nurse-faculty managed mobile healthcare project are: (1) to screen, identify and provide health promotion/disease management services for at-risk populations, (2) to foster community involvement in the health assessment and referral process; and, (3) to provide culturally and linguistically sensitive health promotion/disease management health education.

Instruments for measuring mental health recovery: a systematic review.

PubMed

Sklar, Marisa; Groessl, Erik J; O'Connell, Maria; Davidson, Larry; Aarons, Gregory A

2013-12-01

Persons in recovery, providers, and policymakers alike are advocating for recovery-oriented mental health care, with the promotion of recovery becoming a prominent feature of mental health policy in the United States and internationally. One step toward creating a recovery-oriented system of care is to use recovery-oriented outcome measures. Numerous instruments have been developed to assess progress towards mental health recovery. This review identifies instruments of mental health recovery and evaluates the appropriateness of their use including their psychometric properties, ease of administration, and service-user involvement in their development. A literature search using the Medline and Psych-INFO databases was conducted, identifying 21 instruments for potential inclusion in this review, of which thirteen met inclusion criteria. Results suggest only three instruments (25%) have had their psychometric properties assessed in three or more unique samples of participants. Ease of administration varied between instruments, and for the majority of instruments, development included service user involvement. This review updates and expands previous reviews of instruments to assess mental health recovery. As mental health care continues to transform to a recovery-oriented model of service delivery, this review may facilitate selection of appropriate assessments of mental health recovery for systems to use in evaluating and improving the care they provide. © 2013.

A Double Whammy: Health Promotion Among Cancer Survivors with Pre-Existing Functional Limitations

PubMed Central

Volker, Deborah L.; Becker, Heather; Kang, Sook Jung; Kullberg, Vicki

2012-01-01

Purpose/Objectives To explore the experience of living with a cancer diagnosis within the context of a pre-existing functional disability and to identify strategies to promote health in this growing population of cancer survivors. Research Approach Qualitative descriptive Setting Four sites in the United States Participants 19 female cancer survivors with pre-existing disabling conditions Methodologic Approach Four focus groups were conducted. The audiotapes were transcribed and analyzed using content analysis techniques. Main Research Variables cancer survivor, disability, health promotion Findings Analytic categories included living with a cancer diagnosis, health promotion strategies, and wellness program development for survivors with pre-existing functional limitations. Participants described many challenges associated with managing a cancer diagnosis on top of living with a chronic disabling functional limitation. They identified strategies they used to maintain their health and topics to be included in health promotion programs tailored for this unique group of cancer survivors. Conclusions The “double whammy” of a cancer diagnosis for persons with pre-existing functional limitations requires modification of health promotion strategies and programs to promote wellness in this group of cancer survivors. Interpretation Nurses and other health care providers must attend to patients’ pre-existing conditions as well as the challenges of the physical, emotional, social, and economic sequelae of a cancer diagnosis. PMID:23269771

Monitoring and evaluation of the PAHO/WHO cooperation project, the Mais Médicos (More Doctors) Program: a mid-term assessment.

PubMed

Molina, Joaquín; Tasca, Renato; Suárez, Julio

2016-09-01

Working relations between the Pan- American Health Organization/World Health Organization (PAHO/WHO) and Brazilian health institutions accumulated a long history of cooperation with mutual benefits, which in many cases were shared with other nations under various cooperation frameworks among countries for health development. A milestone in this relationship is the technical cooperation provided by PAHO/WHO to the More Doctors Program (Programa Mais Médicos - PMM). This cooperation has added both strategic value in reducing gaps in health equality and has capitalized on the unique nature of the Cuba-Brazil South-South cooperation experience, triangulated through PAHO/WHO. This paper discusses PAHO/WHO's role in the evaluation of its technical cooperation within PMM. A Monitoring and Evaluation (M&E) Framework has been developed in order to progressively identify the advances in coverage and quality of primary health care provided by the Unified Health System (Sistema Único de Saúde - SUS) through the PMM. Special attention was given to identify best practices in health services, to analyze results and impacts of the PMM, and to manage and share knowledge that has been produced by its implementation, through a web-based knowledge platform. Some relevant results of PMM are briefly presented and discussed.

Threats from emerging and re-emerging neglected tropical diseases (NTDs).

PubMed

Mackey, Tim K; Liang, Bryan A

2012-01-01

Neglected tropical diseases impact over 1 billion of the world's poorest populations and require special attention. However, within the NTDs recognized by the World Health Organization, some are also dually categorized as emerging and re-emerging infectious diseases requiring more detailed examination on potential global health risks. We reviewed the 17 NTDs classified by the WHO to determine if those NTDs were also categorized by the US Centers for Disease Control and Prevention as emerging and re-emerging infectious diseases (''EReNTDs''). We then identified common characteristics and risks associated with EReNTDs. Identified EReNTDs of dengue, rabies, Chagas Disease, and cysticercosis disproportionately impact resource-poor settings with poor social determinants of health, spread through globalization, are impacted by vector control, lack available treatments, and threaten global health security. This traditionally neglected subset of diseases requires urgent attention and unique incentive structures to encourage investment in innovation and coordination. Multi-sectorial efforts and targeted public-private partnerships would spur needed R&D for effective and accessible EReNTD treatments, improvement of social determinants of health, crucial low-income country development, and health system strengthening efforts. Utilization of One Health principles is essential for enhancing knowledge to efficaciously address public health aspects of these EReNTDs globally.

Report of Workshop on Traffic, Health, and Infrastructure Planning

PubMed Central

White, Ronald H.; Spengler, John D.; Dilwali, Kumkum M.; Barry, Brenda E.; Samet, Jonathan M.

2009-01-01

Recent air pollutant measurement data document unique aspects of the air pollution mixture near roadways, and an expanding body of epidemiological data suggests increased risks for exacerbation of asthma and other respiratory diseases, premature mortality, and certain cancers and birth outcomes from air pollution exposures in populations residing in relatively close proximity to roadways. The Workshop on Traffic, Health, and Infrastructure Planning, held in February 2004, was convened to provide a forum for interdisciplinary discussion of motor vehicle emissions, exposures and potential health effects related to proximity to motor vehicle traffic. This report summarizes the workshop discussions and findings regarding the current science on this issue, identifies planning and policy issues related to localized motor vehicle emissions and health concerns, and provides recommendations for future research and policy directions. PMID:16983859

Sexual health and life experiences: Voices from behaviourally bisexual Latino men in the Midwestern USA

PubMed Central

Martinez, Omar; Reece, Michael; Schnarrs, Philip; Rhodes, Scott; Goncalves, Gabriel; Muñoz-Laboy, Miguel; Malebranche, David; Van Der Pol, Barbara; Nix, Ryan; Kelle, Guadalupe; Fortenberry, J. Dennis

2011-01-01

Research on behaviourally bisexual Latino men in the USA has not yet examined sexual health issues among men living in diverse areas of the nation, including the Midwest. A community-based participatory research (CBPR) approach was used to engage a diverse sample of 75 behaviourally bisexual men (25 White, 25 Black, and 25 Latino). Semi-structured interviews were conducted and, in this paper, standard qualitative analysis procedures were used to explore data from the 25 Latino participants. Men described their unique migration experiences as behaviourally bisexual men in this area of the USA, as well as related sexual risk behaviours and health concerns. Lack of culturally congruent public health and community resources for behaviourally bisexual men in the Midwestern USA were identified as significant barriers. As in other studies, familial and community relationships were significant for the participants, especially in terms of the decision to disclose or not disclose their bisexuality. Additionally, alcohol and other drugs were often used while engaging in sexual behaviours particularly with male and transgender, as well as female, partners. Behaviourally bisexual Latino men may benefit from receiving positive and affirmative individual- and structural-level support in regards to their unique experiences in this and other settings. PMID:21815839

Competing health policies: insurance against universal public systems

PubMed Central

Laurell, Asa Ebba Cristina

2016-01-01

Objectives: This article analyzes the content and outcome of ongoing health reforms in Latin America: Universal Health Coverage with Health Insurance, and the Universal and Public Health Systems. It aims to compare and contrast the conceptual framework and practice of each and verify their concrete results regarding the guarantee of the right to health and access to required services. It identifies a direct relationship between the development model and the type of reform. The neoclassical-neoliberal model has succeeded in converting health into a field of privatized profits, but has failed to guarantee the right to health and access to services, which has discredited the governments. The reform of the progressive governments has succeeded in expanding access to services and ensuring the right to health, but faces difficulties and tensions related to the permanence of a powerful, private, industrial-insurance medical complex and persistence of the ideologies about medicalized 'good medicine'. Based on these findings, some strategies to strengthen unique and supportive public health systems are proposed. PMID:26959328

The occupational health and safety of flight attendants.

PubMed

Griffiths, Robin F; Powell, David M C

2012-05-01

In order to perform safety-critical roles in emergency situations, flight attendants should meet minimum health standards and not be impaired by factors such as fatigue. In addition, the unique occupational and environmental characteristics of flight attendant employment may have consequential occupational health and safety implications, including radiation exposure, cancer, mental ill-health, musculoskeletal injury, reproductive disorders, and symptoms from cabin air contamination. The respective roles of governments and employers in managing these are controversial. A structured literature review was undertaken to identify key themes for promoting a future agenda for flight attendant health and safety. Recommendations include breast cancer health promotion, implementation of Fatigue Risk Management Systems, standardization of data collection on radiation exposure and health outcomes, and more coordinated approaches to occupational health and safety risk management. Research is ongoing into cabin air contamination incidents, cancer, and fatigue as health and safety concerns. Concerns are raised that statutory medical certification for flight attendants will not benefit either flight safety or occupational health.

Identifying research priorities for patient safety in mental health: an international expert Delphi study

PubMed Central

Murray, Kevin; Thibaut, Bethan; Ramtale, Sonny Christian; Adam, Sheila; Darzi, Ara; Archer, Stephanie

2018-01-01

Objective Physical healthcare has dominated the patient safety field; research in mental healthcare is not as extensive but findings from physical healthcare cannot be applied to mental healthcare because it delivers specialised care that faces unique challenges. Therefore, a clearer focus and recognition of patient safety in mental health as a distinct research area is still needed. The study aim is to identify future research priorities in the field of patient safety in mental health. Design Semistructured interviews were conducted with the experts to ascertain their views on research priorities in patient safety in mental health. A three-round online Delphi study was used to ascertain consensus on 117 research priority statements. Setting and participants Academic and service user experts from the USA, UK, Switzerland, Netherlands, Ireland, Denmark, Finland, Germany, Sweden, Australia, New Zealand and Singapore were included. Main outcome measures Agreement in research priorities on a five-point scale. Results Seventy-nine statements achieved consensus (>70%). Three out of the top six research priorities were patient driven; experts agreed that understanding the patient perspective on safety planning, on self-harm and on medication was important. Conclusions This is the first international Delphi study to identify research priorities in safety in the mental field as determined by expert academic and service user perspectives. A reasonable consensus was obtained from international perspectives on future research priorities in patient safety in mental health; however, the patient perspective on their mental healthcare is a priority. The research agenda for patient safety in mental health identified here should be informed by patient safety science more broadly and used to further establish this area as a priority in its own right. The safety of mental health patients must have parity with that of physical health patients to achieve this. PMID:29502096

Reproductive Health Care Priorities and Barriers to Effective Care for Lesbian, Gay, Bisexual, Transgender, Queer People Assigned Female at Birth: A Qualitative Study.

PubMed

Wingo, Erin; Ingraham, Natalie; Roberts, Sarah C M

2018-04-13

Little research documents the self-identified reproductive health priorities and health care experiences of lesbian, gay, bisexual, transgender, queer (LGBTQ)-identified individuals who may be in need of services. We conducted in-depth interviews with a diverse sample of 39 female-assigned-at-birth individuals (ages 18-44) who also identified as lesbian, bisexual, queer, and/or genderqueer, or transmasculine. Interviews were primarily conducted in person in the Bay Area of California, and Baltimore, Maryland, with 11 conducted remotely with participants in other U.S. We asked participants about their current reproductive health care needs, topics they felt researchers should pursue, and past reproductive health care experiences. Data were analyzed using a framework method, incorporating deductive and inductive thematic analysis techniques. Reproductive health care needs among participants varied widely and included treatment of polycystic ovary syndrome and irregular menses, gender-affirming hysterectomies, and fertility assistance. Many faced challenges getting their needs met. Themes related to these challenges cross-cutting across identity groups included primary focus on fertility, provider lack of LGBTQ health competency relevant to reproductive health priorities and treatment, and discriminatory comments and treatment. Across themes and identity groups, participants highlighted that sexual activity and reproduction were central topics in reproductive health care settings. These topics facilitated identity disclosures to providers, but also enhanced vulnerability to discrimination. Reproductive health priorities of LGBTQ individuals include needs similar to cisgender and heterosexual groups (e.g., abortion, contraception, PCOS) as well as unique needs (e.g., gender affirming hysterectomies, inclusive safer sex guidance) and challenges in pursuing care. Future reproductive health research should pursue health care concerns prioritized by LGBTQ populations. Copyright © 2018 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that might not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A 2-day consensus meeting was held on November 18-19, 2008 in Chicago, IL, to achieve the objective. Before the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock production specialists, journal editors, assistant editors, and associate editors. Before the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items would need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional subitem was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.

Workplace health understandings and processes in small businesses: a systematic review of the qualitative literature.

PubMed

MacEachen, Ellen; Kosny, Agnieszka; Scott-Dixon, Krista; Facey, Marcia; Chambers, Lori; Breslin, Curtis; Kyle, Natasha; Irvin, Emma; Mahood, Quenby

2010-06-01

Small businesses (SBs) play an important role in global economies, employ half of all workers, and pose distinct workplace health problems. This systematic review of qualitative peer-reviewed literature was carried out to identify and synthesize research findings about how SB workplace parties understand and enact processes related to occupational health and safety (OHS). The review was conducted as part of a larger mixed-method review and in consultation with stakeholders. A comprehensive literature search identified 5067 studies. After screening for relevance, 20 qualitative articles were identified. Quality assessment led to 14 articles of sufficient quality to be included in the meta-ethnographic findings synthesis. This review finds that SBs have distinctive social relations of work, apprehensions of workplace risk, and legislative requirements. Eight themes were identified that consolidate knowledge on how SB workplace parties understand OHS hazards, how they manage risk and health problems, and how broader structures, policies and systems shape the practice of workplace health in SBs. The themes contribute to 'layers of evidence' that address SB work and health phenomena at the micro (e.g. employer or worker behavior), meso (e.g. organizational dynamics) and macro (e.g. state policy) levels. This synthesis details the unique qualities and conditions of SBs that merit particular attention from planners and occupational health policy makers. In particular, the informal workplace social relations can limit workers' and employers' apprehension of risk, and policy and complex contractual conditions in which SBs are often engaged (such as chains of subcontracting) can complicate occupational health responsibilities. This review questions the utility of SB exemptions from OHS regulations and suggests a legislative focus on the particular needs of SBs. It considers ways that workers might activate their own workplace health concerns, and suggests that more qualitative research on OHS solutions is needed. It suggests that answers to the SB OHS problems identified in this review might lie in third party interventions and improved worker representation.

The Need for Comprehensive Health Care Quality Measures for Older Adults.

PubMed

MacLeod, Stephanie; Schwebke, Kay; Hawkins, Kevin; Ruiz, Joann; Hoo, Emma; Yeh, Charlotte S

2017-10-24

Research indicates that older adults receive only about half of their recommended care, with varying quality and limited attention to social issues impacting their health through the most commonly used quality measures. Additionally, many existing measures neglect to address nonclinical social determinants of health. Evidence of the need for more comprehensive measures for seniors is growing. The primary purpose of this article, which is supported by a limited review of literature, is to describe gaps among current quality measures in addressing certain nonclinical needs of older adults, including key social determinants of health. In doing so, the authors describe their position on the need for expanded measures to incorporate these factors to improve care and quality of life. The authors conducted a limited review of the literature to inform this article, focusing specifically on selected measures for older adults rather than a broader systematic review of all measures. Most research identified was related to clinical practice guidelines rather than quality measures of care as applied to older adults. Furthermore, the literature reviewed reflected limited evidence of efforts to tailor quality measures for the unique social needs of older adults, confirming a potential gap in this area. A growing need exists for improved quality measures specifically designed to help providers address the unique social needs of older adults. Filling this gap will improve overall understanding of seniors and help them to achieve optimal health and successful aging.

Setting research priorities for patients on or nearing dialysis.

PubMed

Manns, Braden; Hemmelgarn, Brenda; Lillie, Erin; Dip, Sally Crowe P G; Cyr, Annette; Gladish, Michael; Large, Claire; Silverman, Howard; Toth, Brenda; Wolfs, Wim; Laupacis, Andreas

2014-10-07

With increasing emphasis among health care providers and funders on patient-centered care, it follows that patients and their caregivers should be included when priorities for research are being established. This study sought to identify the most important unanswered questions about the management of kidney failure from the perspective of adult patients on or nearing dialysis, their caregivers, and the health care professionals who care for these patients. Research uncertainties were identified through a national Canadian survey of adult patients on or nearing dialysis, their caregivers, and health care professionals. Uncertainties were refined by a steering committee that included patients, caregivers, researchers, and clinicians to assemble a short-list of the top 30 uncertainties. Thirty-four people (11 patients; five caregivers; eight physicians; six nurses; and one social worker, pharmacist, physiotherapist, and dietitian each) from across Canada subsequently participated in a workshop to determine the top 10 research questions. In total, 1570 usable research uncertainties were received from 317 respondents to the survey. Among these, 259 unique uncertainties were identified; after ranking, these were reduced to a short-list of 30 uncertainties. During the in-person workshop, the top 10 research uncertainties were identified, which included questions about enhanced communication among patients and providers, dialysis modality options, itching, access to kidney transplantation, heart health, dietary restrictions, depression, and vascular access. These can be used alongside the results of other research priority-setting exercises to guide researchers in designing future studies and inform health care funders. Copyright © 2014 by the American Society of Nephrology.

Setting Research Priorities for Patients on or Nearing Dialysis

PubMed Central

Hemmelgarn, Brenda; Lillie, Erin; Dip, Sally Crowe P.G.; Cyr, Annette; Gladish, Michael; Large, Claire; Silverman, Howard; Toth, Brenda; Wolfs, Wim; Laupacis, Andreas

2014-01-01

With increasing emphasis among health care providers and funders on patient-centered care, it follows that patients and their caregivers should be included when priorities for research are being established. This study sought to identify the most important unanswered questions about the management of kidney failure from the perspective of adult patients on or nearing dialysis, their caregivers, and the health care professionals who care for these patients. Research uncertainties were identified through a national Canadian survey of adult patients on or nearing dialysis, their caregivers, and health care professionals. Uncertainties were refined by a steering committee that included patients, caregivers, researchers, and clinicians to assemble a short-list of the top 30 uncertainties. Thirty-four people (11 patients; five caregivers; eight physicians; six nurses; and one social worker, pharmacist, physiotherapist, and dietitian each) from across Canada subsequently participated in a workshop to determine the top 10 research questions. In total, 1570 usable research uncertainties were received from 317 respondents to the survey. Among these, 259 unique uncertainties were identified; after ranking, these were reduced to a short-list of 30 uncertainties. During the in-person workshop, the top 10 research uncertainties were identified, which included questions about enhanced communication among patients and providers, dialysis modality options, itching, access to kidney transplantation, heart health, dietary restrictions, depression, and vascular access. These can be used alongside the results of other research priority–setting exercises to guide researchers in designing future studies and inform health care funders. PMID:24832095

PHYSICIANS' BELIEFS ABOUT USING EMR AND CPOE: IN PURSUIT OF A CONTEXTUALIZED UNDERSTANDING OF HEALTH IT USE BEHAVIOR

PubMed Central

Holden, Richard J.

2010-01-01

Purpose To identify and describe physicians' beliefs about use of electronic medical records (EMR) and computerized provider order entry (CPOE) for inpatient and outpatient care, to build an understanding of what factors shape information technology (IT) use behavior in the unique context of health care delivery. Methods Semi-structured qualitative research interviews were carried out, following the beliefs elicitation approach. Twenty physicians from two large Midwest US hospitals participated. Physicians were asked questions to elicit beliefs and experiences pertaining to their use of EMR and CPOE. Questions were based on a broad set of behavior-shaping beliefs and the methods commonly used to elicit those beliefs. Results Qualitative analysis revealed numerous themes related to the perceived emotional and instrumental outcomes of EMR and CPOE use; perceived external and personal normative pressure to use those systems; perceived volitional control over use behavior; perceived facilitators and barriers to system use; and perceptions about the systems and how they were implemented. EMR and CPOE were commonly believed to both improve and worsen the ease and quality of personal performance, productivity and efficiency, and patient outcomes. Physicians felt encouraged by employers and others to use the systems but also had personal role-related and moral concerns about doing so. Perceived facilitators and barriers were numerous and had their sources in all aspects of the work system. Conclusion Given the breadth and detail of elicited beliefs, numerous design and policy implications can be identified. Additionally, the findings are a first step toward developing a theory of health IT acceptance and use contextualized to the unique setting of health care. PMID:20071219

A protocol for developing an evaluation framework for an academic and private-sector partnership to assess the impact of major food and beverage companies' investments in community health in the United States.

PubMed

Huang, Terry T-K; Ferris, Emily; Crossley, Rachel; Guillermin, Michelle; Costa, Sergio; Cawley, John

2015-01-01

Public health leaders increasingly recognize the importance of multi-sector partnerships and systems approaches to address obesity. Public-private partnerships (PPP), which are joint ventures between government agencies and private sector entities, may help facilitate this process, but need to be delivered through comprehensive, transparent frameworks to maximize potential benefits and minimize potential risks for all partners. The City University of New York (CUNY) School of Public Health and the Healthy Weight Commitment Foundation (HWCF) propose to engage in a unique academic-private-sector research partnership to evaluate the impact and effectiveness of the food and beverage industry's investment in obesity and hunger prevention and reduction through community-level healthful eating and active living programs. The CUNY-HWCF academic-private partnership protocol described here incorporates best practices from the literature on PPP into the partnership's design. The CUNY-HWCF partnership design demonstrates how established guidelines for partnership components will actively incorporate and promote the principles of successful PPPs identified in various research papers. These identified principles of successful PPP, including mutuality (a reciprocal relationship between entities), and equality among partners, recognition of partners' unique strengths and roles, alignment of resources and expertise toward a common cause, and coordination and delegation of responsibilities, will be embedded throughout the design of governance, management, funding, intellectual property and accountability structures. The CUNY-HWCF partnership responds to the call for increased multi-sector work in obesity prevention and control. This framework aims to promote transparency and the shared benefits of complementary expertise while minimizing shared risks and conflicts of interest. This framework serves as a template for future academic-private research partnerships.

An empirical typology of social networks and its association with physical and mental health: a study with older Korean immigrants.

PubMed

Park, Nan Sook; Jang, Yuri; Lee, Beom S; Ko, Jung Eun; Haley, William E; Chiriboga, David A

2015-01-01

In the context of social convoy theory, the purposes of the study were (a) to identify an empirical typology of the social networks evident in older Korean immigrants and (b) to examine its association with self-rated health and depressive symptoms. The sample consisted of 1,092 community-dwelling older Korean immigrants in Florida and New York. Latent class analyses were conducted to identify the optimal social network typology based on 8 indicators of interpersonal relationships and activities. Bivariate and multivariate analyses were conducted to examine how the identified social network typology was associated with self-rating of health and depressive symptoms. Results from the latent class analysis identified 6 clusters as being most optimal, and they were named diverse, unmarried/diverse, married/coresidence, family focused, unmarried/restricted, and restricted. Memberships in the clusters of diverse and married/coresidence were significantly associated with more favorable ratings of health and lower levels of depressive symptoms. Notably, no distinct network solely composed of friends was identified in the present sample of older immigrants; this may reflect the disruptions in social convoys caused by immigration. The findings of this study promote our understanding of the unique patterns of social connectedness in older immigrants. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Reverse innovation: an opportunity for strengthening health systems.

PubMed

Snowdon, Anne W; Bassi, Harpreet; Scarffe, Andrew D; Smith, Alexander D

2015-02-07

Canada, when compared to other OECD countries, ranks poorly with respect to innovation and innovation adoption while struggling with increasing health system costs. As a result of its failure to innovate, the Canadian health system will struggle to meet the needs and demands of both current and future populations. The purpose of this initiative was to explore if a competition-based reverse innovation challenge could mobilize and stimulate current and future leaders to identify and lead potential reverse innovation projects that address health system challenges in Canada. An open call for applications took place over a 4-month period. Applicants were enticed to submit to the competition with a $50,000 prize for the top submission to finance their project. Leaders from a wide cross-section of sectors collectively developed evaluation criteria and graded the submissions. The criteria evaluated: proof of concept, potential value, financial impact, feasibility, and scalability as well as the use of prize money and innovation team. The competition received 12 submissions from across Canada that identified potential reverse innovations from 18 unique geographical locations that were considered developing and/or emerging markets. The various submissions addressed health system challenges relating to education, mobile health, aboriginal health, immigrant health, seniors health and women's health and wellness. Of the original 12 submissions, 5 finalists were chosen and publically profiled, and 1 was chosen to receive the top prize. The results of this initiative demonstrate that a competition that is targeted to reverse innovation does have the potential to mobilize and stimulate leaders to identify reverse innovations that have the potential for system level impact. The competition also provided important insights into the capacity of Canadian students, health care providers, entrepreneurs, and innovators to propose and implement reverse innovation in the context of the Canadian health system.

Factors shaping effective utilization of health information technology in urban safety-net clinics.

PubMed

George, Sheba; Garth, Belinda; Fish, Allison; Baker, Richard

2013-09-01

Urban safety-net clinics are considered prime targets for the adoption of health information technology innovations; however, little is known about their utilization in such safety-net settings. Current scholarship provides limited guidance on the implementation of health information technology into safety-net settings as it typically assumes that adopting institutions have sufficient basic resources. This study addresses this gap by exploring the unique challenges urban resource-poor safety-net clinics must consider when adopting and utilizing health information technology. In-depth interviews (N = 15) were used with key stakeholders (clinic chief executive officers, medical directors, nursing directors, chief financial officers, and information technology directors) from staff at four clinics to explore (a) nonhealth information technology-related clinic needs, (b) how health information technology may provide solutions, and (c) perceptions of and experiences with health information technology. Participants identified several challenges, some of which appear amenable to health information technology solutions. Also identified were requirements for effective utilization of health information technology including physical infrastructural improvements, funding for equipment/training, creation of user groups to share health information technology knowledge/experiences, and specially tailored electronic billing guidelines. We found that despite the potential benefit that can be derived from health information technologies, the unplanned and uninformed introduction of these tools into these settings might actually create more problems than are solved. From these data, we were able to identify a set of factors that should be considered when integrating health information technology into the existing workflows of low-resourced urban safety-net clinics in order to maximize their utilization and enhance the quality of health care in such settings.

[Personalized medicine, privatized medicine? legal and public health stakes].

PubMed

Rial-Sebbag, Emmanuelle

2014-11-01

Personalized medicine is booming. It tends to provide a medical management "tailored" for groups of patients, or for one unique patient, but also to identify risk groups to develop public health strategies. In this context, some radicalization phenomenon can emerge, leading to not only personalized medicine but also privatized medicine, which can lead to a capture of the medical public resource. If the "privatization" of medicine is not limited to producing adverse effects, several potentially destabilizing phenomena for patients still remain. First, some objective factors, like the adjustment of scientific prerequisites, are emerging from personalized medicine practices (clinical trial, public health policy) and are interfering with the medical doctor/patient relationship. Another risk emerges for patients concomitantly to their demand for controlling their own health, in terms of patients' security although these risks are not clearly identified and not effectively communicated. These practices, related to a privatized medicine, develop within the healthcare system but also outside, and the government and legislators will have to take into account these new dimensions in drafting their future regulations and policies. © 2014 médecine/sciences – Inserm.

Democratizing the world health organization.

PubMed

van de Pas, R; van Schaik, L G

2014-02-01

A progressive erosion of the democratic space appears as one of the emerging challenges in global health today. Such delimitation of the political interplay has a particularly evident impact on the unique public interest function of the World Health Organization (WHO). This paper aims to identify some obstacles for a truly democratic functioning of the UN specialized agency for health. The development of civil society's engagement with the WHO, including in the current reform proposals, is described. The paper also analyses how today's financing of the WHO--primarily through multi-bi financing mechanisms--risks to choke the agency's role in global health. Democratizing the public debate on global health, and therefore the role of the WHO, requires a debate on its future role and engagement at the country level. This desirable process can only be linked to national debates on public health, and the re-definition of health as a primary political and societal concern. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Female streetwalkers' perspectives on migration and HIV/STI risks in a changing economic and social environment: a qualitative study in Shanghai, China.

PubMed

Huang, Z Jennifer; Hu, Dier; Chang, Ruth; Zaccaro, Heather; Iguchi, Martin; Zheng, Huang; He, Na

2015-01-01

China's 30-year economic boom has created a unique social and economic market for commercial sex, as well as for a workforce of migrant women from rural China. This qualitative study explores the impact of the rapidly changing social and economic environment on migration patterns, knowledge of sexually transmitted infections (STIs), STI risk behaviours and health beliefs among female streetwalkers in Shanghai. Qualitative data were collected in 2010 through semi-structured in-depth interviews with 16 streetwalkers to characterise their migration passages, sexual health and behaviours, and peer networks. Many streetwalkers reported histories of childhood impoverishment, of family or partner violence or trauma, of migration consistent with the timeline and routes of economic development and of a scarcity in health, social or economic support. Their knowledge of the prevention and treatment of HIV and STIs was limited. They had little bargaining power on condom use and the majority resorted to vaginal douching and self-management with antibiotics as preventative measures. The study identifies streetwalkers' perspectives on the changing environment, their options and actions and, finally, HIV/STI risks that were unique to this hidden population.

Identification and Management of Human Trafficking Victims in the Emergency Department.

PubMed

Hachey, Lisa M; Phillippi, Julia C

Health care practitioners serve an important role in identification and assistance of human trafficking victims. Advanced practice registered nurses, including certified nurse midwives, clinical nurse specialists, and nurse practitioners, are in a unique position to interact with persons trafficked and seen in the clinical setting, yet they require knowledge to identify the signs of human trafficking. Lack of training and education has been identified as a barrier for health care professionals to recognize human trafficking victims and implement needed health care services (; ). Barriers to identification and management include gap in knowledge about the process to screen for trafficking, to assist victims, and to make referrals. A patient-centered, trauma-informed approach can provide a safe environment to sensitively screen patients for human trafficking. Advanced practice registered nurses should be able to assess for trafficking indicators, collaborate with multidisciplinary service providers, and ensure understanding and availability of federal, state, and local resources to manage the care of victims of trafficking.

The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management

PubMed Central

Tompkins, Jordan W.; Luginaah, Isaac N.; Booth, Gillian L.; Harris, Stewart B.

2010-01-01

Recent reports aimed at improving diabetes care in socially disadvantaged populations suggest that interventions must be tailored to meet the unique needs of the local community—specifically, the community’s geography. We have examined the spatial distribution of diabetes in the context of socioeconomic determinants of health in London (Ontario, Canada) to characterize neighbourhoods in an effort to target these neighbourhoods for local level community-based program planning and intervention. Multivariate spatial-statistical techniques and geographic information systems were used to examine diabetes rates and socioeconomic variables aggregated at the census tract level. Creation of a deprivation index facilitated investigation across multiple determinants of health. Findings from our research identified ‘at risk’ neighbourhoods in London with socioeconomic disadvantage and high diabetes. Future endeavours must continue to identify local level trends in order to support policy development, resource planning and care for improved health outcomes and improved equity in access to care across geographic regions. PMID:20623032

Assessment of medication adherence app features, functionality, and health literacy level and the creation of a searchable Web-based adherence app resource for health care professionals and patients.

PubMed

Heldenbrand, Seth; Martin, Bradley C; Gubbins, Paul O; Hadden, Kristie; Renna, Catherine; Shilling, Rebecca; Dayer, Lindsey

2016-01-01

To assess the features and level of health literacy (HL) of available medication adherence apps and to create a searchable website to assist health care providers (HCP) and patients identify quality adherence apps. Medication nonadherence continues to be a significant problem and leads to poor health outcomes and avoidable health care expense. The average adherence rate for chronic medications, regardless of disease state, is approximately 50% leaving significant room for improvement. Smartphone adherence apps are a novel resource to address medication nonadherence. With widespread smartphone use and the growing number of adherence apps, both HCP and patients should be able to identify quality adherence apps to maximize potential benefits. Assess the features, functionality and level of HL of available adherence apps and create a searchable website to help both HCP and patients identify quality adherence apps. Online marketplaces (iTunes, Google Play, Blackberry) were searched in June of 2014 to identify available adherence apps. Online descriptions were recorded and scored based on 28 author-identified features across 4 domains. The 100 highest-scoring apps were user-tested with a standardized regimen to evaluate their functionality and level of HL. 461 adherence apps were identified. 367 unique apps were evaluated after removing "Lite/Trial" versions. The median initial score based on descriptions was 15 (max of 68; range: 3 to 47). Only 77 apps of the top 100 highest-scoring apps completed user-testing and HL evaluations. The median overall user-testing score was 30 (max of 73; range: 16 to 55). App design, functionality, and level of HL varies widely among adherence apps. While no app is perfect, several apps scored highly across all domains. The website www.medappfinder.com is a searchable tool that helps HCP and patients identify quality apps in a crowded marketplace. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

How a Training Program Is Transforming the Role of Traditional Birth Attendants from Cultural Practitioners to Unique Health-care Providers: A Community Case Study in Rural Guatemala.

PubMed

Hernandez, Sasha; Oliveira, Jessica Bastos; Shirazian, Taraneh

2017-01-01

In low- and middle-income countries (LMICs), where the rates of maternal mortality continue to be inappropriately high, there has been recognition of the importance of training traditional birth attendants (TBAs) to help improve outcomes during pregnancy and childbirth. In Guatemala, there is no national comprehensive training program in place despite the fact that the majority of women rely on TBAs during pregnancy and childbirth. This community case study presents a unique education program led by TBAs for TBAs in rural Guatemala. Discussion of this training program focuses on programming implementation, curriculum development, sustainable methodology, and how an educational partnership with the current national health-care system can increase access to health care for women in LMICs. Recent modifications to this training model are also discussed including how a change in the clinical curriculum is further integrating TBAs into the national health infrastructure. The training program has demonstrated that Guatemalan TBAs are able to improve their basic obstetrical knowledge, are capable of identifying and referring early complications of pregnancy and labor, and can deliver basic prenatal care that would otherwise not be provided. This training model is helping transform the role of the TBA from a sole cultural practitioner to a validated health-care provider within the health-care infrastructure of Guatemala and has the potential to do the same in other LMICs.

International Classification of Functioning, Disability and Health Core Sets for cerebral palsy, autism spectrum disorder, and attention-deficit-hyperactivity disorder.

PubMed

Schiariti, Verónica; Mahdi, Soheil; Bölte, Sven

2018-05-30

Capturing functional information is crucial in childhood disability. The International Classification of Functioning, Disability and Health (ICF) Core Sets promote assessments of functional abilities and disabilities in clinical practice regarding circumscribed diagnoses. However, the specificity of ICF Core Sets for childhood-onset disabilities has been doubted. This study aimed to identify content commonalities and differences among the ICF Core Sets for cerebral palsy (CP), and the newly developed Core Sets for autism spectrum disorder (ASD) and attention-deficit-hyperactivity disorder (ADHD). The categories within each Core Set were aggregated at the ICF component and chapter levels. Content comparison was conducted using descriptive analyses. The activities and participation component of the ICF was the most covered across all Core Sets. Main differences included representation of ICF components and coverage of ICF chapters within each component. CP included all ICF components, while ADHD and ASD predominantly focused on activities and participation. Environmental factors were highly represented in the ADHD Core Sets (40.5%) compared to the ASD (28%) and CP (27%) Core Sets. International Classification of Functioning, Disability and Health Core Sets for CP, ASD, and ADHD capture both common but also unique functional information, showing the importance of creating condition-specific, ICF-based tools to build functional profiles of individuals with childhood-onset disabilities. The International Classification of Functioning, Disability and Health (ICF) Core Sets for cerebral palsy (CP), autism spectrum disorder (ASD), and attention-deficit-hyperactivity disorder (ADHD) include unique functional information. The ICF-based tools for CP, ASD, and ADHD differ in terms of representation and coverage of ICF components and ICF chapters. Representation of environmental factors uniquely influences functioning and disability across ICF Core Sets for CP, ASD and ADHD. © 2018 Mac Keith Press.

Phosphoproteomics profiling of human skin fibroblast cells reveals pathways and proteins affected by low doses of ionizing radiation.

PubMed

Yang, Feng; Waters, Katrina M; Miller, John H; Gritsenko, Marina A; Zhao, Rui; Du, Xiuxia; Livesay, Eric A; Purvine, Samuel O; Monroe, Matthew E; Wang, Yingchun; Camp, David G; Smith, Richard D; Stenoien, David L

2010-11-30

High doses of ionizing radiation result in biological damage; however, the precise relationships between long-term health effects, including cancer, and low-dose exposures remain poorly understood and are currently extrapolated using high-dose exposure data. Identifying the signaling pathways and individual proteins affected at the post-translational level by radiation should shed valuable insight into the molecular mechanisms that regulate dose-dependent responses to radiation. We have identified 7117 unique phosphopeptides (2566 phosphoproteins) from control and irradiated (2 and 50 cGy) primary human skin fibroblasts 1 h post-exposure. Semi-quantitative label-free analyses were performed to identify phosphopeptides that are apparently altered by radiation exposure. This screen identified phosphorylation sites on proteins with known roles in radiation responses including TP53BP1 as well as previously unidentified radiation-responsive proteins such as the candidate tumor suppressor SASH1. Bioinformatic analyses suggest that low and high doses of radiation affect both overlapping and unique biological processes and suggest a role for MAP kinase and protein kinase A (PKA) signaling in the radiation response as well as differential regulation of p53 networks at low and high doses of radiation. Our results represent the most comprehensive analysis of the phosphoproteomes of human primary fibroblasts exposed to multiple doses of ionizing radiation published to date and provide a basis for the systems-level identification of biological processes, molecular pathways and individual proteins regulated in a dose dependent manner by ionizing radiation. Further study of these modified proteins and affected networks should help to define the molecular mechanisms that regulate biological responses to radiation at different radiation doses and elucidate the impact of low-dose radiation exposure on human health.

Phosphoproteomics Profiling of Human Skin Fibroblast Cells Reveals Pathways and Proteins Affected by Low Doses of Ionizing Radiation

PubMed Central

Yang, Feng; Waters, Katrina M.; Miller, John H.; Gritsenko, Marina A.; Zhao, Rui; Du, Xiuxia; Livesay, Eric A.; Purvine, Samuel O.; Monroe, Matthew E.; Wang, Yingchun; Camp, David G.; Smith, Richard D.; Stenoien, David L.

2010-01-01

Background High doses of ionizing radiation result in biological damage; however, the precise relationships between long-term health effects, including cancer, and low-dose exposures remain poorly understood and are currently extrapolated using high-dose exposure data. Identifying the signaling pathways and individual proteins affected at the post-translational level by radiation should shed valuable insight into the molecular mechanisms that regulate dose-dependent responses to radiation. Principal Findings We have identified 7117 unique phosphopeptides (2566 phosphoproteins) from control and irradiated (2 and 50 cGy) primary human skin fibroblasts 1 h post-exposure. Semi-quantitative label-free analyses were performed to identify phosphopeptides that are apparently altered by radiation exposure. This screen identified phosphorylation sites on proteins with known roles in radiation responses including TP53BP1 as well as previously unidentified radiation-responsive proteins such as the candidate tumor suppressor SASH1. Bioinformatic analyses suggest that low and high doses of radiation affect both overlapping and unique biological processes and suggest a role for MAP kinase and protein kinase A (PKA) signaling in the radiation response as well as differential regulation of p53 networks at low and high doses of radiation. Conclusions Our results represent the most comprehensive analysis of the phosphoproteomes of human primary fibroblasts exposed to multiple doses of ionizing radiation published to date and provide a basis for the systems-level identification of biological processes, molecular pathways and individual proteins regulated in a dose dependent manner by ionizing radiation. Further study of these modified proteins and affected networks should help to define the molecular mechanisms that regulate biological responses to radiation at different radiation doses and elucidate the impact of low-dose radiation exposure on human health. PMID:21152398

Stakeholders' perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study.

PubMed

Housten, A J; Furtado, K; Kaphingst, K A; Kebodeaux, C; McBride, T; Cusanno, B; Politi, M C

2016-11-08

Approximately 29 million individuals are expected to enroll in health insurance using the Patient Protection and Affordable Care Act (ACA) Marketplace by 2022. Those seeking health insurance struggle to understand insurance options and choose a plan that best suits their needs. We interviewed stakeholders to identify the challenges associated with the ACA Marketplace health insurance enrollment and elicited feedback about what to include in health insurance decision support tools. Interviews were transcribed and themes were identified using inductive thematic analysis. Stakeholders stated that consumers felt frustrated by unclear terminology, high plan costs, and complex calculations required to assess costs. Consumers felt anxious about making the wrong choice and being unable to change plans within a calendar year. Stakeholders recommended using plain language tables defining complex terms, grouping information, and using engaging graphics to communicate information about health insurance. Stakeholders thought that narratives of how others made decisions about insurance might be helpful to consumers, but recommended that they be tailored to the needs of specific consumers. Strategies that clarify health insurance terms using plain language and graphics, acknowledge concern associated with making the wrong choice, calculate and enable cost comparison, and tailor information to consumers' unique needs could benefit those enrolling in ACA Marketplace plans, Narratives developed should be simple and inclusive enough for diverse populations.

Medical Complexity among Children with Special Health Care Needs: A Two-Dimensional View.

PubMed

Coller, Ryan J; Lerner, Carlos F; Eickhoff, Jens C; Klitzner, Thomas S; Sklansky, Daniel J; Ehlenbach, Mary; Chung, Paul J

2016-08-01

To identify subgroups of U.S. children with special health care needs (CSHCN) and characterize key outcomes. Secondary analysis of 2009-2010 National Survey of CSHCN. Latent class analysis grouped individuals into substantively meaningful classes empirically derived from measures of pediatric medical complexity. Outcomes were compared among latent classes with weighted logistic or negative binomial regression. LCA identified four unique CSHCN subgroups: broad functional impairment (physical, cognitive, and mental health) with extensive health care (Class 1), broad functional impairment alone (Class 2), predominant physical impairment requiring family-delivered care (Class 3), and physical impairment alone (Class 4). CSHCN from Class 1 had the highest ED visit rates (IRR 3.3, p < .001) and hospitalization odds (AOR: 12.0, p < .001) and lowest odds of a medical home (AOR: 0.17, p < .001). CSHCN in Class 3, despite experiencing more shared decision making and medical home attributes, had more ED visits and missed school than CSHCN in Class 2 (p < .001); the latter, however, experienced more cost-related difficulties, care delays, and parents having to stop work (p < .001). Recognizing distinct impacts of cognitive and mental health impairments and health care delivery needs on CSHCN outcomes may better direct future intervention efforts. © Health Research and Educational Trust.

Risky business: Lived experience mental health practice, nurses as potential allies.

PubMed

Byrne, Louise; Happell, Brenda; Reid-Searl, Kerry

2017-06-01

Mental health policy includes a clear expectation that consumers will participate in all aspects of the design and delivery of mental health services. This edict has led to employment roles for people with lived experience of significant mental health challenges and service use. Despite the proliferation of these roles, research into factors impacting their success or otherwise is limited. This paper presents findings from a grounded theory study investigating the experiences of Lived Experience Practitioners in the context of their employment. In-depth interviews were conducted with 13 Lived Experience Practitioners. Risk was identified as a core category, and included sub-categories: vulnerability, 'out and proud', fear to disclose, and self-care. Essentially participants described the unique vulnerabilities of their mental health challenges being known, and while there were many positives about disclosing there was also apprehension about personal information being so publically known. Self-care techniques were important mediators against these identified risks. The success of lived experience roles requires support and nurses can play an important role, given the size of the nursing workforce in mental health, the close relationships nurses enjoy with consumers and the contribution they have made to the development of lived experience roles within academia. © 2016 Australian College of Mental Health Nurses Inc.

A large point-source outbreak of Salmonella Typhimurium phage type 9 linked to a bakery in Sydney, March 2007.

PubMed

Mannes, Trish; Gupta, Leena; Craig, Adam; Rosewell, Alexander; McGuinness, Clancy Aimers; Musto, Jennie; Shadbolt, Craig; Biffin, Brian

2010-03-01

This report describes the investigation and public health response to a large point-source outbreak of salmonellosis in Sydney, Australia. The case-series investigation involved telephone interviews with 283 cases or their guardians and active surveillance through hospitals, general practitioners, laboratories and the public health network. In this outbreak 319 cases of gastroenteritis were identified, of which 221 cases (69%) presented to a hospital emergency department and 136 (43%) required hospital admission. This outbreak was unique in its scale and severity and the surge capacity of hospital emergency departments was stretched. It highlights that foodborne illness outbreaks can cause substantial preventable morbidity and resultant health service burden, requiring close attention to regulatory and non-regulatory interventions.

The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website.

PubMed

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

2016-05-11

Increasingly, older adults and their informal caregivers are using the Internet to search for health-related information. There is a proliferation of health information online, but the quality of this information varies, often based on exaggerated or dramatic findings, and not easily comprehended by consumers. The McMaster Optimal Aging Portal (Portal) was developed to provide Internet users with high-quality evidence about aging and address some of these current limitations of health information posted online. The Portal includes content for health professionals coming from three best-in-class resources (MacPLUS, Health Evidence, and Health Systems Evidence) and four types of content specifically prepared for the general public (Evidence Summaries, Web Resource Ratings, Blog Posts, and Twitter messages). Our objectives were to share the findings of the usability evaluation of the Portal with particular focus on the content features for the general public and to inform designers of health information websites and online resources for older adults about key usability themes. Data analysis included task performance during usability testing and qualitative content analyses of both the usability sessions and interviews to identify core themes. A total of 37 participants took part in 33 usability testing sessions and 21 focused interviews. Qualitative analysis revealed common themes regarding the Portal's strengths and challenges to usability. The strengths of the website were related to credibility, applicability, browsing function, design, and accessibility. The usability challenges included reluctance to register, process of registering, searching, terminology, and technical features. The study reinforced the importance of including end users during the development of this unique, dynamic, evidence-based health information website. The feedback was applied to iteratively improve website usability. Our findings can be applied by designers of health-related websites.

The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website

PubMed Central

Dobbins, Maureen; Haynes, R. Brian; Iorio, Alfonso; Lavis, John N; Raina, Parminder

2016-01-01

Background Increasingly, older adults and their informal caregivers are using the Internet to search for health-related information. There is a proliferation of health information online, but the quality of this information varies, often based on exaggerated or dramatic findings, and not easily comprehended by consumers. The McMaster Optimal Aging Portal (Portal) was developed to provide Internet users with high-quality evidence about aging and address some of these current limitations of health information posted online. The Portal includes content for health professionals coming from three best-in-class resources (MacPLUS, Health Evidence, and Health Systems Evidence) and four types of content specifically prepared for the general public (Evidence Summaries, Web Resource Ratings, Blog Posts, and Twitter messages). Objective Our objectives were to share the findings of the usability evaluation of the Portal with particular focus on the content features for the general public and to inform designers of health information websites and online resources for older adults about key usability themes. Methods Data analysis included task performance during usability testing and qualitative content analyses of both the usability sessions and interviews to identify core themes. Results A total of 37 participants took part in 33 usability testing sessions and 21 focused interviews. Qualitative analysis revealed common themes regarding the Portal’s strengths and challenges to usability. The strengths of the website were related to credibility, applicability, browsing function, design, and accessibility. The usability challenges included reluctance to register, process of registering, searching, terminology, and technical features. Conclusions The study reinforced the importance of including end users during the development of this unique, dynamic, evidence-based health information website. The feedback was applied to iteratively improve website usability. Our findings can be applied by designers of health-related websites. PMID:27170443

Patient Electronic Health Records as a Means to Approach Genetic Research in Gastroenterology.

PubMed

Ananthakrishnan, Ashwin N; Lieberman, David

2015-10-01

Electronic health records (EHRs) are being increasingly utilized and form a unique source of extensive data gathered during routine clinical care. Through use of codified and free text concepts identified using clinical informatics tools, disease labels can be assigned with a high degree of accuracy. Analysis linking such EHR-assigned disease labels to a biospecimen repository has demonstrated that genetic associations identified in prospective cohorts can be replicated with adequate statistical power and novel phenotypic associations identified. In addition, genetic discovery research can be performed utilizing clinical, laboratory, and procedure data obtained during care. Challenges with such research include the need to tackle variability in quality and quantity of EHR data and importance of maintaining patient privacy and data security. With appropriate safeguards, this novel and emerging field of research offers considerable promise and potential to further scientific research in gastroenterology efficiently, cost-effectively, and with engagement of patients and communities. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Predicting Future Suicide Attempts among Depressed Suicide Ideators: A 10-year Longitudinal Study

PubMed Central

May, Alexis M.; Klonsky, E. David; Klein, Daniel N.

2012-01-01

Suicidal ideation and attempts are a major public health problem. Research has identified many risk factors for suicidality; however, most fail to identify which suicide ideators are at greatest risk of progressing to a suicide attempt. Thus, the present study identified predictors of future suicide attempts in a sample of psychiatric patients reporting suicidal ideation. The sample comprised 49 individuals who met full DSM-IV criteria for major depressive disorder and/or dysthymic disorder and reported suicidal ideation at baseline. Participants were followed for 10 years. Demographic, psychological, personality, and psychosocial risk factors were assessed using validated questionnaires and structured interviews. Phi coefficients and point-biserial correlations were used to identify prospective predictors of attempts, and logistic regressions were used to identify which variables predicted future attempts over and above past suicide attempts. Six significant predictors of future suicide attempts were identified – cluster A personality disorder, cluster B personality disorder, lifetime substance abuse, baseline anxiety disorder, poor maternal relationship, and poor social adjustment. Finally, exploratory logistic regressions were used to examine the unique contribution of each significant predictor controlling for the others. Co-morbid cluster B personality disorder emerged as the only robust, unique predictor of future suicide attempts among depressed suicide ideators. Future research should continue to identify variables that predict transition from suicidal thoughts to suicide attempts, as such work will enhance clinical assessment of suicide risk as well as theoretical models of suicide. PMID:22575331

Ozone Exposure, Cardiopulmonary Health, and Obesity: A Substantive Review.

PubMed

Koman, Patricia D; Mancuso, Peter

2017-07-17

From 1999-2014, obesity prevalence increased among adults and youth. Obese individuals may be uniquely susceptible to the proinflammatory effects of ozone because obese humans and animals have been shown to experience a greater decline in lung function than normal-weight subjects. Obesity is independently associated with limitations in lung mechanics with increased ozone dose. However, few epidemiologic studies have examined the interaction between excess weight and ozone exposure among adults. Using PubMed keyword searches and reference lists, we reviewed epidemiologic evidence to identify potential response-modifying factors and determine if obese or overweight adults are at increased risk of ozone-related health effects. We initially identified 170 studies, of which seven studies met the criteria of examining the interaction of excess weight and ozone exposure on cardiopulmonary outcomes in adults, including four short-term ozone exposure studies in controlled laboratory settings and three community epidemiologic studies. In the studies identified, obesity was associated with decreased lung function and increased inflammatory mediators. Results were inconclusive about the effect modification when data were stratified by sex. Obese and overweight populations should be considered as candidate at-risk groups for epidemiologic studies of cardiopulmonary health related to air pollution exposures. Air pollution is a modifiable risk factor that may decrease lung function among obese individuals with implications for environmental and occupational health policy.

Young Men, Help-Seeking, and Mental Health Services: Exploring Barriers and Solutions

PubMed Central

Lynch, Louise; Long, Maggie; Moorhead, Anne

2016-01-01

International research has identified young men as reluctant to seek help for mental health problems. This research explored barriers and solutions to professional help seeking for mental health problems among young men living in the North West of Ireland. A qualitative approach, using two focus groups with six participants each and five face-to-face interviews, was conducted with men aged 18 to 24 years (total N = 17). Data were analyzed using thematic analysis. Seven key themes of barriers to professional help seeking were identified: “acceptance from peers,” “personal challenges,” “cultural and environmental influences,” “self-medicating with alcohol,” “perspectives around seeking professional help,” “fear of homophobic responses,” and “traditional masculine ideals.” Five key themes of solutions to these barriers included “tailored mental health advertising,” “integrating mental health into formal education,” “education through semiformal support services,” “accessible mental health care,” and “making new meaning.” Interesting findings on barriers include fear of psychiatric medication, fear of homophobic responses from professionals, the legacy of Catholic attitudes, and the genuine need for care. This study offers an in-depth exploration of how young men experience barriers and uniquely offers solutions identified by participants themselves. Youth work settings were identified as a resource for engaging young men in mental health work. Young men can be encouraged to seek help if services and professionals actively address barriers, combining advertising, services, and education, with particular attention and respect to how and when young men seek help and with whom they want to share their problems. PMID:27365212

Toxicological assessments of Gulf War veterans.

PubMed

Brown, Mark

2006-04-29

Concerns about unexplained illnesses among veterans of the 1991 Gulf War appeared soon after that conflict ended. Many environmental causes have been suggested, including possible exposure to depleted uranium munitions, vaccines and other drugs used to protect troops, deliberate or accidental exposure to chemical warfare agents and pesticides and smoke from oil-well fires. To help resolve these issues, US and UK governments have sought independent expert scientific advice from prestigious, independent scientific and public health experts, including the US National Academies of Science and the UK Royal Society and Medical Research Council. Their authoritative and independent scientific and medical reviews shed light on a wide range of Gulf War environmental hazards. However, they have added little to our understanding of Gulf War veterans' illnesses, because identified health effects have been previously well characterized, primarily in the occupational health literature. This effort has not identified any new health effects or unique syndromes associated with the evaluated environmental hazards. Nor do their findings provide an explanation for significant amounts of illnesses among veterans of the 1991 Gulf War. Nevertheless, these independent and highly credible scientific reviews have proven to be an effective means for evaluating potential health effects from deployment-related environmental hazards.

Toxicological assessments of Gulf War veterans

PubMed Central

Brown, Mark

2006-01-01

Concerns about unexplained illnesses among veterans of the 1991 Gulf War appeared soon after that conflict ended. Many environmental causes have been suggested, including possible exposure to depleted uranium munitions, vaccines and other drugs used to protect troops, deliberate or accidental exposure to chemical warfare agents and pesticides and smoke from oil-well fires. To help resolve these issues, US and UK governments have sought independent expert scientific advice from prestigious, independent scientific and public health experts, including the US National Academies of Science and the UK Royal Society and Medical Research Council. Their authoritative and independent scientific and medical reviews shed light on a wide range of Gulf War environmental hazards. However, they have added little to our understanding of Gulf War veterans' illnesses, because identified health effects have been previously well characterized, primarily in the occupational health literature. This effort has not identified any new health effects or unique syndromes associated with the evaluated environmental hazards. Nor do their findings provide an explanation for significant amounts of illnesses among veterans of the 1991 Gulf War. Nevertheless, these independent and highly credible scientific reviews have proven to be an effective means for evaluating potential health effects from deployment-related environmental hazards. PMID:16687269

Modifiable worker risk factors contributing to workplace absence: a stakeholder-centred best-evidence synthesis of systematic reviews.

PubMed

Wagner, Shannon; White, Marc; Schultz, Izabela; Murray, Eleanor; Bradley, Susan M; Hsu, Vernita; McGuire, Lisa; Schulz, Werner

2014-01-01

A challenge facing stakeholders is the identification and translation of relevant high quality research to inform policy and practice. This study engaged academic and community stakeholders in conducting a best evidence-synthesis to identify modifiable risk and protective worker factors across health conditions impacting work-related absence. To identify modifiable worker disability risk and protective factors across common health conditions impacting work-related absence. We searched Medline, Embase, CINHAL, The Cochrane Library, PsycINFO, BusinessSourceComplete, and ABI/Inform from 2000 to 2011. Quantitative, qualitative, or mixed methods systematic reviews of work-focused population were considered for inclusion. Two or more reviewers independently reviewed articles for inclusion and methodological screening. The search strategy, expert input and grey literature identified 2,467 unique records. One hundred and forty-two full text articles underwent comprehensive review. Twenty-four systematic reviews met eligibility criteria. Modifiable worker factors found to have consistent evidence across two or more health conditions included emotional distress, negative enduring psychology/personality factors, negative health and disability perception, decreased physical activity, lack of family support, poor general health, increased functional disability, increased pain, increased fatigue and lack of motivation to return to work. Systematic reviews are limited by availability of high quality studies, lack of consistency of methodological screening and reporting, and variability of outcome measures used.

Health and nutrition content claims on websites advertising infant formula available in Australia: A content analysis.

PubMed

Berry, Nina J; Gribble, Karleen D

2017-10-01

The use of health and nutrition content claims in infant formula advertising is restricted by many governments in response to WHO policies and WHA resolutions. The purpose of this study was to determine whether such prohibited claims could be observed in Australian websites that advertise infant formula products. A comprehensive internet search was conducted to identify websites that advertise infant formula available for purchase in Australia. Content analysis was used to identify prohibited claims. The coding frame was closely aligned with the provisions of the Australian and New Zealand Food Standard Code, which prohibits these claims. The outcome measures were the presence of health claims, nutrition content claims, or references to the nutritional content of human milk. Web pages advertising 25 unique infant formula products available for purchase in Australia were identified. Every advertisement (100%) contained at least one health claim. Eighteen (72%) also contained at least one nutrition content claim. Three web pages (12%) advertising brands associated with infant formula products referenced the nutritional content of human milk. All of these claims appear in spite of national regulations prohibiting them indicating a failure of monitoring and/or enforcement. Where countries have enacted instruments to prohibit health and other claims in infant formula advertising, the marketing of infant formula must be actively monitored to be effective. © 2016 John Wiley & Sons Ltd.

Discrimination and the health of immigrants and refugees: exploring Canada's evidence base and directions for future research in newcomer receiving countries.

PubMed

Edge, Sara; Newbold, Bruce

2013-02-01

Research and practice increasingly suggests discrimination compromises health. Yet the unique experiences and effects facing immigrant and refugee populations remain poorly understood in Canada and abroad. We review current knowledge on discrimination against newcomers in Canada, emphasizing impacts upon health status and service access to identify gaps and research needs. Existing knowledge centers around experiences within health-care settings, differences in perception and coping, mental health impacts, and debates about "non-discriminatory" health-care. There is need for comparative analyses within and across ethno-cultural groups and newcomer classes to better understand factors shaping how discrimination and its health effects are differentially experienced. Women receive greater attention in the literature given their compounded vulnerability. While this must continue, little is known about the experiences of youth and men. Governance and policy discourse analyses would elucidate how norms, institutions and practices shape discriminatory attitudes and responses. Finally, "non-discriminatory health-care" interventions require critical evaluation to determine their effectiveness.

Mental Health and Sociocultural Determinants in an Asian Indian Community

PubMed Central

Roberts, Lisa R.; Mann, Semran K.; Montgomery, Susanne B.

2015-01-01

In a US population of adult male and female Sikh immigrant participants (N = 350), we explored sociocultural factors related to depression, giving participants a choice between English or Punjabi surveys. Language preference pointed to a subgroup with higher levels of depression and lower satisfaction with life. Underreporting of depression suggests a general reluctance to discuss depression. While multiple sociocultural variables were associated with depression bivariably, multivariate analysis identified negative religious coping and anxiety as unique predictors of depression. Community interventions should tap into the protective close-knit social fabric of this community as an opportunity to change the stigma of mental health. PMID:26605953

Health Insurance for "Humans": Information Frictions, Plan Choice, and Consumer Welfare.

PubMed

Handel, Benjamin R; Kolstad, Jonathan T

2015-08-01

Traditional models of insurance choice are predicated on fully informed and rational consumers protecting themselves from exposure to financial risk. In practice, choosing an insurance plan is a complicated decision often made without full information. In this paper we combine new administrative data on health plan choices and claims with unique survey data on consumer information to identify risk preferences, information frictions, and hassle costs. Our additional friction measures are important predictors of choices and meaningfully impact risk preference estimates. We study the implications of counterfactual insurance allocations to illustrate the importance of distinguishing between these micro-foundations for welfare analysis.

Mental Health and Sociocultural Determinants in an Asian Indian Community.

PubMed

Roberts, Lisa R; Mann, Semran K; Montgomery, Susanne B

2016-01-01

In a US population of adult male and female Sikh immigrant participants (N = 350), we explored sociocultural factors related to depression, giving participants a choice between English or Punjabi surveys. Language preference pointed to a subgroup with higher levels of depression and lower satisfaction with life. Underreporting of depression suggests a general reluctance to discuss depression. While multiple sociocultural variables were associated with depression bivariably, multivariate analysis identified negative religious coping and anxiety as unique predictors of depression. Community interventions should tap into the protective close-knit social fabric of this community as an opportunity to change the stigma of mental health.

Types of Lay Health Influencers in Tobacco Cessation: A Qualitative Study

PubMed Central

Yuan, Nicole P.; Wind, Steven; Nichter, Mimi; Nichter, Mark; Castañeda, Heide; Carruth, Lauren; Muramoto, Myra L.

2014-01-01

Objective To identify types of health influencers in tobacco cessation based on the frequency and characteristics of brief intervention activities. Methods Longitudinal qualitative interviews were completed with 28 individuals post-training. Results Four individuals were categorized as Rarely Active, 5 as Active with Family and Friends, 9 as Active in the Workplace, and 10 as Proactive in Multiple Settings. Unique motivators, intervention behaviors, and barriers were documented. Some individuals displayed high levels of self-efficacy necessary for expanding the reach of community-based interventions. Conclusion Training programs need to address the impact of contextual factors on initiating and sustaining intervention activities. PMID:20524890

Policy Perspective: Ensuring Comprehensive Care and Support for Gender Nonconforming Children and Adolescents

PubMed Central

Dowshen, Nadia; Meadows, Rachel; Byrnes, Maureen; Hawkins, Linda; Eder, Jennifer; Noonan, Kathleen

2016-01-01

Abstract Despite recent notable advances in societal equality for lesbian, gay, bisexual, and transgender (LGBT) individuals, youth who identify as trans* or gender nonconforming, in particular, continue to experience significant challenges accessing the services they need to grow into healthy adults. This policy perspective first offers background information describing this population, their unique healthcare needs, and obstacles when seeking care, including case study examples. The authors then provide recommendations for medical education, health systems, and insurance payers, as well as recommendations for school systems and broader public policy changes to improve the health and well-being of gender nonconforming youth. PMID:28861528

Human Trafficking in Areas of Conflict: Health Care Professionals' Duty to Act.

PubMed

Bloem, Christina; Morris, Rikki E; Chisolm-Straker, Makini

2017-01-01

Given the significant global burden of human trafficking, the ability of clinicians to identify and provide treatment for trafficked persons is critical. Particularly in conflict settings, health care facilities often serve as the first and sometimes only point of contact for trafficked persons. As such, medical practitioners have a unique opportunity and an ethical imperative to intervene, even in nonclinical roles. With proper training, medical practitioners can assist trafficked persons by documenting human trafficking cases, thereby placing pressure on key stakeholders to enforce legal protections, and by providing adequate services to those trafficked. © 2017 American Medical Association. All Rights Reserved.

A Multidisciplinary Investigation of a Polycythemia Vera Cancer Cluster of Unknown Origin

PubMed Central

Seaman, Vincent; Dearwent, Steve M; Gable, Debra; Lewis, Brian; Metcalf, Susan; Orloff, Ken; Tierney, Bruce; Zhu, Jane; Logue, James; Marchetto, David; Ostroff, Stephen; Hoffman, Ronald; Xu, Mingjiang; Carey, David; Erlich, Porat; Gerhard, Glenn; Roda, Paul; Iannuzzo, Joseph; Lewis, Robert; Mellow, John; Mulvihill, Linda; Myles, Zachary; Wu, Manxia; Frank, Arthur; Gross-Davis, Carol Ann; Klotz, Judith; Lynch, Adam; Weissfeld, Joel; Weinberg, Rona; Cole, Henry

2010-01-01

Cancer cluster investigations rarely receive significant public health resource allocations due to numerous inherent challenges and the limited success of past efforts. In 2008, a cluster of polycythemia vera, a rare blood cancer with unknown etiology, was identified in northeast Pennsylvania. A multidisciplinary group of federal and state agencies, academic institutions, and local healthcare providers subsequently developed a multifaceted research portfolio designed to better understand the cause of the cluster. This research agenda represents a unique and important opportunity to demonstrate that cancer cluster investigations can produce desirable public health and scientific outcomes when necessary resources are available. PMID:20617023

The Perfect Storm of Information: Combining Traditional and Non-Traditional Data Sources for Public Health Situational Awareness During Hurricane Response

PubMed Central

Bennett, Kelly J.; Olsen, Jennifer M.; Harris, Sara; Mekaru, Sumiko; Livinski, Alicia A.; Brownstein, John S.

2013-01-01

Background: Hurricane Isaac made landfall in southeastern Louisiana in late August 2012, resulting in extensive storm surge and inland flooding. As the lead federal agency responsible for medical and public health response and recovery coordination, the Department of Health and Human Services (HHS) must have situational awareness to prepare for and address state and local requests for assistance following hurricanes. Both traditional and non-traditional data have been used to improve situational awareness in fields like disease surveillance and seismology. This study investigated whether non-traditional data (i.e., tweets and news reports) fill a void in traditional data reporting during hurricane response, as well as whether non-traditional data improve the timeliness for reporting identified HHS Essential Elements of Information (EEI). Methods: HHS EEIs provided the information collection guidance, and when the information indicated there was a potential public health threat, an event was identified and categorized within the larger scope of overall Hurricane Issac situational awareness. Tweets, news reports, press releases, and federal situation reports during Hurricane Isaac response were analyzed for information about EEIs. Data that pertained to the same EEI were linked together and given a unique event identification number to enable more detailed analysis of source content. Reports of sixteen unique events were examined for types of data sources reporting on the event and timeliness of the reports. Results: Of these sixteen unique events identified, six were reported by only a single data source, four were reported by two data sources, four were reported by three data sources, and two were reported by four or more data sources. For five of the events where news tweets were one of multiple sources of information about an event, the tweet occurred prior to the news report, press release, local government\\emergency management tweet, and federal situation report. In all circumstances where citizens were reporting along with other sources, the citizen tweet was the earliest notification of the event. Conclusion: Critical information is being shared by citizens, news organizations, and local government representatives. To have situational awareness for providing timely, life-saving public health and medical response following a hurricane, this study shows that non-traditional data sources should augment traditional data sources and can fill some of the gaps in traditional reporting. During a hurricane response where early event detection can save lives and reduce morbidity, tweets can provide a source of information for early warning. In times of limited budgets, investing technical and personnel resources to efficiently and effectively gather, curate, and analyze non-traditional data for improved situational awareness can yield a high return on investment. PMID:24459610

The perfect storm of information: combining traditional and non-traditional data sources for public health situational awareness during hurricane response.

PubMed

Bennett, Kelly J; Olsen, Jennifer M; Harris, Sara; Mekaru, Sumiko; Livinski, Alicia A; Brownstein, John S

2013-12-16

Hurricane Isaac made landfall in southeastern Louisiana in late August 2012, resulting in extensive storm surge and inland flooding. As the lead federal agency responsible for medical and public health response and recovery coordination, the Department of Health and Human Services (HHS) must have situational awareness to prepare for and address state and local requests for assistance following hurricanes. Both traditional and non-traditional data have been used to improve situational awareness in fields like disease surveillance and seismology. This study investigated whether non-traditional data (i.e., tweets and news reports) fill a void in traditional data reporting during hurricane response, as well as whether non-traditional data improve the timeliness for reporting identified HHS Essential Elements of Information (EEI). HHS EEIs provided the information collection guidance, and when the information indicated there was a potential public health threat, an event was identified and categorized within the larger scope of overall Hurricane Issac situational awareness. Tweets, news reports, press releases, and federal situation reports during Hurricane Isaac response were analyzed for information about EEIs. Data that pertained to the same EEI were linked together and given a unique event identification number to enable more detailed analysis of source content. Reports of sixteen unique events were examined for types of data sources reporting on the event and timeliness of the reports. Of these sixteen unique events identified, six were reported by only a single data source, four were reported by two data sources, four were reported by three data sources, and two were reported by four or more data sources. For five of the events where news tweets were one of multiple sources of information about an event, the tweet occurred prior to the news report, press release, local government\\emergency management tweet, and federal situation report. In all circumstances where citizens were reporting along with other sources, the citizen tweet was the earliest notification of the event. Critical information is being shared by citizens, news organizations, and local government representatives. To have situational awareness for providing timely, life-saving public health and medical response following a hurricane, this study shows that non-traditional data sources should augment traditional data sources and can fill some of the gaps in traditional reporting. During a hurricane response where early event detection can save lives and reduce morbidity, tweets can provide a source of information for early warning. In times of limited budgets, investing technical and personnel resources to efficiently and effectively gather, curate, and analyze non-traditional data for improved situational awareness can yield a high return on investment.

Identifying and collecting pertinent medical records for centralized abstraction in a multi-center randomized clinical trial: the model used by the American College of Radiology arm of the National Lung Screening Trial.

PubMed

Gareen, Ilana F; Sicks, JoRean D; Jain, Amanda Adams; Moline, Denise; Coffman-Kadish, Nancy

2013-01-01

In clinical trials and epidemiologic studies, information on medical care utilization and health outcomes is often obtained from medical records. For multi-center studies, this information may be gathered by personnel at individual sites or by staff at a central coordinating center. We describe the process used to develop a HIPAA-compliant centralized process to collect medical record information for a large multi-center cancer screening trial. The framework used to select, request, and track medical records incorporated a participant questionnaire with unique identifiers for each medical provider. De-identified information from the questionnaires was sent to the coordinating center indexed by these identifiers. The central coordinating center selected specific medical providers for abstraction and notified sites using these identifiers. The site personnel then linked the identifiers with medical provider information. Staff at the sites collected medical records and provided them for central abstraction. Medical records were successfully obtained and abstracted to ascertain information on outcomes and health care utilization in a study with over 18,000 study participants. Collection of records required for outcomes related to positive screening examinations and lung cancer diagnosis exceeded 90%. Collection of records for all aims was 87.32%. We designed a successful centralized medical record abstraction process that may be generalized to other research settings, including observational studies. The coordinating center received no identifying data. The process satisfied requirements imposed by the Health Insurance Portability and Accountability Act and concerns of site institutional review boards with respect to protected health information. Copyright © 2012 Elsevier Inc. All rights reserved.

Identifying and collecting pertinent medical records for centralized abstraction in a multi-center randomized clinical trial: The model used by the American College of Radiology arm of the National Lung Screening Trial

PubMed Central

Gareen, Ilana F.; Sicks, JoRean; Adams, Amanda; Moline, Denise; Coffman-Kadish, Nancy

2012-01-01

Background In clinical trials and epidemiologic studies, information on medical care utilization and health outcomes is often obtained from medical records. For multi-center studies, this information may be gathered by personnel at individual sites or by staff at a central coordinating center. We describe the process used to develop a HIPAA-compliant centralized process to collect medical record information for a large multi-center cancer screening trial. Methods The framework used to select, request, and track medical records incorporated a participant questionnaire with unique identifiers for each medical provider. De-identified information from the questionnaires was sent to the coordinating center indexed by these identifiers. The central coordinating center selected specific medical providers for abstraction and notified sites using these identifiers. The site personnel then linked the identifiers with medical provider information. Staff at the sites collected medical records and provided them for central abstraction. Results Medical records were successfully obtained and abstracted to ascertain information on outcomes and health care utilization in a study with over 18,000 study participants. Collection of records required for outcomes related to positive screening examinations and lung cancer diagnosis exceeded 90%. Collection of records for all aims was 87.32%. Conclusions We designed a successful centralized medical record abstraction process that may be generalized to other research settings, including observational studies. The coordinating center received no identifying data. The process satisfied requirements imposed by the Health Insurance Portability and Accountability Act and concerns of site institutional review boards with respect to protected health information. PMID:22982342

Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: a validation study

PubMed Central

2010-01-01

Background Surname lists are useful for identifying cohorts of ethnic minority patients from secondary data sources. This study sought to develop and validate lists to identify people of South Asian and Chinese origin. Methods Comprehensive lists of South Asian and Chinese surnames were reviewed to identify those that uniquely belonged to the ethnic minority group. Surnames that were common in other populations, communities or ethnic groups were specifically excluded. These surname lists were applied to the Registered Persons Database, a registry of the health card numbers assigned to all residents of the Canadian province of Ontario, so that all residents were assigned to South Asian ethnicity, Chinese ethnicity or the General Population. Ethnic assignment was validated against self-identified ethnicity through linkage with responses to the Canadian Community Health Survey. Results The final surname lists included 9,950 South Asian surnames and 1,133 Chinese surnames. All 16,688,384 current and former residents of Ontario were assigned to South Asian ethnicity, Chinese ethnicity or the General Population based on their surnames. Among 69,859 respondents to the Canadian Community Health Survey, both lists performed extremely well when compared against self-identified ethnicity: positive predictive value was 89.3% for the South Asian list, and 91.9% for the Chinese list. Because surnames shared with other ethnic groups were deliberately excluded from the lists, sensitivity was lower (50.4% and 80.2%, respectively). Conclusions These surname lists can be used to identify cohorts of people with South Asian and Chinese origins from secondary data sources with a high degree of accuracy. These cohorts could then be used in epidemiologic and health service research studies of populations with South Asian and Chinese origins. PMID:20470433

Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: a validation study.

PubMed

Shah, Baiju R; Chiu, Maria; Amin, Shubarna; Ramani, Meera; Sadry, Sharon; Tu, Jack V

2010-05-15

Surname lists are useful for identifying cohorts of ethnic minority patients from secondary data sources. This study sought to develop and validate lists to identify people of South Asian and Chinese origin. Comprehensive lists of South Asian and Chinese surnames were reviewed to identify those that uniquely belonged to the ethnic minority group. Surnames that were common in other populations, communities or ethnic groups were specifically excluded. These surname lists were applied to the Registered Persons Database, a registry of the health card numbers assigned to all residents of the Canadian province of Ontario, so that all residents were assigned to South Asian ethnicity, Chinese ethnicity or the General Population. Ethnic assignment was validated against self-identified ethnicity through linkage with responses to the Canadian Community Health Survey. The final surname lists included 9,950 South Asian surnames and 1,133 Chinese surnames. All 16,688,384 current and former residents of Ontario were assigned to South Asian ethnicity, Chinese ethnicity or the General Population based on their surnames. Among 69,859 respondents to the Canadian Community Health Survey, both lists performed extremely well when compared against self-identified ethnicity: positive predictive value was 89.3% for the South Asian list, and 91.9% for the Chinese list. Because surnames shared with other ethnic groups were deliberately excluded from the lists, sensitivity was lower (50.4% and 80.2%, respectively). These surname lists can be used to identify cohorts of people with South Asian and Chinese origins from secondary data sources with a high degree of accuracy. These cohorts could then be used in epidemiologic and health service research studies of populations with South Asian and Chinese origins.

Exercise deficit disorder in youth: an emergent health concern for school nurses.

PubMed

Faigenbaum, Avery D; Gipson-Jones, Trina L; Myer, Gregory D

2012-08-01

Although the benefits of regular physical activity are widely acknowledged, recent findings indicate that a growing number of youth are not as active as they should be. The impact of a sedentary lifestyle during childhood on lifelong pathological processes and associated health care costs have created a need for immediate action to manage, if not prevent, unhealthy behaviors during this vulnerable period of life. The concept of identifying children with exercise deficit disorder early in life and prescribing effective interventions to prevent the cascade of adverse health outcomes later in life is needed to raise public awareness, focus on primary prevention, and impact the collective behaviors of health care providers and public health agencies. School nurses are in a unique position to take advantage of well-child visits as an ideal opportunity to assess physical activity habits and encourage daily participation in play, recess, sports, planned exercise, and physical education.

Latino Adolescent Reproductive and Sexual Health Behaviors and Outcomes: Research Informed Guidance for Agency-based Practitioners

PubMed Central

Guilamo-Ramos, Vincent; Goldberg, Vincent; Lee, Jane; McCarthy, Katherine; Leavitt, Sarah

2011-01-01

Latinos are the largest and fastest growing minority youth group in the United States. Currently, Latino adolescents experience higher rates of teen pregnancy compared to any other racial or ethnic group and have disproportionately high levels of sexually transmitted infections and HIV. Latino teens are also affected by a number of social problems such as school dropout, poverty, depression and limited access to healthcare, which contributes to disparities in reproductive health outcomes for this population. Relatively few intervention research studies and programs have been dedicated to reducing sexual risk among Latino youth, despite their particular vulnerabilities in experiencing negative reproductive health outcomes. We provide recommendations for identifying the unique reproductive health needs of Latino youth and specific applied strategies so that agency-based social workers and other providers can develop family-based interventions that improve adolescent Latino sexual and reproductive health. PMID:23279981

DG Connect Funded Projects on Information and Communication Technologies (ICT) for Old Age People: Beyond Silos, CareWell and SmartCare.

PubMed

Keijser, W; de Manuel-Keenoy, E; d'Angelantonio, M; Stafylas, P; Hobson, P; Apuzzo, G; Hurtado, M; Oates, J; Bousquet, J; Senn, A

2016-01-01

Information and communication technologies (ICT) are promising for the long-term care of older and frequently frail people. These innovations can improve health outcomes, quality of life and efficiency of care processes, while supporting independent living. However, they may be disruptive innovations. As all European member states are facing an increasing complexity of health and social care, good practices in ICT should be identified and evaluated. Three projects funded by DG CNECT are related to Active and Healthy Ageing (AHA) and frailty: (i) BeyondSilos, dealing with independent living and integrated services, (ii) CareWell, providing integrated care coordination, patient empowerment and home support and (iii) SmartCare, proposing a common set of standard functional specifications for an ICT platform enabling the delivery of integrated care to older patients. The three projects described in this paper provide a unique pan-European research field to further study implementation efforts and outcomes of new technologies. Below, based on a description of the projects, the authors display four domains that are in their views fundamental for in-depth exploration of heterogeneity in the European context: 1. Definition of easily transferable, high level pathways with solid evidence-base; 2. Change management in implementing ICT enabled integrated care; 3. Evaluation and data collection methodologies based on existing experience with MAST and MEDAL methodologies; and 4. Construction of new models for delivery of health and social care. Understanding complementarity, synergies and differences between the three unique projects can help to identify a more effective roll out of best practices within a varying European context.

Acculturation Needs of Pediatric International Medical Graduates: A Qualitative Study.

PubMed

Osta, Amanda D; Barnes, Michelle M; Pessagno, Regina; Schwartz, Alan; Hirshfield, Laura E

2017-01-01

Phenomenon: International medical graduates (IMGs) play a key role in host countries' health systems but face unique challenges, which makes effective, tailored support for IMGs essential. Prior literature describing the acculturation needs of IMGs focused primarily on communication content and style. We conducted a qualitative study to explore acculturation that might be specific to IMG residents who care for children. In a study conducted from November 2011 to April 2012, we performed four 90-minute semistructured focus groups with 26 pediatric IMG residents from 12 countries. The focus group transcripts were analyzed using open and focused coding methodology. The focus groups and subsequent analysis demonstrated that pediatric IMG residents' socialization to their home culture impacts their transition to practice in the United States; they must adjust not only to a U.S. culture, different from their own, but also to the culture of medicine in the United States. We identified the following new acculturation themes: understanding the education system and family structure, social determinants of health, communication with African American parents, contraception, physician handoffs, physicians' role in prevention, adolescent health, and physicians' role in child advocacy. We further highlight the acculturation challenges faced by pediatric IMG residents and offer brief recommendations for the creation of a deliberate acculturation curriculum for pediatric IMG residents. Insight: Residency training is a unique period in physicians' personal and professional development and can be particularly challenging for IMGs. There is a significant gap in the identified acculturation needs and the current curricula available to IMG residents who care for children.

Gender-differences in risk factors for suicidal behaviour identified by perceived burdensomeness, thwarted belongingness and acquired capability: cross-sectional analysis from a longitudinal cohort study.

PubMed

Donker, Tara; Batterham, Philip J; Van Orden, Kimberly A; Christensen, Helen

2014-01-01

The Interpersonal-Psychological Theory of Suicidal Behavior (IPT) is supported by recent epidemiological data. Unique risk factors for the IPT constructs have been identified in community epidemiological studies. Gender differences in these risk factors may contribute substantially to our understanding of suicidal risk, and require further investigation. The present study explores gender differences in the predictors and correlates of perceived burdensomeness, thwarted belongingness and acquired capability for suicide. Participants (547 males, 739 females) aged 32-38 from the PATH through Life study, an Australian population-based longitudinal cohort study (n=1,177) were assessed on perceived burdensomeness, thwarted belongingness and acquired capability for suicide using the Interpersonal Needs Questionnaire and Acquired Capability for Suicide Survey, and on a range of demographic, social support, psychological, mental health and physical health measures. Gender differences in the predictors of the IPT constructs were assessed using linear regression analyses. Higher perceived burdensomeness increased suicide ideation in both genders, while higher thwarted belongingness increased suicide ideation only in females. In females, thwarted belongingness was uniquely related to perceived burdensomeness, while greater physical health was significantly associated with greater thwarted belongingness in males but not in females. There were trends suggesting greater effects of being single and greater perceived burdensomeness for men, and stronger effects of less positive friendship support for women associated with greater thwarted belongingness. Men and women differ in the pattern of psychological characteristics that predict suicide ideation, and in the factors predicting vulnerability. Suicide prevention strategies need to take account of gender differences.

Mass spectrometric analyses of organophosphate insecticide oxon protein adducts.

PubMed

Thompson, Charles M; Prins, John M; George, Kathleen M

2010-01-01

Organophosphate (OP) insecticides continue to be used to control insect pests. Acute and chronic exposures to OP insecticides have been documented to cause adverse health effects, but few OP-adducted proteins have been correlated with these illnesses at the molecular level. Our aim was to review the literature covering the current state of the art in mass spectrometry (MS) used to identify OP protein biomarkers. We identified general and specific research reports related to OP insecticides, OP toxicity, OP structure, and protein MS by searching PubMed and Chemical Abstracts for articles published before December 2008. A number of OP-based insecticides share common structural elements that result in predictable OP-protein adducts. The resultant OP-protein adducts show an increase in molecular mass that can be identified by MS and correlated with the OP agent. Customized OP-containing probes have also been used to tag and identify protein targets that can be identified by MS. MS is a useful and emerging tool for the identification of proteins that are modified by activated organophosphate insecticides. MS can characterize the structure of the OP adduct and also the specific amino acid residue that forms the key bond with the OP. Each protein that is modified in a unique way by an OP represents a unique molecular biomarker that with further research can lead to new correlations with exposure.

Mass Spectrometric Analyses of Organophosphate Insecticide Oxon Protein Adducts

PubMed Central

Thompson, Charles M.; Prins, John M.; George, Kathleen M.

2010-01-01

Objective Organophosphate (OP) insecticides continue to be used to control insect pests. Acute and chronic exposures to OP insecticides have been documented to cause adverse health effects, but few OP-adducted proteins have been correlated with these illnesses at the molecular level. Our aim was to review the literature covering the current state of the art in mass spectrometry (MS) used to identify OP protein biomarkers. Data sources and extraction We identified general and specific research reports related to OP insecticides, OP toxicity, OP structure, and protein MS by searching PubMed and Chemical Abstracts for articles published before December 2008. Data synthesis A number of OP-based insecticides share common structural elements that result in predictable OP–protein adducts. The resultant OP–protein adducts show an increase in molecular mass that can be identified by MS and correlated with the OP agent. Customized OP-containing probes have also been used to tag and identify protein targets that can be identified by MS. Conclusions MS is a useful and emerging tool for the identification of proteins that are modified by activated organophosphate insecticides. MS can characterize the structure of the OP adduct and also the specific amino acid residue that forms the key bond with the OP. Each protein that is modified in a unique way by an OP represents a unique molecular biomarker that with further research can lead to new correlations with exposure. PMID:20056576

Investigating a tuberculosis cluster among Filipino health care workers in a low-incidence country.

PubMed

Davidson, J A; Fulton, N; Thomas, H L; Lalor, M K; Zenner, D; Brown, T; Murphy, S; Anderson, L F

2018-03-01

Nearly 8% of adult tuberculosis (TB) cases in England, Wales and Northern Ireland (EW&NI) occur among health care workers (HCWs), the majority of whom are from high TB incidence countries. To determine if a TB cluster containing multiple HCWs was due to nosocomial transmission. A cluster of TB cases notified in EW&NI from 2009 to 2014, with indistinguishable 24-locus mycobacterial interspersed repetitive unit-variable number of tandem repeats (MIRU-VNTR) profiles, was identified through routine national cluster review. Cases were investigated to identify epidemiological links, and occupational health (OH) information was collected for HCW cases. To further discriminate strains, typing of eight additional loci was conducted. Of the 53 cases identified, 22 were HCWs. The majority (n = 43), including 21 HCWs, were born in the Philippines. Additional typing split the cluster into three subclusters and seven unique strains. No epidemiological links were identified beyond one household and a common residential area. HCWs in this cluster received no or inadequate OH assessment. The MIRU-VNTR profile of this cluster probably reflects common endemic strains circulating in the Philippines, with reactivation occurring in the UK. Furthermore, 32-locus typing showed that 24-locus MIRU-VNTR failed to distinguish strain diversity. The lack of OH assessment indicates that latent tuberculous infection could have been identified and treated, thereby preventing active cases from occurring.

Adaptation and translation of mental health interventions in Middle Eastern Arab countries: a systematic review of barriers to and strategies for effective treatment implementation.

PubMed

Gearing, Robin E; Schwalbe, Craig S; MacKenzie, Michael J; Brewer, Kathryne B; Ibrahim, Rawan W; Olimat, Hmoud S; Al-Makhamreh, Sahar S; Mian, Irfan; Al-Krenawi, Alean

2013-11-01

All too often, efficacious psychosocial evidence-based interventions fail when adapted from one culture to another. International translation requires a deep understanding of the local culture, nuanced differences within a culture, established service practices, and knowledge of obstacles and promoters to treatment implementation. This research investigated the following objectives to better facilitate cultural adaptation and translation of psychosocial and mental health treatments in Arab countries: (1) identify barriers or obstacles; (2) identify promoting strategies; and (3) provide clinical and research recommendations. This systematic review of 22 psychosocial or mental health studies in Middle East Arab countries identified more barriers (68%) than promoters (32%) to effective translation and adaptation of empirically supported psychosocial interventions. Identified barriers include obstacles related to acceptability of the intervention within the cultural context, community and system difficulties, and problems with clinical engagement processes. Whereas identified promoter strategies centre on the importance of partnering and working within the local and cultural context, the need to engage with acceptable and traditional intervention characteristics, and the development of culturally appropriate treatment strategies and techniques. Although Arab cultures across the Middle East are unique, this article provides a series of core clinical and research recommendations to assist effective treatment adaptation and translation within Arab communities in the Middle East.

A survey of health-related activities on second life.

PubMed

Beard, Leslie; Wilson, Kumanan; Morra, Dante; Keelan, Jennifer

2009-05-22

Increasingly, governments, health care agencies, companies, and private groups have chosen Second Life as part of their Web 2.0 communication strategies. Second Life offers unique design features for disseminating health information, training health professionals, and enabling patient education for both academic and commercial health behavior research. This study aimed to survey and categorize the range of health-related activities on Second Life; to examine the design attributes of the most innovative and popular sites; and to assess the potential utility of Second Life for the dissemination of health information and for health behavior change. We used three separate search strategies to identify health-related sites on Second Life. The first used the application's search engine, entering both generic and select illness-specific keywords, to seek out sites. The second identified sites through a comprehensive review of print, blog, and media sources discussing health activities on Second Life. We then visited each site and used a snowball method to identify other health sites until we reached saturation (no new health sites were identified). The content, user experience, and chief purpose of each site were tabulated as well as basic site information, including user traffic data and site size. We found a wide range of health-related activities on Second Life, and a diverse group of users, including organizations, groups, and individuals. For many users, Second Life activities are a part of their Web 2.0 communication strategy. The most common type of health-related site in our sample (n = 68) were those whose principle aim was patient education or to increase awareness about health issues. The second most common type of site were support sites, followed by training sites, and marketing sites. Finally, a few sites were purpose-built to conduct research in SL or to recruit participants for real-life research. Studies show that behaviors from virtual worlds can translate to the real world. Our survey suggests that users are engaged in a range of health-related activities in Second Life which are potentially impacting real-life behaviors. Further research evaluating the impact of health-related activities on Second Life is warranted.

A Survey of Health-Related Activities on Second Life

PubMed Central

Beard, Leslie; Wilson, Kumanan; Morra, Dante

2009-01-01

Background Increasingly, governments, health care agencies, companies, and private groups have chosen Second Life as part of their Web 2.0 communication strategies. Second Life offers unique design features for disseminating health information, training health professionals, and enabling patient education for both academic and commercial health behavior research. Objectives This study aimed to survey and categorize the range of health-related activities on Second Life; to examine the design attributes of the most innovative and popular sites; and to assess the potential utility of Second Life for the dissemination of health information and for health behavior change. Methods We used three separate search strategies to identify health-related sites on Second Life. The first used the application’s search engine, entering both generic and select illness-specific keywords, to seek out sites. The second identified sites through a comprehensive review of print, blog, and media sources discussing health activities on Second Life. We then visited each site and used a snowball method to identify other health sites until we reached saturation (no new health sites were identified). The content, user experience, and chief purpose of each site were tabulated as well as basic site information, including user traffic data and site size. Results We found a wide range of health-related activities on Second Life, and a diverse group of users, including organizations, groups, and individuals. For many users, Second Life activities are a part of their Web 2.0 communication strategy. The most common type of health-related site in our sample (n = 68) were those whose principle aim was patient education or to increase awareness about health issues. The second most common type of site were support sites, followed by training sites, and marketing sites. Finally, a few sites were purpose-built to conduct research in SL or to recruit participants for real-life research. Conclusions Studies show that behaviors from virtual worlds can translate to the real world. Our survey suggests that users are engaged in a range of health-related activities in Second Life which are potentially impacting real-life behaviors. Further research evaluating the impact of health-related activities on Second Life is warranted. PMID:19632971

NHash: Randomized N-Gram Hashing for Distributed Generation of Validatable Unique Study Identifiers in Multicenter Research

PubMed Central

Zhang, Guo-Qiang; Tao, Shiqiang; Xing, Guangming; Mozes, Jeno; Zonjy, Bilal; Lhatoo, Samden D

2015-01-01

Background A unique study identifier serves as a key for linking research data about a study subject without revealing protected health information in the identifier. While sufficient for single-site and limited-scale studies, the use of common unique study identifiers has several drawbacks for large multicenter studies, where thousands of research participants may be recruited from multiple sites. An important property of study identifiers is error tolerance (or validatable), in that inadvertent editing mistakes during their transmission and use will most likely result in invalid study identifiers. Objective This paper introduces a novel method called "Randomized N-gram Hashing (NHash)," for generating unique study identifiers in a distributed and validatable fashion, in multicenter research. NHash has a unique set of properties: (1) it is a pseudonym serving the purpose of linking research data about a study participant for research purposes; (2) it can be generated automatically in a completely distributed fashion with virtually no risk for identifier collision; (3) it incorporates a set of cryptographic hash functions based on N-grams, with a combination of additional encryption techniques such as a shift cipher; (d) it is validatable (error tolerant) in the sense that inadvertent edit errors will mostly result in invalid identifiers. Methods NHash consists of 2 phases. First, an intermediate string using randomized N-gram hashing is generated. This string consists of a collection of N-gram hashes f 1, f 2, ..., f k. The input for each function f i has 3 components: a random number r, an integer n, and input data m. The result, f i(r, n, m), is an n-gram of m with a starting position s, which is computed as (r mod |m|), where |m| represents the length of m. The output for Step 1 is the concatenation of the sequence f 1(r 1, n 1, m 1), f 2(r 2, n 2, m 2), ..., f k(r k, n k, m k). In the second phase, the intermediate string generated in Phase 1 is encrypted using techniques such as shift cipher. The result of the encryption, concatenated with the random number r, is the final NHash study identifier. Results We performed experiments using a large synthesized dataset comparing NHash with random strings, and demonstrated neglegible probability for collision. We implemented NHash for the Center for SUDEP Research (CSR), a National Institute for Neurological Disorders and Stroke-funded Center Without Walls for Collaborative Research in the Epilepsies. This multicenter collaboration involves 14 institutions across the United States and Europe, bringing together extensive and diverse expertise to understand sudden unexpected death in epilepsy patients (SUDEP). Conclusions The CSR Data Repository has successfully used NHash to link deidentified multimodal clinical data collected in participating CSR institutions, meeting all desired objectives of NHash. PMID:26554419

A Scoping Study on the Ethics of Health Systems Research.

PubMed

Bachani, Abdulgafoor M; Rattani, Abbas; Hyder, Adnan A

2016-12-01

Currently, health systems research (HSR) is reviewed by the same ethical standards as clinical research, which has recently been argued in the literature to be an inappropriate standard of evaluation. The issues unique to HSR warrant a different review by research ethics committees (RECs), as it does not impose the same risks to study participants as other types of clinical or public health research. However, there are limited tools and supporting documents that clarify the ethical considerations. Therefore, there is a need for additional reflection around ethical review of HSR and their consideration by RECs. The purpose of this paper is to review, understand, and synthesize the current state of literature and practice to inform these deliberations and the larger discourse on ethics review guidelines for HSR. This paper presents a review of the literature on ethics of HSR in the biomedical, public health, and implementation research to identify ethical considerations specific to HSR; and to identify examples of commonly available guidance and/or tools for the ethical review of HSR studies. Fifteen articles were identified on HSR ethics issues, and forty-two international academic institutions were contacted (of the responses (n=29), no institution had special ethical guidelines for reviewing HSR) about their HSR ethics review guidelines. There appears to be a clear gap in the current health research ethics discourse around health systems research ethics. This review serves as a first step (to better understand the current status) towards a larger dialogue on the topic. © 2016 John Wiley & Sons Ltd.

Teaching community diagnosis to medical students: evaluation of a case study approach.

PubMed

Bair, C W

1980-01-01

A unique case study approach to training medical students in community diagnosis techniques was initiated at the Medical College of Ohio at Toledo. This paper describes the five elements of this teaching method: preliminary specification of target community and data base; group problem-solving requirement; specification of desired output; defined performance objectives; and regularly scheduled time for analysis. Experience with the case study method over two years was evaluated to identify specific strengths and weaknesses. The identified strengths include use of limited educational time to introduce community health problems, development of experience in a collegial team work setting, and specific awareness of the types of data useful to the analysis of community health service problems. Negative evaluations suggested that the method was not conducive to the development of skills in three areas: ability to establish the relative importance of health problems in communities; ability to identify an appropriate health system response to a community health problem from feasible alternatives; and ability to anticipate the community impact of health program modifications or improvements. Potential explanations for these deficiencies include: need for increased didactic support in the classroom for particular skill areas; need to establish a direct field experience in community diagnosis; inappropriateness of the data base used for evaluation of particular skills; and the probability that quantitative analysis, as used in this evaluation, may not be sufficient in and of itself to measure the outcome of a community diagnosis experience.

Executive skills 21: a forecast of leadership skills and associated competencies required by naval hospital administrators into the 21st century.

PubMed

Sentell, J W; Finstuen, K

1998-01-01

Those in the Naval Medical Department are experiencing an exciting time of bridled chaos and creative change. Many mid-career officers are uncertain of the leadership behaviors and skills that will be necessary for successful managerial careers. Changes in the method of health care delivery of this nation combined with the reengineering of the armed forces' world-wide mission has driven military medical leaders to expand their professional skills, knowledge, and abilities beyond the clinical sciences. This research identifies the most critical domains in the science of health care administration and differentiates and ranks job skill, knowledge, and ability requirements that will be necessary for successful health care management into the 21st century. Top Naval hospital executives responded to two iterations of a Delphi inquiry. These medical leaders identified 106 unique issues that were content-analyzed into nine domains by a neutral, expert panel. Domains, in order of ranked importance, were leadership, health care delivery systems, cost-finance, technology, accessibility, professional staff relations, marketing, quality-risk management, and ethics. In the second Delphi iteration, hospital executives reviewed domain results and rated identified job requirements on their required job importance. The top-10 rated skills, knowledge, and abilities are reported. Results indicated that although a business orientation is needed for organizational survival, an emphasis on person-oriented skills, knowledge, and abilities is required for future success as a health care administrator in the Naval health care system.

Program Characteristics and Enrollees' Outcomes in the Program of All-Inclusive Care for the Elderly (PACE)

PubMed Central

Mukamel, Dana B; Peterson, Derick R; Temkin-Greener, Helena; Delavan, Rachel; Gross, Diane; Kunitz, Stephen J; Williams, T Franklin

2007-01-01

The Program of All-Inclusive Care for the Elderly (PACE) is a unique program providing a full spectrum of health care services, from primary to acute to long-term care for frail elderly individuals certified to require nursing home care. The objective of this article is to identify program characteristics associated with better risk-adjusted health outcomes: mortality, functional status, and self-assessed health. The article examines statistical analyses of information combining DataPACE (individual-level clinical data), a survey of direct care staff about team performance, and interviews with management in twenty-three PACE programs. Several program characteristics were associated with better functional outcomes. Fewer were associated with long-term self-assessed health, and only one with mortality. These findings offer strategies that may lead to better care. PMID:17718666

Desired mental health resources for urban, ethnically diverse, impoverished women struggling with anxiety and depression.

PubMed

Doornbos, Mary Molewyk; Zandee, Gail Landheer; DeGroot, Joleen; Warpinski, Mary

2013-01-01

Depression and anxiety are mental health issues that disproportionately affect women-particularly when access to culturally sensitive care is limited. The purpose of this study was to identify mental health concerns in three urban, ethnically diverse, underserved, and impoverished neighborhoods using the ideological perspective of community-based participatory research. In the context of long-term partnerships between a department of nursing and these neighborhoods, we recruited 61 women aged 18 to 69 years and collected data via homogeneous focus groups comprised of Black, Hispanic, and White women, respectively. We conducted five of the focus groups in English and one in Spanish. The women perceived anxiety and depression as significant concerns for themselves, their families, and their communities. They used unique community resources to manage mental health issues and desired new resources, including support groups and education.

National health surveillance of adults with disabilities, adults with intellectual and developmental disabilities, and adults with no disabilities.

PubMed

Havercamp, Susan M; Scott, Haleigh M

2015-04-01

People with disabilities experience worse health and poorer access to health care compared to people without disability. Large-scale health surveillance efforts have largely excluded adults with intellectual and developmental disability. This study expands knowledge of health status, health risks and preventative health care in a representative US sample comparing the health of adults with no disability to adults with intellectual and developmental disability and to adults with other types of disability. The purposes of this study were (1) to identify disparities between adults with intellectual and developmental disability and adults with no disability and (2) compare this pattern of disparities to the pattern between adults with other types of disability and adults without disability. This study compares health status, health risks and preventative health care in a national sample across three groups of adults: No Disability, Disability, and Intellectual and Developmental Disability. Data sources were the 2010 Behavior Risk Factor Surveillance Survey and the National Core Indicators Consumer Survey. Adults with disability and with intellectual and developmental disability were more likely to report being in poor health compared to adults without disability. Disability and intellectual and developmental disability conferred unique health risks and health care utilization patterns. Significant disparities in health and health care utilization were found for adults with disability and developmental disability relative to adults without disability. Disability training for health care providers and health promotion research that identifies disability as a demographic group is needed. Copyright © 2015 Elsevier Inc. All rights reserved.

Identifying state resources and support programs on e-government websites for persons with intellectual and developmental disabilities.

PubMed

Fisher, Kathleen M; Peterson, Justin D; Albert, Jon D

2015-01-01

This descriptive cross-sectional study identified resources and programs that are available nationwide on the Internet to support individuals and families with intellectual and developmental disabilities (I/DD), with a focus on intellectual disability. This evaluation included easily identifiable information on specific resources and highlighted unique programs found in individual states that were linked from e-government websites. Researchers documented the ease of access and available information for all 50 states and the District of Columbia. A number of disparities and areas for improvement were recorded for states and I/DD websites. The researchers conclude that a number of additional health and support services will be needed to address the growing needs of this vulnerable population.

Technology-enabled examinations of cardiac rhythm, optic nerve, oral health, tympanic membrane, gait and coordination evaluated jointly with routine health screenings: an observational study at the 2015 Kumbh Mela in India

PubMed Central

Gupta, Otkrist; Patalano II, Vincent; Mohit, Mrinal; Merchant, Rikin; Subramanian, S V

2018-01-01

Objectives Technology-enabled non-invasive diagnostic screening (TES) using smartphones and other point-of-care medical devices was evaluated in conjunction with conventional routine health screenings for the primary care screening of patients. Design Dental conditions, cardiac ECG arrhythmias, tympanic membrane disorders, blood oxygenation levels, optic nerve disorders and neurological fitness were evaluated using FDA-approved advanced smartphone powered technologies. Routine health screenings were also conducted. A novel remote web platform was developed to allow expert physicians to examine TES data and compare efficacy with routine health screenings. Setting The study was conducted at a primary care centre during the 2015 Kumbh Mela in Maharashtra, India. Participants 494 consenting 18–90 years old adults attending the 2015 Kumbh Mela were tested. Results TES and routine health screenings identified unique clinical conditions in distinct patients. Intraoral fluorescent imaging classified 63.3% of the population with dental caries and periodontal diseases. An association between poor oral health and cardiovascular illnesses was also identified. Tympanic membrane imaging detected eardrum abnormalities in 13.0% of the population, several with a medical history of hearing difficulties. Gait and coordination issues were discovered in eight subjects and one subject had arrhythmia. Cross-correlations were observed between low oxygen saturation and low body mass index (BMI) with smokers (p=0.0087 and p=0.0122, respectively), and high BMI was associated with elevated blood pressure in middle-aged subjects. Conclusions TES synergistically identified clinically significant abnormalities in several subjects who otherwise presented as normal in routine health screenings. Physicians validated TES findings and used routine health screening data and medical history responses for comprehensive diagnoses for at-risk patients. TES identified high prevalence of oral diseases, hypertension, obesity and ophthalmic conditions among the middle-aged and elderly Indian population, calling for public health interventions. PMID:29678964

Integrated Healthcare Delivery: A Qualitative Research Approach to Identifying and Harmonizing Perspectives of Integrated Neglected Tropical Disease Programs

PubMed Central

Jacobson, Julie; Mosher, Aryc W.; Walson, Judd L.

2016-01-01

Background While some evidence supports the beneficial effects of integrating neglected tropical disease (NTD) programs to optimize coverage and reduce costs, there is minimal information regarding when or how to effectively operationalize program integration. The lack of systematic analyses of integration experiences and of integration processes may act as an impediment to achieving more effective NTD programming. We aimed to learn about the experiences of NTD stakeholders and their perceptions of integration. Methodology We evaluated differences in the definitions, roles, perceived effectiveness, and implementation experiences of integrated NTD programs among a variety of NTD stakeholder groups, including multilateral organizations, funding partners, implementation partners, national Ministry of Health (MOH) teams, district MOH teams, volunteer rural health workers, and community members participating in NTD campaigns. Semi-structured key informant interviews were conducted. Coding of themes involved a mix of applying in-vivo open coding and a priori thematic coding from a start list. Findings In total, 41 interviews were conducted. Salient themes varied by stakeholder, however dominant themes on integration included: significant variations in definitions, differential effectiveness of specific integrated NTD activities, community member perceptions of NTD programs, the influence of funders, perceived facilitators, perceived barriers, and the effects of integration on health system strength. In general, stakeholder groups provided unique perspectives, rather than contrarian points of view, on the same topics. The stakeholders identified more advantages to integration than disadvantages, however there are a number of both unique facilitators and challenges to integration from the perspective of each stakeholder group. Conclusions Qualitative data suggest several structural, process, and technical opportunities that could be addressed to promote more effective and efficient integrated NTD elimination programs. We highlight a set of ten recommendations that may address stakeholder concerns and perceptions regarding these key opportunities. For example, public health stakeholders should embrace a broader perspective of community-based health needs, including and beyond NTDs, and available platforms for addressing those needs. PMID:27776127

Proteomic analysis of corneal endothelial cell-descemet membrane tissues reveals influence of insulin dependence and disease severity in type 2 diabetes mellitus.

PubMed

Skeie, Jessica M; Aldrich, Benjamin T; Goldstein, Andrew S; Schmidt, Gregory A; Reed, Cynthia R; Greiner, Mark A

2018-01-01

The objective of this study was to characterize the proteome of the corneal endothelial cell layer and its basement membrane (Descemet membrane) in humans with various severities of type II diabetes mellitus compared to controls, and identify differentially expressed proteins across a range of diabetic disease severities that may influence corneal endothelial cell health. Endothelium-Descemet membrane complex tissues were peeled from transplant suitable donor corneas. Protein fractions were isolated from each sample and subjected to multidimensional liquid chromatography and tandem mass spectrometry. Peptide spectra were matched to the human proteome, assigned gene ontology, and grouped into protein signaling pathways unique to each of the disease states. We identified an average of 12,472 unique proteins in each of the endothelium-Descemet membrane complex tissue samples. There were 2,409 differentially expressed protein isoforms that included previously known risk factors for type II diabetes mellitus related to metabolic processes, oxidative stress, and inflammation. Gene ontology analysis demonstrated that diabetes progression has many protein footprints related to metabolic processes, binding, and catalysis. The most represented pathways involved in diabetes progression included mitochondrial dysfunction, cell-cell junction structure, and protein synthesis regulation. This proteomic dataset identifies novel corneal endothelial cell and Descemet membrane protein expression in various stages of diabetic disease. These findings give insight into the mechanisms involved in diabetes progression relevant to the corneal endothelium and its basement membrane, prioritize new pathways for therapeutic targeting, and provide insight into potential biomarkers for determining the health of this tissue.

Cafeteria factors that influence milk-drinking behaviors of elementary school children: grounded theory approach.

PubMed

Connors, P; Bednar, C; Klammer, S

2001-01-01

This study was conducted to identify factors that influenced milk-drinking behaviors of elementary school children in North Texas. Ten focus groups with a total of 41 children aged 6 to 11 years were conducted using a grounded theory approach. Based on the principles of Social Learning Theory, milk preferences and health beliefs were identified as personal factors that influenced drinking. Cafeteria rules, milk flavor, product packaging, modeling by adults, and shared experiences were environmental factors. The data suggest that school cafeterias can capitalize on their unique position to offer milk-drinking opportunities that children can share to combine nutrition education with sensory experience.

The relationship between trajectories of family/cultural stressors and depression and suicidal ideation among substance using Mexican-American adults.

PubMed

Saint Onge, Jarron M; Cepeda, Alice; Lee King, Patricia A; Valdez, Avelardo

2013-12-01

We used an intersectional minority stress perspective to examine the association between family/cultural stress and mental health among substance-using Mexican-Americans. Employing a unique longitudinal sample of 239 socioeconomically disadvantaged, non-injecting heroin-using Mexican-Americans from San Antonio, Texas, we examined how culturally relevant stressors are related to depression and suicidal ideation. First, we identified depression and suicidal ideation prevalence rates for this disadvantaged sample. Second, we determined how cultural stress is experienced over time using stress trajectories. Third, we evaluated how family/cultural stressors and stress trajectories are related to depression and suicidal ideation outcomes. Results showed high rates of baseline depression (24 %) and suicidal ideation (30 %). We used latent class growth analysis to identify three primary stress trajectories (stable, high but decreasing, and increasing) over three time points during 1 year. We found that the increasing stressors trajectory was associated with higher rates of depression and suicidal ideation, and that stress trajectories had unique relationships with mental illness. We also showed that baseline stressors, sum stressors, and high but decreasing stressors maintained positive associations with mental illness after controlling for baseline depression. Our results highlight the importance of focusing on within-group, culturally specific stressors and addressing both operant and cumulative stressors in the study of mental health for marginalized populations and suggest the importance of early intervention in minimizing stressors.

Accessibility, nature and quality of health information on the Internet: a survey on osteoarthritis.

PubMed

Maloney, S; Ilic, D; Green, S

2005-03-01

This study aims to determine the quality and validity of information available on the Internet about osteoarthritis and to investigate the best way of sourcing this information. Keywords relevant to osteoarthritis were searched across 15 search engines representing medical, general and meta-search engines. Search engine efficiency was defined as the percentage of unique and relevant websites from all websites returned by each search engine. The quality of relevant information was appraised using the DISCERN tool and the concordance of the information offered by the website with the available evidence about osteoarthritis determined. A total of 3443 websites were retrieved, of which 344 were identified as unique and providing information relevant to osteoarthritis. The overall quality of website information was poor. There was no significant difference between types of search engine in sourcing relevant information; however, the information retrieved from medical search engines was of a higher quality. Fewer than a third of the websites identified as offering relevant information cited evidence to support their recommendations. Although the overall quality of website information about osteoarthritis was poor, medical search engines may provide consumers with the opportunity to source high-quality health information on the Internet. In the era of evidence-based medicine, one of the main obstacles to the Internet reaching its potential as a medical resource is the failure of websites to incorporate and attribute evidence-based information.

A Qualitative Evaluation of Elev8 New Mexico School-Based Health Centers.

PubMed

Soto Mas, Francisco; Sussman, Andrew L

There is a scarcity of qualitative studies on school-based health centers (SBHCs). We established two primary aims for this study: (a) to assess stakeholders' perceptions of Elev8 New Mexico SBHCs' functionality and (b) to provide a snapshot of the overall contribution of the program to the schools and communities they serve. We collected the data through observations and semistructured interviews. We identified issues that diminish the functionality of SBHCs, such as limited infrastructure and services, lack of cooperation between school personnel and health care providers, and lack of long-term financial sustainability. These structural, interpersonal, and logistical issues limited the contribution of the SBHCs to the health of the students and the community at large. However, Elev8 New Mexico SBHCs serve communities with considerable education and health needs and constitute a unique opportunity to provide health education, disease prevention, and quality health care to a large number of youth and adults. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Introduction to Reproduction: Online Education for the Millennial Learner.

PubMed

Castle, Megan; Kick, Laura; Haseley, Heather; Wallach, Harlan; Woodruff, Teresa K

2016-07-01

Despite staggering rates of sexually transmitted infections and unplanned pregnancies, reproductive health education is not yet standardized across secondary or postsecondary curricula. The Women's Health Research Institute and Northwestern University Information Technology created Introduction to Reproduction, a massive open online course to encourage global students to learn the biological foundations of reproductive health. This digital education experience appeals to the Millennial learner and offers unique opportunities to explore topics in reproductive biology via lectures, animations, and three-dimensional anatomical illustrations. Data were collected anonymously from de-identified learners who elected to self-report on their experiences while completing the course as well as through Coursera datasets. Northwestern University's Institutional Review Board classified this research project as an exempt status due to the de-identified nature of the collected data. Participants from 47 countries report on reproductive health content knowledge, past reproductive health education, and level of engagement with the topic. These data indicate that the Introduction to Reproduction course has a meaningful impact on its participants and presents the information in a concise and accessible format. Distribution of this course to a wider audience is the goal for the program and important to the field of reproductive health. © 2016 by the Society for the Study of Reproduction, Inc.

Geriatric Education in the Health Professions: Are We Making Progress?

PubMed Central

Bardach, Shoshana H.; Rowles, Graham D.

2012-01-01

Purpose: Relative to the overall population, older adults consume a disproportionally large percentage of health care resources. Despite advocacy and efforts initiated more than 30 years ago, the number of providers with specialized training in geriatrics is still not commensurate with the growing population of older adults. This contribution provides a contemporary update on the status of geriatric education and explores how geriatric coverage is valued, how geriatric competence is defined, and how students are evaluated for geriatric competencies. Design and Methods: Semi-structured interviews were conducted with curriculum representatives from 7 health profession disciplines in a case study of one academic medical center. Findings: Geriatric training varies across health professions’ disciplines. Although participants recognized the unique needs of older patients and valued geriatric coverage, they identified shortage of time in packed curricula, lack of geriatrics-trained educators, absence of financial incentive, and low student demand (resulting from limited exposure to older adults and gerontological stereotyping) as barriers to improving geriatric training. Implications: Progress in including geriatric training within curricula across the health professions continues to lag behind need as a result of the continuing presence of barriers identified several decades ago. There remains an urgent need for institutional commitment to enhance geriatric education as a component of health professions curricula. PMID:22394495

Estimating community health needs against a Triple Aim background: What can we learn from current predictive risk models?

PubMed

Elissen, Arianne M J; Struijs, Jeroen N; Baan, Caroline A; Ruwaard, Dirk

2015-05-01

To support providers and commissioners in accurately assessing their local populations' health needs, this study produces an overview of Dutch predictive risk models for health care, focusing specifically on the type, combination and relevance of included determinants for achieving the Triple Aim (improved health, better care experience, and lower costs). We conducted a mixed-methods study combining document analyses, interviews and a Delphi study. Predictive risk models were identified based on a web search and expert input. Participating in the study were Dutch experts in predictive risk modelling (interviews; n=11) and experts in healthcare delivery, insurance and/or funding methodology (Delphi panel; n=15). Ten predictive risk models were analysed, comprising 17 unique determinants. Twelve were considered relevant by experts for estimating community health needs. Although some compositional similarities were identified between models, the combination and operationalisation of determinants varied considerably. Existing predictive risk models provide a good starting point, but optimally balancing resources and targeting interventions on the community level will likely require a more holistic approach to health needs assessment. Development of additional determinants, such as measures of people's lifestyle and social network, may require policies pushing the integration of routine data from different (healthcare) sources. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Late Life Depression Detection: An Evidence-Based Guideline

PubMed Central

Smith, Marianne; Haedtke, Christine; Shibley, Deborah

2015-01-01

The disability associated with late life depression makes it an important target for screening. Identifying clinically significant depression symptoms in older adults who have known risk factors provides an important opportunity for early evaluation and treatment. Screening that leads to evaluation and treatment is critical to both preventing depression, and reducing the associated disability, symptom burden, and costs of major depressive disorders (MDD). The guideline described here recommends the 9-item Patient Health Questionnaire (PHQ-9) for screening because it is based on diagnostic criteria for MDD and has the advantages of being brief, self-administered, easily scored and interpreted, and reliable and valid in diverse populations and care settings. Nurses and allied health professionals who provide care to older adults across the continuum of care are uniquely positioned to identify at risk older adults, use depression screening scales, make needed referrals for evaluation and treatment, and monitor outcomes across time. PMID:25633861

Zero-Inflated Poisson Modeling of Fall Risk Factors in Community-Dwelling Older Adults.

PubMed

Jung, Dukyoo; Kang, Younhee; Kim, Mi Young; Ma, Rye-Won; Bhandari, Pratibha

2016-02-01

The aim of this study was to identify risk factors for falls among community-dwelling older adults. The study used a cross-sectional descriptive design. Self-report questionnaires were used to collect data from 658 community-dwelling older adults and were analyzed using logistic and zero-inflated Poisson (ZIP) regression. Perceived health status was a significant factor in the count model, and fall efficacy emerged as a significant predictor in the logistic models. The findings suggest that fall efficacy is important for predicting not only faller and nonfaller status but also fall counts in older adults who may or may not have experienced a previous fall. The fall predictors identified in this study--perceived health status and fall efficacy--indicate the need for fall-prevention programs tailored to address both the physical and psychological issues unique to older adults. © The Author(s) 2014.

Resistome diversity in cattle and the environment decreases during beef production.

PubMed

Noyes, Noelle R; Yang, Xiang; Linke, Lyndsey M; Magnuson, Roberta J; Dettenwanger, Adam; Cook, Shaun; Geornaras, Ifigenia; Woerner, Dale E; Gow, Sheryl P; McAllister, Tim A; Yang, Hua; Ruiz, Jaime; Jones, Kenneth L; Boucher, Christina A; Morley, Paul S; Belk, Keith E

2016-03-08

Antimicrobial resistant determinants (ARDs) can be transmitted from livestock systems through meat products or environmental effluents. The public health risk posed by these two routes is not well understood, particularly in non-pathogenic bacteria. We collected pooled samples from 8 groups of 1741 commercial cattle as they moved through the process of beef production from feedlot entry through slaughter. We recorded antimicrobial drug exposures and interrogated the resistome at points in production when management procedures could potentially influence ARD abundance and/or transmission. Over 300 unique ARDs were identified. Resistome diversity decreased while cattle were in the feedlot, indicating selective pressure. ARDs were not identified in beef products, suggesting that slaughter interventions may reduce the risk of transmission of ARDs to beef consumers. This report highlights the utility and limitations of metagenomics for assessing public health risks regarding antimicrobial resistance, and demonstrates that environmental pathways may represent a greater risk than the food supply.

Gender differences in computer-mediated communication: a systematic literature review of online health-related support groups.

PubMed

Mo, Phoenix K H; Malik, Sumaira H; Coulson, Neil S

2009-04-01

Previous research has contended that the unique characteristics of the Internet might remove some of the gender differences that exist in face-to-face healthcare. The aims of the present study were to systematically review studies that have examined gender differences in communication within online health communities. A literature search was conducted to identify studies addressing gender differences in messages posted to online health-related support groups. Out of the 1186 articles identified, twelve were retrieved for review. Half of the studies examined gender differences by comparing male and female cancer discussion boards. The literature review revealed that some gender differences were observed in these studies. However, for studies that analysed mixed-gender communities, gender differences were less evident. Results seemed to reveal gender differences in communications in single-sex online health support groups, and similarities in communication patterns in mixed-sex online health support groups. However, findings should be treated with caution due to the diversity in studies and methodological issues highlighted in the present review. There is a need for health care professionals to take into account a range of situational and contextual factors that may affect how men and women use online health support groups. However, more robust research is needed before concrete guidelines can be developed to help health care professionals develop effective online support interventions.

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

PubMed Central

Smylie, Janet; Firestone, Michelle

2015-01-01

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

Quality of life in adolescent and young adult cancer patients: a systematic review of the literature

PubMed Central

Quinn, Gwendolyn P; Gonçalves, Vânia; Sehovic, Ivana; Bowman, Meghan L; Reed, Damon R

2015-01-01

Introduction Adolescent and young adult (AYA) cancer survivors experience many unique challenges and quality of life (QoL) effects that persist beyond cancer diagnosis and treatment. Due to continuous improvements in technology and cancer treatments resulting in improved survival rates, the identification of late effects, survivorship issues, and QoL is moving to the forefront of cancer research. The goal of this systematic review was to identify key psychosocial factors impacting QoL in AYA oncology populations. Methods A systematic review of the literature was conducted using combinations of these phrases or keywords: “adolescent and young adult or AYA” AND “health outcomes OR quality of life OR psychology” AND “neoplasm OR cancer OR oncology”. A total of 35 articles were included in this review. Studies were classified into two categories: AYA perceptions and stakeholder perceptions. Results AYA cancer survivors were more likely to have “worse” or impaired QoL compared with the general population, regardless of other demographic factors. AYAs described both positive and negatives experiences with their medical care, the educational information received, and the supportive care services. Although health care professionals were likely to underestimate or misjudge the health preferences and support needs of AYAs, these perceptions varied across disciplines and levels of experience. Conclusion The literature is lacking in sufficient evidence-based interventions to improve QoL in AYA cancer populations. Further, the tools to adequately measure QoL in this population are also unsatisfactory. The literature, however, consistently shows agreement regarding the unique needs of this population, indicating a trend toward health care standardization within age ranges or life stages. We suggest the need for AYA-specific programs in health care institutions that comprise a multidisciplinary team that addresses all the unique medical and QoL needs of AYAs. PMID:25733941

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A two-day consensus meeting was held on November 18-19, 2008 in Chicago, IL, United States of America, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock-production specialists, journal editors, assistant editors, and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines For Randomized Control Trials) statement for livestock and food safety (LFS) and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety by modifying the CONSORT statement.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J; Ward, M P; Wills, R

2010-03-01

The conduct of randomized controlled trials in livestock with production, health and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A 2-day consensus meeting was held on 18-19 November 2008 in Chicago, IL, USA, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock-production specialists, journal editors, assistant editors and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety and 22-item checklist. Fourteen items were modified from the CONSORT checklist and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health and food-safety outcomes.

The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety.

PubMed

O'Connor, A M; Sargeant, J M; Gardner, I A; Dickson, J S; Torrence, M E; Dewey, C E; Dohoo, I R; Evans, R B; Gray, J T; Greiner, M; Keefe, G; Lefebvre, S L; Morley, P S; Ramirez, A; Sischo, W; Smith, D R; Snedeker, K; Sofos, J N; Ward, M P; Wills, R

2010-01-01

The conduct of randomized controlled trials in livestock with production, health, and food-safety outcomes presents unique challenges that may not be adequately reported in trial reports. The objective of this project was to modify the CONSORT (Consolidated Standards of Reporting Trials) statement to reflect the unique aspects of reporting these livestock trials. A two-day consensus meeting was held on November 18-19, 2008 in Chicago, Ill, United States of America, to achieve the objective. Prior to the meeting, a Web-based survey was conducted to identify issues for discussion. The 24 attendees were biostatisticians, epidemiologists, food-safety researchers, livestock production specialists, journal editors, assistant editors, and associate editors. Prior to the meeting, the attendees completed a Web-based survey indicating which CONSORT statement items may need to be modified to address unique issues for livestock trials. The consensus meeting resulted in the production of the REFLECT (Reporting Guidelines for Randomized Control Trials) statement for livestock and food safety (LFS) and 22-item checklist. Fourteen items were modified from the CONSORT checklist, and an additional sub-item was proposed to address challenge trials. The REFLECT statement proposes new terminology, more consistent with common usage in livestock production, to describe study subjects. Evidence was not always available to support modification to or inclusion of an item. The use of the REFLECT statement, which addresses issues unique to livestock trials, should improve the quality of reporting and design for trials reporting production, health, and food-safety outcomes.

Measuring and improving patient safety through health information technology: The Health IT Safety Framework

PubMed Central

Singh, Hardeep

2016-01-01

Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns in three related domains: 1) concerns that are unique and specific to technology (e.g., to address unsafe health IT related to unavailable or malfunctioning hardware or software); 2) concerns created by the failure to use health IT appropriately or by misuse of health IT (e.g. to reduce nuisance alerts in the electronic health record (EHR)), and 3) the use of health IT to monitor risks, health care processes and outcomes and identify potential safety concerns before they can harm patients (e.g. use EHR-based algorithms to identify patients at risk for medication errors or care delays). The framework proposes to integrate both retrospective and prospective measurement of HIT safety with an organization's existing clinical risk management and safety programs. It aims to facilitate organizational learning, comprehensive 360 degree assessment of HIT safety that includes vendor involvement, refinement of measurement tools and strategies, and shared responsibility to identify problems and implement solutions. A long term framework goal is to enable rigorous measurement that helps achieve the safety benefits of health IT in real-world clinical settings. PMID:26369894

Half-century of Dental Public Health research: bibliometric analysis of world scientific trends.

PubMed

Celeste, Roger Keller; Broadbent, Jonathan M; Moyses, Samuel Jorge

2016-12-01

To describe the characteristics of Dental Public Health (DPH) scientific publications within core DPH journals over time and to compare DPH journals with DPH content from other journal types. The Scopus database was used to identify DPH-relevant articles published from 1965 to 2014 in three core DPH journals (DPHJs) and from 2005 to 2014 in Dental Journals (DJs), Public Health (PHJs) and General Journals (GJs). To identify DPH-relevant articles, a search strategy with words about oral health and public health was applied to each group of journals. Research themes were created by grouping similar keywords to report changes in the focus of articles over time. The most productive journals, countries, institutions and authors were also estimated for each set of journals. In 2005-2014, 60 297 articles were identified, of which 2.7% in DPHJs, 10.4% from PHJs, 38.2% from GJs and 48.7% from DJs. DPH-relevant articles published in the core DPHJs, DJs and PHJs tended to share a strong emphasis on dental caries, healthcare/services research on children and adolescents. Over time, the focus in the DPHJs has increased towards health behaviour/promotion/education, quality of life and socioeconomic factors. In the last decade, those themes were more frequent in DPH journals than in the other groups. DPH research published in DPHJs had some unique features and greater focus on the themes of quality of life, socioeconomic factors and health behaviour/education/promotion than other groups of journals. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Algorithm development and the clinical and economic burden of Cushing's disease in a large US health plan database.

PubMed

Burton, Tanya; Le Nestour, Elisabeth; Neary, Maureen; Ludlam, William H

2016-04-01

This study aimed to develop an algorithm to identify patients with CD, and quantify the clinical and economic burden that patients with CD face compared to CD-free controls. A retrospective cohort study of CD patients was conducted in a large US commercial health plan database between 1/1/2007 and 12/31/2011. A control group with no evidence of CD during the same time was matched 1:3 based on demographics. Comorbidity rates were compared using Poisson and health care costs were compared using robust variance estimation. A case-finding algorithm identified 877 CD patients, who were matched to 2631 CD-free controls. The age and sex distribution of the selected population matched the known epidemiology of CD. CD patients were found to have comorbidity rates that were two to five times higher and health care costs that were four to seven times higher than CD-free controls. An algorithm based on eight pituitary conditions and procedures appeared to identify CD patients in a claims database without a unique diagnosis code. Young CD patients had high rates of comorbidities that are more commonly observed in an older population (e.g., diabetes, hypertension, and cardiovascular disease). Observed health care costs were also high for CD patients compared to CD-free controls, but may have been even higher if the sample had included healthier controls with no health care use as well. Earlier diagnosis, improved surgery success rates, and better treatments may all help to reduce the chronic comorbidity and high health care costs associated with CD.

Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study

PubMed Central

Kohno, Ayako; Nik Farid, Nik Daliana; Musa, Ghazali; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

2016-01-01

Objective While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia. Design We conducted 6 focus group discussions with Japanese retirees and interviewed 8 relevant medical services providers in-depth. Guided by the Andersen Healthcare Utilisation Model, we managed and analysed the data, using QSR NVivo 10 software and the directed content analysis method. Setting We interviewed participants at Japan Clubs and their offices. Participants 30 Japanese retirees who live in Kuala Lumpur and Ipoh, and 8 medical services providers. Results We identified health beliefs, medical symptoms and health insurance as the 3 most important themes, respectively, representing the 3 dimensions within the Andersen Healthcare Utilisation Model. Additionally, language barriers, voluntary health repatriation to Japan and psychological support were unique themes that influence healthcare service utilisation among Japanese retirees. Conclusions The healthcare service utilisation among Japanese retirees in Malaysia could be partially explained by the Andersen Healthcare Utilisation Model, together with some factors that were unique findings to this study. Healthcare service utilisation among Japanese retirees in Malaysia could be improved by alleviating negative health beliefs through awareness programmes for Japanese retirees about the healthcare systems and cultural aspects of medical care in Malaysia. PMID:27006344

The utility of Twitter as a tool for increasing reach of research on sexual violence.

PubMed

Wekerle, Christine; Vakili, Negar; Stewart, Sherry H; Black, Tara

2018-05-16

Researchers in violence prevention areas seek to disseminate work for impact to practice and policy. Knowledge transfer, exchange, and mobilization are common terms for research knowledge utilization where public communication platforms are playing an increasing role, having unique capacity to connect stakeholders in advocacy and lived experience, academia, non-governmental organizations, government-supported organizations, such as child welfare, and research funding bodies. Social networking platforms provide a communication intervention opportunity to test the effectiveness of the research reach. A Canadian Institutes of Health Research- funded team grant in boys' and men's health, focusing on sexual violence (SV) victimization, health, and resilience undertook an evaluation to examine whether a strategic approach involving a cadre of SV experts (n = 46) and their research increased engagement. Using a unique identifier (#CIHRTeamSV) content was shared on social media (Twitter) within an ABABAB experimental monthly format (A = no sharing; B = sharing content), following a baseline entry of researchers. Active Twitter engagement lead to increases in the number of individuals' profile views, article downloads, and citations. These findings encourage further research into the utility of social media for disseminating sexual violence research, and that social media has developed as a forum for evidence-based conversation on sensitive topics of public health import. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Publication of confirmatory studies required by Health Canada for drugs approved under a Notice of Compliance with conditions: a cohort study

PubMed Central

Lexchin, Joel

2017-01-01

Background: Health Canada approves drugs based on limited data (Notice of Compliance with conditions [NOC/c]) and then requires companies to conduct confirmatory studies to validate the drugs' efficacy/effectiveness. The current investigation was carried out to determine whether these confirmatory studies are eventually published and are available to health care practitioners. Methods: A list of drugs for which the confirmatory studies had been completed from 1998 to Sept. 30, 2014 was created from 2 published articles that listed NOCs/c and investigated whether they had been fulfilled, the NOC database and the NOC/c Web site. The confirmatory studies for these drugs were determined from Qualifying Notices, agreements between Health Canada and the drug companies. Possible publications from these studies were identified through a Web search, and companies were asked to confirm these publications. The time in days between fulfillment of the NOC/c and publication of the studies was calculated. Results: There were 58 distinct confirmatory studies for 24 products made by 14 different companies. Eleven companies responded and identified 29 unique publications that reported on 31 studies. One company did not confirm a publication that was subsequently independently identified. Three companies did not respond, and in these cases another 18 publications were independently identified for an additional 19 studies. No publications were found for 7 studies. Thirty-one publications appeared a mean of 610 days before the NOC/c was fulfilled, and 17 appeared a mean of 572 days after fulfillment of the NOC/c. Interpretation: Eighty-eight percent of the confirmatory studies were eventually published. Health Canada and drug manufacturers should take steps to ensure that knowledge about these publications is available to health care practitioners.

Military and mental health correlates of unemployment in a national sample of women veterans.

PubMed

Hamilton, Alison B; Williams, Lindsay; Washington, Donna L

2015-04-01

The unemployment rate is currently higher among women Veterans than among male Veterans and civilian women. Employment is a key social determinant of health, with unemployment being strongly associated with adverse health. To identify military-related and health-related characteristics associated with unemployment in women Veterans. Secondary analysis of workforce participants (n=1605) in the National Survey of Women Veterans telephone survey. Demographics, mental health conditions, health care utilization, and military experiences and effects. Unemployment was defined as being in the labor force but unemployed and looking for work. The χ analyses to identify characteristics of unemployed women Veterans; logistic regression to identify independent factors associated with unemployment. Ten percent of women Veterans were unemployed. Independent correlates of unemployment were screening positive for depression [odds ratio (OR)=4.7; 95% confidence interval [CI], 1.8-12.4], military service during wartime (OR=2.9; 95%, CI 1.1-7.3), and service in the regular military (vs. in the National Guards/Reserves only) (OR=6.8; 95% CI, 2.2-20.5). Two postactive duty perceptions related to not being respected and understood as a Veteran were each independently associated with unemployment. Whether depression underlies unemployment, is exacerbated by unemployment, or both, it is critical to identify and treat depression among women Veterans, and also to investigate women Veterans' experiences and identities in civilian life. Community-based employers may need education regarding women Veterans' unique histories and strengths. Women who served in the regular military and during wartime may benefit from job assistance before and after they leave the military. Gender-specific adaptation of employment services may be warranted.

Environmental health impact assessment: evaluation of a ten-step model.

PubMed

Fehr, R

1999-09-01

"Environmental impact assessment" denotes the attempt to predict and assess the impact of development projects on the environment. A component dealing specifically with human health is often called an "environmental health impact assessment." It is widely held that such impact assessment offers unique opportunities for the protection and promotion of human health. The following components were identified as key elements of an integrated environmental health impact assessment model: project analysis, analysis of status quo (including regional analysis, population analysis, and background situation), prediction of impact (including prognosis of future pollution and prognosis of health impact), assessment of impact, recommendations, communication of results, and evaluation of the overall procedure. The concept was applied to a project of extending a waste disposal facility and to a city bypass highway project. Currently, the coverage of human health aspects in environmental impact assessment still tends to be incomplete, and public health departments often do not participate. Environmental health impact assessment as a tool for health protection and promotion is underutilized. It would be useful to achieve consensus on a comprehensive generic concept. An international initiative to improve the situation seems worth some consideration.

HIPAA is larger and more complex than Y2K.

PubMed

Tempesco, J W

2000-07-01

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a larger and more complex problem than Y2K ever was. According to the author, the costs associated with a project of such unending scope and in support of intrusion into both information and operational systems of every health care transaction will be incalculable. Some estimate that the administrative simplification policies implemented through HIPAA will save billions of dollars annually, but it remains to be seen whether the savings will outweigh implementation and ongoing expenses associated with systemwide application of the regulations. This article addresses the rules established for electronic data interchange, data set standards for diagnostic and procedure codes, unique identifiers, coordination of benefits, privacy of individual health care information, electronic signatures, and security requirements.

Patterns of Adolescent Regulatory Responses during Family Conflict and Mental Health Trajectories

PubMed Central

Koss, Kalsea J.; Cummings, E. Mark; Davies, Patrick T.; Cicchetti, Dante

2016-01-01

Four distinct patterns of adolescents’ behavioral, emotional, and physiological responses to family conflict were identified during mother-father-adolescent (M=13.08 years) interactions. Most youth displayed adaptively-regulated patterns comprised of low overt and subjective distress. Under-controlled adolescents exhibited elevated observable and subjective anger. Over-controlled adolescents were withdrawn and reported heightened subjective distress. Physiologically reactive adolescents had elevated cortisol coupled with low overt and subjective distress. Regulation patterns were associated with unique mental health trajectories. Under-controlled adolescents had elevated conduct and peer problems whereas over-controlled adolescents had higher anxiety and depressive symptoms. Physiologically reactive adolescents had low concurrent, but increasing levels of depressive, anxiety, and peer problem symptoms. Findings underscore the importance of examining organizations of regulatory strategies in contributing to adolescent mental health. PMID:28498540

Mapping Residency Global Health Experiences to the ACGME Family Medicine Milestones.

PubMed

Grissom, Maureen O; Iroku-Malize, Tochi; Peila, Rita; Perez, Marco; Philippe, Neubert

2017-07-01

Global health (GH) experiences are a unique part of family medicine (FM) training that offer an opportunity for residents to demonstrate development across a multitude of the milestones recently implemented by the Accreditation Council for Graduate Medical Education (ACGME). The GH experience presents an opportunity for resident development, and including a component of written reflection can provide tangible evidence of development in areas that can be difficult to assess. A mixed methods approach was used to integrate quantitative (frequency) data with qualitative content from the written reflections of 12 of our FM residents who participated in GH experiences. Written reflections touched on each of the 22 milestones, although some milestones were noted more frequently than others. The most commonly identified milestones fell within the competency areas of systems-based practice, professionalism, and practice-based learning and improvement. Our qualitative approach allowed us to gain an appreciation of the unique experiences that demonstrated growth across the various milestones. We conclude that any program that offers GH experiences should incorporate some form of written reflection to maximize resident growth and offer evaluative faculty a window into that development.

Generating unique IDs from patient identification data using security models

PubMed Central

Mohammed, Emad A.; Slack, Jonathan C.; Naugler, Christopher T.

2016-01-01

Background: The use of electronic health records (EHRs) has continued to increase within healthcare systems in the developed and developing nations. EHRs allow for increased patient safety, grant patients easier access to their medical records, and offer a wealth of data to researchers. However, various bioethical, financial, logistical, and information security considerations must be addressed while transitioning to an EHR system. The need to encrypt private patient information for data sharing is one of the foremost challenges faced by health information technology. Method: We describe the usage of the message digest-5 (MD5) and secure hashing algorithm (SHA) as methods for encrypting electronic medical data. In particular, we present an application of the MD5 and SHA-1 algorithms in encrypting a composite message from private patient information. Results: The results show that the composite message can be used to create a unique one-way encrypted ID per patient record that can be used for data sharing. Conclusion: The described software tool can be used to share patient EMRs between practitioners without revealing patients identifiable data. PMID:28163977

What value is the CINAHL database when searching for systematic reviews of qualitative studies?

PubMed

Wright, Kath; Golder, Su; Lewis-Light, Kate

2015-06-26

The Cumulative Index to Nursing and Allied Health Literature (CINAHL) is generally thought to be a good source to search when conducting a review of qualitative evidence. Case studies have suggested that using CINAHL could be essential for reviews of qualitative studies covering topics in the nursing field, but it is unclear whether this can be extended more generally to reviews of qualitative studies in other topic areas. We carried out a retrospective analysis of a sample of systematic reviews of qualitative studies to investigate CINAHL's potential contribution to identifying the evidence. In particular, we planned to identify the percentage of included studies available in CINAHL and the percentage of the included studies unique to the CINAHL database. After screening 58 qualitative systematic reviews identified from the Database of Abstracts of Reviews of Effects (DARE), we created a sample set of 43 reviews covering a range of topics including patient experience of both illnesses and interventions. For all 43 reviews (21 %) in our sample, we found that some of the included studies were available in CINAHL. For nine of these reviews, all the studies that had been included in the final synthesis were available in the CINAHL database, so it could have been possible to identify all the included studies using just this one database, while for an additional 21 reviews (49 %), 80 % or more of the included studies were available in CINAHL. Consequently, for a total of 30 reviews, or 70 % of our sample, 80 % or more of the studies could be identified using CINAHL alone. 11 reviews, where we were able to recheck all the databases used by the original review authors, had included a study that was uniquely identified from the CINAHL database. The median % of unique studies was 9.09%; while the range had a lowest value of 5.0% to the highest value of 33.0%. [corrected]. Assuming a rigorous search strategy was used and the records sought were accurately indexed, we could expect CINAHL to be a good source of primary studies for qualitative evidence syntheses. While we found some indication that CINAHL had the potential to provide unique studies for systematic reviews, we could only fully test this on a limited number of reviews, so we are less confident about this finding.

Exploratory studies to decide whether and how to proceed with full-scale evaluations of public health interventions: a systematic review of guidance.

PubMed

Hallingberg, Britt; Turley, Ruth; Segrott, Jeremy; Wight, Daniel; Craig, Peter; Moore, Laurence; Murphy, Simon; Robling, Michael; Simpson, Sharon Anne; Moore, Graham

2018-01-01

Evaluations of complex interventions in public health are frequently undermined by problems that can be identified before the effectiveness study stage. Exploratory studies, often termed pilot and feasibility studies, are a key step in assessing the feasibility and value of progressing to an effectiveness study. Such studies can provide vital information to support more robust evaluations, thereby reducing costs and minimising potential harms of the intervention. This systematic review forms the first phase of a wider project to address the need for stand-alone guidance for public health researchers on designing and conducting exploratory studies. The review objectives were to identify and examine existing recommendations concerning when such studies should be undertaken, questions they should answer, suitable methods, criteria for deciding whether to progress to an effectiveness study and appropriate reporting. We searched for published and unpublished guidance reported between January 2000 and November 2016 via bibliographic databases, websites, citation tracking and expert recommendations. Included papers were thematically synthesized. The search retrieved 4095 unique records. Thirty papers were included, representing 25 unique sources of guidance/recommendations. Eight themes were identified: pre-requisites for conducting an exploratory study, nomenclature, guidance for intervention assessment, guidance surrounding any future evaluation study design, flexible versus fixed design, progression criteria to a future evaluation study, stakeholder involvement and reporting of exploratory studies. Exploratory studies were described as being concerned with the intervention content, the future evaluation design or both. However, the nomenclature and endorsed methods underpinning these aims were inconsistent across papers. There was little guidance on what should precede or follow an exploratory study and decision-making surrounding this. Existing recommendations are inconsistent concerning the aims, designs and conduct of exploratory studies, and guidance is lacking on the evidence needed to inform when to proceed to an effectiveness study. PROSPERO 2016, CRD42016047843.

Field Epidemiology and Laboratory Training Programs in West Africa as a model for sustainable partnerships in animal and human health.

PubMed

Becker, Karen M; Ohuabunwo, Chima; Ndjakani, Yassa; Nguku, Patrick; Nsubuga, Peter; Mukanga, David; Wurapa, Frederick

2012-09-01

The concept of animal and human health experts working together toward a healthier world has been endorsed, but challenges remain in identifying concrete actions to move this one health concept from vision to action. In 2008, as a result of avian influenza outbreaks in West Africa, international donor support led to a unique opportunity to invest in Field Epidemiology and Laboratory Training Programs (FELTPs) in the region that engaged the animal and human health sectors to strengthen the capacity for prevention and control of zoonotic diseases. The FELTPs mixed 25% to 35% classroom and 65% to 75% field-based training and service for cohorts of physicians, veterinarians, and laboratory scientists. They typically consisted of a 2-year course leading to a master's degree in field epidemiology and public health laboratory management for midlevel public health leaders and competency-based short courses for frontline public health surveillance workers. Trainees and graduates work in multidisciplinary teams to conduct surveillance, outbreak investigations, and epidemiological studies for disease control locally and across borders. Critical outcomes of these programs include development of a cadre of public health leaders with core skills in integrated disease surveillance, outbreak investigation, vaccination campaigns, laboratory diagnostic testing, and epidemiological studies that address priority public health problems. A key challenge exists in identifying ways to successfully scale up and transform this innovative donor-driven program into a sustainable multisectoral one health workforce capacity development model.

Identifying Local Hotspots of Pediatric Chronic Diseases Using Emergency Department Surveillance

PubMed Central

Lee, David C.; Yi, Stella S.; Fong, Hiu-Fai; Athens, Jessica K.; Ravenell, Joseph E.; Sevick, Mary Ann; Wall, Stephen P.; Elbel, Brian

2016-01-01

Objective To use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City. Methods Using a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden. Results We identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at pre-specified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, p=0.05 and 0.99, p<0.01, respectively). Moderate correlations by neighborhood were identified for obesity and cancer (0.53 and 0.54, p<0.01). Among adolescents, correlations by health districts were strong for obesity (0.95, p=0.05), and depression estimates had a non-significant, but strong negative correlation with suicide attempts (−0.88, p=0.12). Using SaTScan, we also identified local hotspots of pediatric chronic disease. Conclusions For conditions easily identified in claims data, emergency department surveillance may help estimate pediatric chronic disease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates. What’s New This study demonstrated how emergency department surveillance may improve estimates of pediatric disease prevalence with higher geographic resolution. We identified 29% of New York City children with a single year of data and identified local hotspots of pediatric chronic diseases. PMID:28385326

[Internet use and adolescents' sexual health].

PubMed

Tseng, Ying-Hua; Wang, Ruey-Hsia; Wang, Hsiu-Hung; Chou, Fan-Hao

2012-12-01

Internet use is an important part of the daily life of adolescents. The ease of searching the internet for information makes finding information on sex, a topic of particular interest to adolescents, easy. Although the internet is replete with sexual information, the influence of internet use on adolescents' sexual health is analogous to a double-edged sword. This article identifies the four main sexual dilemmas facing Taiwan adolescents and analyzes the pros and cons of internet use with regard to adolescents' sexual health. Cons include the predominance of internet pornography and the potential risks of making friends online. Pros include the internet's role as an optimal communications platform and tool for sex-related research. We suggest that nurses have a unique role and functions to play in promoting adolescent sexual health. We also offer recommendations for school health nursing and clinical nursing. Further internet-based quantitative and qualitative research is necessary to clarify relevant sexual health issues. Finally, we offer design suggestions for sexual education homepages.

[The competencies of health professionals and the ministerial policies].

PubMed

da Silva Marques, Cláudia Maria; Egry, Emiko Yoshikawa

2011-03-01

In Brazil, nursing professionals are trained based on the perspective of professional competencies. The objective of this exploratory, descriptive study was to identify the critical-emancipator potential of the competency, as described by the Brazilian Ministries of Education and of Health. The sources used for data collection were the regulating documents of technical professional education of the referred Ministries regarding the years 1996 and 2006. Results showed that, for the Ministry of Education, the guiding principles of professional education are the demands of the working market; the idea of competency is supported on the constructivist perspective, highlighting personal features over their social dimension. For the Ministry of Health, professional education is an instrument of citizenship, guided by the political health care paradigm of the national public health system, referred to as the Unique Health System; the idea of competency is founded on the critical-emancipatory perspective. In conclusion, the two Ministries, despite having regulations regarding professional education, are contradictory in terms of their conceptual foundations.

Typologies of Childhood Exposure to Violence: Associations With College Student Mental Health.

PubMed

Miller-Graff, Laura E; Howell, Kathryn H; Martinez-Torteya, Cecilia; Hunter, Erin C

2015-01-01

This study examined typologies of childhood violence exposure (CVE) and the associations of profiles with current demographic characteristics and mental health in emerging adulthood. The study evaluated a sample of college students from 2 US geographic regions (Midwest, n = 195; Southeast, n = 200). An online questionnaire (collected 2013-2014) assessed CVE and current mental health. Latent class analysis was used to identify typologies of CVE. Follow-up analyses were conducted to distinguish differences between typologies in demographic characteristics and mental health. Four distinct profiles emerged: High-Exposed, Domestic-Exposed, Community-Exposed, and Low-Exposed. High- and Domestic-Exposed groups were more likely to be first-generation college students and to experience symptoms of psychopathology. This study offers a unique presentation of CVE profiles and a nuanced interpretation of their differential relationship to current demographic characteristics and mental health. It may befit university mental health initiatives to engage first-generation students and utilize comprehensive assessments of previous victimization.

Securing support for eye health policy in low- and middle-income countries: identifying stakeholders through a multi-level analysis.

PubMed

Morone, Piergiuseppe; Camacho Cuena, Eva; Kocur, Ivo; Banatvala, Nicholas

2014-05-01

This article empirically evaluates advocacy in low- and middle-income countries as a key tool for raising policy priority and securing high-level decision maker support in eye health. We used a unique data set based on a survey conducted by World Health Organization in 2011 on eye care and prevention of blindness in 82 low- and middle-income countries. The theoretical framework derives from the idea that a plethora of stakeholders at local and global level pressure national governments, acting in economic and the political spheres. Previously, eye care has not been investigated in such a framework. We found structural differences across countries with different income levels and proposed policy recommendations to secure high-level decision makers' support for promoting eye health. Three case studies suggest that, in order to secure more support and resources for eye health, domestic and international stakeholders must strengthen their engagement with ministries of health at political and above all economic levels.

Patient source of learning about health technologies and ratings of trust in technologies used in their care

PubMed Central

Montague, Enid

2011-01-01

In order to design effective health technologies and systems, it is important to understand how patients learn and make decisions about health technologies used in their care. The objective of this study was to examine patients' source of learning about technologies used in their care and how the source related to their trust in the technology used. Individual face-to-face and telephone interviews were conducted with 24 patients. Thirteen unique sources of information about technology were identified and three major themes emerged; outside of the work system versus inside the work system, when the health information was provided, and the medium used. Patients used multiple sources outside of the health care work system to learn about technologies that will be used in their care. Results showed a relationship between learning about technologies from web sources and trust in technologies but no relationship between learning about technologies from health care providers and trust in technologies. PMID:20967654

Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India

PubMed Central

Shaikh, Simran; Mburu, Gitau; Arumugam, Viswanathan; Mattipalli, Naveen; Aher, Abhina; Mehta, Sonal; Robertson, James

2016-01-01

Introduction Transgender populations face inequalities in access to HIV, health and social services. In addition, there is limited documentation of models for providing appropriately tailored services and social support for transgender populations in low- and middle-income countries. This paper presents outcomes of the Global Fund-supported Pehchan programme, which aimed to strengthen community systems and provide HIV, health, legal and social services to transgender communities across 18 Indian states through a rights-based empowerment approach. Methods We used a pre- and post-intervention cross-sectional survey design with retrospective analysis of programmatic data. Using stratified sampling, we identified 268 transgender participants in six Indian states from a total of 48,280 transgender people served by Pehchan through 186 community-based organizations. We quantified the impact of interventions by comparing baseline and end line indicators of accessed health social and legal services. We also assessed end line self-efficacy and collective action with regard to social support networks. Results There were significant increases in community-based demand and use of tailored health, legal, social and psychological services over the time of the Pehchan programme. We report significant increases in access to condoms (12.5%, p<0.001) and condom use at last anal sex with both regular (18.1%, p<0.001) and casual (8.1%, p<0.001) male partners. Access to HIV outreach education and testing and counselling services significantly increased (20.10%, p<0.001; 33.7%, p<0.001). In addition, significant increases in access to emergency crisis response (19.7%, p<0.001), legal support (26.8%, p<0.001) and mental health services (33.0%, p<0.001) were identified. Finally, we note that the Pehchan programme successfully provided a platform for the formation, collectivization and visibility of peer support groups. Conclusions The Pehchan programme's community involvement, rights-based collectivization and gender-affirming approaches significantly improved both demand and access to tailored HIV, health and social services for transgender individuals across India. Furthermore, the Pehchan programme successfully fostered both self-efficacy and collective identity and served as a model for addressing the unique health needs of transgender communities. Continued strengthening of health, social and community systems to better respond to the unique needs of transgender communities is needed in order to sustain these gains. PMID:27431474

Empowering communities and strengthening systems to improve transgender health: outcomes from the Pehchan programme in India.

PubMed

Shaikh, Simran; Mburu, Gitau; Arumugam, Viswanathan; Mattipalli, Naveen; Aher, Abhina; Mehta, Sonal; Robertson, James

2016-01-01

Transgender populations face inequalities in access to HIV, health and social services. In addition, there is limited documentation of models for providing appropriately tailored services and social support for transgender populations in low- and middle-income countries. This paper presents outcomes of the Global Fund-supported Pehchan programme, which aimed to strengthen community systems and provide HIV, health, legal and social services to transgender communities across 18 Indian states through a rights-based empowerment approach. We used a pre- and post-intervention cross-sectional survey design with retrospective analysis of programmatic data. Using stratified sampling, we identified 268 transgender participants in six Indian states from a total of 48,280 transgender people served by Pehchan through 186 community-based organizations. We quantified the impact of interventions by comparing baseline and end line indicators of accessed health social and legal services. We also assessed end line self-efficacy and collective action with regard to social support networks. There were significant increases in community-based demand and use of tailored health, legal, social and psychological services over the time of the Pehchan programme. We report significant increases in access to condoms (12.5%, p<0.001) and condom use at last anal sex with both regular (18.1%, p<0.001) and casual (8.1%, p<0.001) male partners. Access to HIV outreach education and testing and counselling services significantly increased (20.10%, p<0.001; 33.7%, p<0.001). In addition, significant increases in access to emergency crisis response (19.7%, p<0.001), legal support (26.8%, p<0.001) and mental health services (33.0%, p<0.001) were identified. Finally, we note that the Pehchan programme successfully provided a platform for the formation, collectivization and visibility of peer support groups. The Pehchan programme's community involvement, rights-based collectivization and gender-affirming approaches significantly improved both demand and access to tailored HIV, health and social services for transgender individuals across India. Furthermore, the Pehchan programme successfully fostered both self-efficacy and collective identity and served as a model for addressing the unique health needs of transgender communities. Continued strengthening of health, social and community systems to better respond to the unique needs of transgender communities is needed in order to sustain these gains.

An innovative expression model of human health risk based on the quantitative analysis of soil metals sources contribution in different spatial scales.

PubMed

Zhang, Yimei; Li, Shuai; Wang, Fei; Chen, Zhuang; Chen, Jie; Wang, Liqun

2018-09-01

Toxicity of heavy metals from industrialization poses critical concern, and analysis of sources associated with potential human health risks is of unique significance. Assessing human health risk of pollution sources (factored health risk) concurrently in the whole and the sub region can provide more instructive information to protect specific potential victims. In this research, we establish a new expression model of human health risk based on quantitative analysis of sources contribution in different spatial scales. The larger scale grids and their spatial codes are used to initially identify the level of pollution risk, the type of pollution source and the sensitive population at high risk. The smaller scale grids and their spatial codes are used to identify the contribution of various sources of pollution to each sub region (larger grid) and to assess the health risks posed by each source for each sub region. The results of case study show that, for children (sensitive populations, taking school and residential area as major region of activity), the major pollution source is from the abandoned lead-acid battery plant (ALP), traffic emission and agricultural activity. The new models and results of this research present effective spatial information and useful model for quantifying the hazards of source categories and human health a t complex industrial system in the future. Copyright © 2018 Elsevier Ltd. All rights reserved.

A Sensitivity Analysis of an Inverted Pendulum Balance Control Model.

PubMed

Pasma, Jantsje H; Boonstra, Tjitske A; van Kordelaar, Joost; Spyropoulou, Vasiliki V; Schouten, Alfred C

2017-01-01

Balance control models are used to describe balance behavior in health and disease. We identified the unique contribution and relative importance of each parameter of a commonly used balance control model, the Independent Channel (IC) model, to identify which parameters are crucial to describe balance behavior. The balance behavior was expressed by transfer functions (TFs), representing the relationship between sensory perturbations and body sway as a function of frequency, in terms of amplitude (i.e., magnitude) and timing (i.e., phase). The model included an inverted pendulum controlled by a neuromuscular system, described by several parameters. Local sensitivity of each parameter was determined for both the magnitude and phase using partial derivatives. Both the intrinsic stiffness and proportional gain shape the magnitude at low frequencies (0.1-1 Hz). The derivative gain shapes the peak and slope of the magnitude between 0.5 and 0.9 Hz. The sensory weight influences the overall magnitude, and does not have any effect on the phase. The effect of the time delay becomes apparent in the phase above 0.6 Hz. The force feedback parameters and intrinsic stiffness have a small effect compared with the other parameters. All parameters shape the TF magnitude and phase and therefore play a role in the balance behavior. The sensory weight, time delay, derivative gain, and the proportional gain have a unique effect on the TFs, while the force feedback parameters and intrinsic stiffness contribute less. More insight in the unique contribution and relative importance of all parameters shows which parameters are crucial and critical to identify underlying differences in balance behavior between different patient groups.

The experience of living with advanced-stage cancer: a thematic synthesis of the literature.

PubMed

García-Rueda, N; Carvajal Valcárcel, A; Saracíbar-Razquin, M; Arantzamendi Solabarrieta, M

2016-07-01

The aim of the study was to understand the experience of people living with advanced-stage cancer through literature. The search included The Cochrane Library, PubMed, PsycInfo, CINAHL and Cuiden. Thirteen studies were included. A qualitative meta-synthesis was conducted. One thread emerged from the thematic synthesis: the desire to live as normally as possible, despite being aware of the proximity of death. Three themes also emerged: "a process that is unique" with its four sub-themes; "support network" and "health context," each of them having two sub-themes. This study concludes that living with advanced-stage cancer is a unique and complex process which has both positive and negative aspects. The review provides a comprehensive view of the experience, which considers the importance of the support network and the health context in which the person lives. In this study, "normalcy" is the adjustment to the new reality and living as closely as possible to the way one lived before the disease, while developing a new relationship with being finite and death. A better understanding of the experience of living with advanced-stage cancer will help health professionals to identify the needs of the patients in order to plan individual, high-quality care. © 2016 John Wiley & Sons Ltd.

Strategies for mHealth research: lessons from 3 mobile intervention studies.

PubMed

Ben-Zeev, Dror; Schueller, Stephen M; Begale, Mark; Duffecy, Jennifer; Kane, John M; Mohr, David C

2015-03-01

The capacity of Mobile Health (mHealth) technologies to propel healthcare forward is directly linked to the quality of mobile interventions developed through careful mHealth research. mHealth research entails several unique characteristics, including collaboration with technologists at all phases of a project, reliance on regional telecommunication infrastructure and commercial mobile service providers, and deployment and evaluation of interventions "in the wild", with participants using mobile tools in uncontrolled environments. In the current paper, we summarize the lessons our multi-institutional/multi-disciplinary team has learned conducting a range of mHealth projects using mobile phones with diverse clinical populations. First, we describe three ongoing projects that we draw from to illustrate throughout the paper. We then provide an example for multidisciplinary teamwork and conceptual mHealth intervention development that we found to be particularly useful. Finally, we discuss mHealth research challenges (i.e. evolving technology, mobile phone selection, user characteristics, the deployment environment, and mHealth system "bugs and glitches"), and provide recommendations for identifying and resolving barriers, or preventing their occurrence altogether.

Linking exposures and health outcomes to a large population-based longitudinal study: the Millennium Cohort Study.

PubMed

Smith, Tyler C

2011-07-01

To describe current efforts and future potential for understanding long-term health of military service members by linking the Millennium Cohort Study data to exposures and health outcomes. The Millennium Cohort Study launched in 2001, before September 11 and the start of combat operations in Afghanistan and Iraq. Other substantial Department of Defense (DoD) health, personnel, and exposure databases are maintained in electronic form and may be linked by personal identifiers. More than 150,000 consenting members comprise the Millennium Cohort from all services, and include active duty, Reserve, and National Guard current and past members, and represent demographic, occupational, military, and health characteristics of the U.S. military. These prospective data offer symptom assessment, behavioral health, and self-reported exposures that may complement and fill gaps in capability presented by other DoD electronic health and exposure data. In conjunction with Millennium Cohort survey data, prospective individual-level exposure and health outcome assessment is crucial to understand and quantify any long-term health outcomes potentially associated with unique military occupational exposures.

Strategies for mHealth research: lessons from 3 mobile intervention studies

PubMed Central

Ben-Zeev, Dror; Schueller, Stephen M.; Begale, Mark; Duffecy, Jennifer; Kane, John M.; Mohr, David C.

2014-01-01

The capacity of Mobile Health (mHealth) technologies to propel healthcare forward is directly linked to the quality of mobile interventions developed through careful mHealth research. mHealth research entails several unique characteristics, including collaboration with technologists at all phases of a project, reliance on regional telecommunication infrastructure and commercial mobile service providers, and deployment and evaluation of interventions “in the wild”, with participants using mobile tools in uncontrolled environments. In the current paper, we summarize the lessons our multi-institutional/multi-disciplinary team has learned conducting a range of mHealth projects using mobile phones with diverse clinical populations. First, we describe three ongoing projects that we draw from to illustrate throughout the paper. We then provide an example for multidisciplinary teamwork and conceptual mHealth intervention development that we found to be particularly useful. Finally, we discuss mHealth research challenges (i.e. evolving technology, mobile phone selection, user characteristics, the deployment environment, and mHealth system “bugs and glitches”), and provide recommendations for identifying and resolving barriers, or preventing their occurrence altogether. PMID:24824311

Sound Science: Taking Action with Acoustics

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

Sinha, Dipen

2014-07-16

From tin whistles to sonic booms, sound waves interact with each other and with the medium through which they travel. By observing these interactions, we can identify substances that are hidden in sealed containers and obtain images of buried objects. By manipulating the ability of sound to push matter around, we can create novel structures and unique materials. Join the Lab's own sound hound, Dipen Sinha, as he describes how he uses fundamental research in acoustics for solving problems in industry, security and health.

Sound Science: Taking Action with Acoustics

ScienceCinema

Sinha, Dipen

2018-01-16

From tin whistles to sonic booms, sound waves interact with each other and with the medium through which they travel. By observing these interactions, we can identify substances that are hidden in sealed containers and obtain images of buried objects. By manipulating the ability of sound to push matter around, we can create novel structures and unique materials. Join the Lab's own sound hound, Dipen Sinha, as he describes how he uses fundamental research in acoustics for solving problems in industry, security and health.

Patient perspectives on care received at community acupuncture clinics: a qualitative thematic analysis.

PubMed

Tippens, Kimberly M; Chao, Maria T; Connelly, Erin; Locke, Adrianna

2013-10-29

Community acupuncture is a recent innovation in acupuncture service delivery in the U.S. that aims to improve access to care through low-cost treatments in group-based settings. Patients at community acupuncture clinics represent a broader socioeconomic spectrum and receive more frequent treatments compared to acupuncture users nationwide. As a relatively new model of acupuncture in the U.S., little is known about the experiences of patients at community acupuncture clinics and whether quality of care is compromised through this high-volume model. The aim of this study was to assess patients' perspectives on the care received through community acupuncture clinics. The investigators conducted qualitative, thematic analysis of written comments from an observational, cross-sectional survey of clients of the Working Class Acupuncture clinics in Portland, Oregon. The survey included an open-ended question for respondents to share comments about their experiences with community acupuncture. Comments were received from 265 community acupuncture patients. Qualitative analysis of written comments identified two primary themes that elucidate patients' perspectives on quality of care: 1) aspects of health care delivery unique to community acupuncture, and 2) patient engagement in health care. Patients identified unique aspects of community acupuncture, including structures that facilitate access, processes that make treatments more comfortable and effective and holistic outcomes including physical improvements, enhanced quality of life, and empowerment. The group setting, community-based locations, and low cost were highlighted as aspects of this model that allow patients to access acupuncture. Patients' perspectives on the values and experiences unique to community acupuncture offer insights on the quality of care received in these settings. The group setting, community-based locations, and low cost of this model potentially reduce access barriers for those who might not otherwise consider using acupuncture. In addition, the community acupuncture model may offer individuals the opportunity for increased frequency of treatments, which raises pertinent questions about the dose-response relationship of acupuncture and health outcomes. This study provides preliminary data for future evaluations of the quality and effectiveness of community acupuncture. Future studies should include the perspectives of patients who initiated, and subsequently, discontinued community acupuncture treatment.

New politics, an opportunity for maternal health advancement in eastern myanmar: an integrative review.

PubMed

Loyer, Adam B; Ali, Mohammed; Loyer, Diana

2014-09-01

Myanmar (formerly Burma) is a southeast Asian country, with a long history of military dictatorship, human rights violations, and poor health indicators. The health situation is particularly dire among pregnant women in the ethnic minorities of the eastern provinces (Kachin, Shan, Mon, Karen and Karenni regions). This integrative review investigates the current status of maternal mortality in eastern Myanmar in the context of armed conflict between various separatist groups and the military regime. The review examines the underlying factors contributing to high maternal mortality in eastern Myanmar and assesses gaps in the existing research, suggesting areas for further research and policy response. Uncovered were a number of underlying factors uniquely contributing to maternal mortality in eastern Myanmar. These could be grouped into the following analytical themes: ongoing conflict, health system deficits, and political and socioeconomic influences. Abortion was interestingly not identified as an important contributor to maternal mortality. Recent political liberalization may provide space to act upon identified roles and opportunities for the Myanmar Government, the international community, and non-governmental organizations (NGOs) in a manner that positively impacts on maternal healthcare in the eastern regions of Myanmar. This review makes a number of recommendations to this effect.

A review of equity issues in quantitative studies on health inequalities: the case of asthma in adults

PubMed Central

2011-01-01

Background The term 'inequities' refers to avoidable differences rooted in injustice. This review examined whether or not, and how, quantitative studies identifying inequalities in risk factors and health service utilization for asthma explicitly addressed underlying inequities. Asthma was chosen because recent decades have seen strong increases in asthma prevalence in many international settings, and inequalities in risk factors and related outcomes. Methods A review was conducted of studies that identified social inequalities in asthma-related outcomes or health service use in adult populations. Data were extracted on use of equity terms (objective evidence), and discussion of equity issues without using the exact terms (subjective evidence). Results Of the 219 unique articles retrieved, 21 were eligible for inclusion. None used the terms equity/inequity. While all but one article traced at least partial pathways to inequity, only 52% proposed any intervention and 55% of these interventions focused exclusively on the more proximal, clinical level. Conclusions Without more in-depth and systematic examination of inequities underlying asthma prevalence, quantitative studies may fail to provide the evidence required to inform equity-oriented interventions to address underlying circumstances restricting opportunities for health. PMID:21749720

Overcoming Barriers in Kidney Health-Forging a Platform for Innovation.

PubMed

Linde, Peter G; Archdeacon, Patrick; Breyer, Matthew D; Ibrahim, Tod; Inrig, Jula K; Kewalramani, Reshma; Lee, Celeste Castillo; Neuland, Carolyn Y; Roy-Chaudhury, Prabir; Sloand, James A; Meyer, Rachel; Smith, Kimberly A; Snook, Jennifer; West, Melissa; Falk, Ronald J

2016-07-01

Innovation in kidney diseases is not commensurate with the effect of these diseases on human health and mortality or innovation in other key therapeutic areas. A primary cause of the dearth in innovation is that kidney diseases disproportionately affect a demographic that is largely disenfranchised, lacking sufficient advocacy, public attention, and funding. A secondary and likely consequent cause is that the existing infrastructure supporting nephrology research pales in comparison with those for other internal medicine specialties, especially cardiology and oncology. Citing such inequities, however, is not enough. Changing the status quo will require a coordinated effort to identify and redress the existing deficits. Specifically, these deficits relate to the need to further develop and improve the following: understanding of the disease mechanisms and pathophysiology, patient engagement and activism, clinical trial infrastructure, and investigational clinical trial designs as well as coordinated efforts among critical stakeholders. This paper identifies potential solutions to these barriers, some of which are already underway through the Kidney Health Initiative. The Kidney Health Initiative is unique and will serve as a current and future platform from which to overcome these barriers to innovation in nephrology. Copyright © 2016 by the American Society of Nephrology.

Understanding domains of health-related quality of life concerns of Singapore Chinese patients with advanced cancer: a qualitative analysis.

PubMed

Lee, G L; Pang, G S Y; Akhileswaran, R; Ow, M Y L; Fan, G K T; Wong, C C F; Wee, H L; Cheung, Y B

2016-03-01

Quality of life concerns in patients with advanced diseases might be different from other patients and are shaped by sociocultural context. The objective of this qualitative study was to identify domains and themes of health-related quality of life (HRQoL) that Chinese patients with advanced cancer in Singapore considered relevant and important. English- and Chinese-speaking patients with advanced solid cancer were recruited from a tertiary cancer center and a community-based hospice for in-depth interview or focused group discussion. Thematic analysis was used to identify subthemes, themes, and domains from the transcripts. Forty-six ethnic Chinese (aged 26-86, 48% male) participated in the study. Six domains of HRQoL concerns were identified: pain and suffering, physical health, social health, mental health, financial well-being, and spiritual health. Pain and suffering are not limited to the physical domain, reflecting the multidimensional nature of this concept. Pain and suffering must also be understood within the cultural context. Healthcare relations (i.e., social health), existential well-being and religious well-being (i.e., spiritual health), and suffering (i.e., pain and suffering) are not fully captured in the existing HRQoL instruments. In addition, financial issues and the practice of secrecy in interpersonal relationships emerged as unique features possibly arising from our sociocultural context and healthcare financing landscape. Socioculturally specific issues not measured by the existing HRQoL instruments for use in patients with advanced cancers or terminal diseases were found in our study. These are non-physical pain and suffering, meaning of illness, meaning of death, financial issues, and practice of secrecy in interpersonal relationships.

Decoding the Effect of Isobaric Substitutions on Identifying Missing Proteins and Variant Peptides in Human Proteome.

PubMed

Choong, Wai-Kok; Lih, Tung-Shing Mamie; Chen, Yu-Ju; Sung, Ting-Yi

2017-12-01

To confirm the existence of missing proteins, we need to identify at least two unique peptides with length of 9-40 amino acids of a missing protein in bottom-up mass-spectrometry-based proteomic experiments. However, an identified unique peptide of the missing protein, even identified with high level of confidence, could possibly coincide with a peptide of a commonly observed protein due to isobaric substitutions, mass modifications, alternative splice isoforms, or single amino acid variants (SAAVs). Besides unique peptides of missing proteins, identified variant peptides (SAAV-containing peptides) could also alternatively map to peptides of other proteins due to the aforementioned issues. Therefore, we conducted a thorough comparative analysis on data sets in PeptideAtlas Tiered Human Integrated Search Proteome (THISP, 2017-03 release), including neXtProt (2017-01 release), to systematically investigate the possibility of unique peptides in missing proteins (PE2-4), unique peptides in dubious proteins, and variant peptides affected by isobaric substitutions, causing doubtful identification results. In this study, we considered 11 isobaric substitutions. From our analysis, we found <5% of the unique peptides of missing proteins and >6% of variant peptides became shared with peptides of PE1 proteins after isobaric substitutions.

A Systematic Scoping Review of Engagement in Physical Activity Among LGBTQ+ Adults.

PubMed

Herrick, Shannon S C; Duncan, Lindsay R

2018-03-01

LGBTQ+ (lesbian, gay, bisexual, transgender, queer, etc) persons are subject to elevated rates of chronic diseases and health concerns that can be addressed through regular participation in physical activity. However, LGBTQ+ adults experience unique challenges to engaging in physical activity. Subsequently, the aim of this study is to describe the dominant narratives related to the complex intersection of sexual orientation, gender identity, and physical activity. A systematic search and scoping review of existing literature was conducted in June 2016. Studies were identified by searching 9 electronic databases. Data were then extracted, summarized, and organized by LGBTQ+ subgroups. Conceptual maps of prominent narratives were created. Separate narratives were identified for sexual minority men and women. The dominant trend for sexual minority men was increased physical activity levels, often motivated by a perceived body ideal of being thin and/or muscular. The dominant trend for sexual minority women was decreased physical activity levels, predicated on a social norm that emphasizes bodily acceptance. Sexual orientation affects engagement in physical activity differentially by gender. Our findings suggest that physical activity interventions should be targeted to unique subgroups of the LGBTQ+ population.

Language as a Facilitator of Cultural Connection

PubMed Central

Gonzalez, Miigis B.; Aronson, Benjamin D.; Kellar, Sidnee; Walls, Melissa L.; Greenfield, Brenna L.

2018-01-01

Understanding culture as a means of preventing or treating health concerns is growing in popularity among social behavioral health scientists. Language is one component of culture and therefore may be a means to improve health among Indigenous populations. This study explores language as a unique aspect of culture through its relationship to other demographic and cultural variables. Participants (n = 218) were adults who self-identified as American Indian, had a type 2 diabetes diagnosis, and were drawn from two Ojibwe communities using health clinic records. We used chi-squared tests to compare language proficiency by demographic groups and ANOVA tests to examine relationships between language and culture. A higher proportion of those living on reservation lands could use the Ojibwe language, and fluent speakers were most notably sixty-five years of age and older. Regarding culture, those with greater participation and value belief in cultural activities reported greater language proficiency. PMID:29782622

Promotion of meaningful use of a personal health record in second life.

PubMed

Knapfel, Sarah; Plattner, Broc; Santo, Taylor; Tyndall, Sarah

2014-01-01

Patients today are demanding greater access to and control of their health information. Personal Health Records (PHRs) are paving the way for patients to update, maintain and share their comprehensive medical information. The opportunity to develop and maintain a PHR is equally as important for those individuals in the disabled community who face many unique challenges to access health information. The project, conducted as part of our graduate course, explored the use of Second Life to educate the disabled community on Virtual Ability Island (VAI) about the importance of PHRs. The project examined the tools needed to offer such a presentation for the disabled community and identified legal, ethical, social, or public challenges for PHR use. The project outcomes indicated a desire for knowledge and genuine concerns by the attendees regarding PHRs. The authors note that more research is needed to make this technology available to all.

Leadership in Surgery for Public Sector Hospitals in Jamaica: Strategies for the Operating Room

PubMed Central

Cawich, Shamir O; Harding, Hyacinth E; Crandon, Ivor W; McGaw, Clarence D; Barnett, Alan T; Tennant, Ingrid; Evans, Necia R; Martin, Allie C; Simpson, Lindberg K; Johnson, Peter

2013-01-01

The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica. Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys. PMID:24355903

Developing a virtual community for health sciences library book selection: Doody's Core Titles.

PubMed

Shedlock, James; Walton, Linda J

2006-01-01

The purpose of this article is to describe Doody's Core Titles in the Health Sciences as a new selection guide and a virtual community based on an effective use of online systems and to describe its potential impact on library collection development. The setting is the availability of health sciences selection guides. Participants include Doody Enterprise staff, Doody's Library Board of Advisors, content specialists, and library selectors. Resources include the online system used to create Doody's Core Titles along with references to complementary databases. Doody's Core Titles is described and discussed in relation to the literature of selection guides, especially in comparison to the Brandon/Hill selected lists that were published from 1965 to 2003. Doody's Core Titles seeks to fill the vacuum created when the Brandon/Hill lists ceased publication. Doody's Core Titles is a unique selection guide based on its method of creating an online community of experts to identify and score a core list of titles in 119 health sciences specialties and disciplines. The result is a new selection guide, now available annually, that will aid health sciences librarians in identifying core titles for local collections. Doody's Core Titles organizes the evaluation of core titles that are identified and recommended by content specialists associated with Doody's Book Review Service and library selectors. A scoring mechanism is used to create the selection of core titles, similar to the star rating system employed in other Doody Enterprise products and services.

The re-identification risk of Canadians from longitudinal demographics

PubMed Central

2011-01-01

Background The public is less willing to allow their personal health information to be disclosed for research purposes if they do not trust researchers and how researchers manage their data. However, the public is more comfortable with their data being used for research if the risk of re-identification is low. There are few studies on the risk of re-identification of Canadians from their basic demographics, and no studies on their risk from their longitudinal data. Our objective was to estimate the risk of re-identification from the basic cross-sectional and longitudinal demographics of Canadians. Methods Uniqueness is a common measure of re-identification risk. Demographic data on a 25% random sample of the population of Montreal were analyzed to estimate population uniqueness on postal code, date of birth, and gender as well as their generalizations, for periods ranging from 1 year to 11 years. Results Almost 98% of the population was unique on full postal code, date of birth and gender: these three variables are effectively a unique identifier for Montrealers. Uniqueness increased for longitudinal data. Considerable generalization was required to reach acceptably low uniqueness levels, especially for longitudinal data. Detailed guidelines and disclosure policies on how to ensure that the re-identification risk is low are provided. Conclusions A large percentage of Montreal residents are unique on basic demographics. For non-longitudinal data sets, the three character postal code, gender, and month/year of birth represent sufficiently low re-identification risk. Data custodians need to generalize their demographic information further for longitudinal data sets. PMID:21696636

Patient centered care: A path to better health outcomes through engagement and activation.

PubMed

Miller, Kenneth L

2016-10-14

Patient Activation and Health confidence are constructs to assess patient engagement and are utilized to encourage patient engagement. A health care provider may increase patient engagement further by utilizing behavior change theories and models such as the Trans-Theoretical Model of Change (TTM), Self-Determination Theory (SDT) and Motivational Interviewing (MI) to realize effective and lasting health behavior change by placing accountability increasingly on the patient/caregiver to choose to make changes in their health behavior on their terms. Reducing or eliminating harmful behaviors such as smoking and/or beginning or increasing beneficial health behaviors such as diet modification or performance of an exercise program, patients realize improved outcomes and better health. The purpose of this article is to define health confidence as a measurement tool for patient engagement, use the TTM as a measure of the patient's readiness to change, use TTM, SDT and MI as interventional approaches to effect patient change of behavior encouraged by physical therapists and incorporate the ICF as a means of identifying barriers and facilitators and incorporate the bio-psychosocial model for patient-centered care to improve health behavior, health and patient outcomes. Patient-centered care requires involvement of the patient and/or their caregiver at the center of the plan. Use of the International Classification of Functioning, Disability and Health (ICF) to identify facilitators and barriers unique to the patient/caregiver offers another opportunity to successfully engage the patient by incorporating the patient's bio-psychosocial support system into care delivery and for sustainability. The ICF is a taxonomy and classification system that prompts clinicians to identify environmental factors (facilitators and barriers) that will influence the patient's ability to perform during therapy session and to sustain the interventions and employ suggestions outside of formal therapy sessions. Using the facilitators to encourage sustainable change and removing barriers, patients are more likely to realize positive health behavior change and in turn demonstrate improved outcomes and health as a result of physical therapy intervention.

Identifying research priorities for patient safety in mental health: an international expert Delphi study.

PubMed

Dewa, Lindsay H; Murray, Kevin; Thibaut, Bethan; Ramtale, Sonny Christian; Adam, Sheila; Darzi, Ara; Archer, Stephanie

2018-03-03

Physical healthcare has dominated the patient safety field; research in mental healthcare is not as extensive but findings from physical healthcare cannot be applied to mental healthcare because it delivers specialised care that faces unique challenges. Therefore, a clearer focus and recognition of patient safety in mental health as a distinct research area is still needed. The study aim is to identify future research priorities in the field of patient safety in mental health. Semistructured interviews were conducted with the experts to ascertain their views on research priorities in patient safety in mental health. A three-round online Delphi study was used to ascertain consensus on 117 research priority statements. Academic and service user experts from the USA, UK, Switzerland, Netherlands, Ireland, Denmark, Finland, Germany, Sweden, Australia, New Zealand and Singapore were included. Agreement in research priorities on a five-point scale. Seventy-nine statements achieved consensus (>70%). Three out of the top six research priorities were patient driven; experts agreed that understanding the patient perspective on safety planning, on self-harm and on medication was important. This is the first international Delphi study to identify research priorities in safety in the mental field as determined by expert academic and service user perspectives. A reasonable consensus was obtained from international perspectives on future research priorities in patient safety in mental health; however, the patient perspective on their mental healthcare is a priority. The research agenda for patient safety in mental health identified here should be informed by patient safety science more broadly and used to further establish this area as a priority in its own right. The safety of mental health patients must have parity with that of physical health patients to achieve this. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A proposed architecture and method of operation for improving the protection of privacy and confidentiality in disease registers

PubMed Central

Churches, Tim

2003-01-01

Background Disease registers aim to collect information about all instances of a disease or condition in a defined population of individuals. Traditionally methods of operating disease registers have required that notifications of cases be identified by unique identifiers such as social security number or national identification number, or by ensembles of non-unique identifying data items, such as name, sex and date of birth. However, growing concern over the privacy and confidentiality aspects of disease registers may hinder their future operation. Technical solutions to these legitimate concerns are needed. Discussion An alternative method of operation is proposed which involves splitting the personal identifiers from the medical details at the source of notification, and separately encrypting each part using asymmetrical (public key) cryptographic methods. The identifying information is sent to a single Population Register, and the medical details to the relevant disease register. The Population Register uses probabilistic record linkage to assign a unique personal identification (UPI) number to each person notified to it, although not necessarily everyone in the entire population. This UPI is shared only with a single trusted third party whose sole function is to translate between this UPI and separate series of personal identification numbers which are specific to each disease register. Summary The system proposed would significantly improve the protection of privacy and confidentiality, while still allowing the efficient linkage of records between disease registers, under the control and supervision of the trusted third party and independent ethics committees. The proposed architecture could accommodate genetic databases and tissue banks as well as a wide range of other health and social data collections. It is important that proposals such as this are subject to widespread scrutiny by information security experts, researchers and interested members of the general public, alike. PMID:12515580

Juvenile Justice, Mental Health, and the Transition to Adulthood: A Review of Service System Involvement and Unmet Needs in the U.S

PubMed Central

Zajac, Kristyn; Sheidow, Ashli J.; Davis, Maryann

2015-01-01

Although adolescents are the primary focus of juvenile justice, a significant number of young people involved with this system are considered transition age youth (i.e., 16–25 years of age). The aim of this review is to summarize the specific needs of transition age youth with mental health conditions involved with the juvenile justice system, identify the multiple service systems relevant to this group, and offer recommendations for policies and practice. A comprehensive search strategy was used to identify and synthesize the literature. Findings highlight the paucity of research specific to transition age youth. Thus, we also summarized relevant research on justice-involved adolescents, with a focus evaluating its potential relevance in the context of the unique milestones of the transition age, including finishing one’s education, setting and working towards vocational goals, and transitioning from ones’ family of origin to more independent living situations. Existing programs and initiatives relevant to transition age youth with mental health conditions are highlighted, and nine specific recommendations for policy and practice are offered. PMID:26273119

Colorectal Cancer Epidemiology in the Nurses’ Health Study

PubMed Central

Lee, Dong Hoon; Giovannucci, Edward L.

2016-01-01

Objectives. To review the contribution of the Nurses’ Health Study (NHS) to identifying risk and protective factors for colorectal adenomas and colorectal cancer (CRC). Methods. We performed a narrative review of the publications using the NHS between 1976 and 2016. Results. Existing epidemiological studies using the NHS have reported that red and processed meat, alcohol, smoking, and obesity were associated with an increased risk of CRC, whereas folate, calcium, vitamin D, aspirin, and physical activity were associated with decreased risk of CRC. Moreover, modifiable factors, such as physical activity, vitamin D, folate, insulin and insulin-like growth factor binding protein-1, and diet quality, were identified to be associated with survival among CRC patients. In recent years, molecular pathological epidemiological studies have been actively conducted and have shown refined results by molecular subtypes of CRC. Conclusions. The NHS has provided new insights into colorectal adenomas, CRC etiology, and pathogenic mechanisms. With its unique strengths, the NHS should continue to contribute to the field of CRC epidemiology and play a major role in public health. PMID:27459444

Juvenile Justice, Mental Health, and the Transition to Adulthood: A Review of Service System Involvement and Unmet Needs in the U.S.

PubMed

Zajac, Kristyn; Sheidow, Ashli J; Davis, Maryann

2015-09-01

Although adolescents are the primary focus of juvenile justice, a significant number of young people involved with this system are considered transition age youth (i.e., 16-25 years of age). The aim of this review is to summarize the specific needs of transition age youth with mental health conditions involved with the juvenile justice system, identify the multiple service systems relevant to this group, and offer recommendations for policies and practice. A comprehensive search strategy was used to identify and synthesize the literature. Findings highlight the paucity of research specific to transition age youth. Thus, we also summarized relevant research on justice-involved adolescents, with a focus evaluating its potential relevance in the context of the unique milestones of the transition age, including finishing one's education, setting and working towards vocational goals, and transitioning from ones' family of origin to more independent living situations. Existing programs and initiatives relevant to transition age youth with mental health conditions are highlighted, and nine specific recommendations for policy and practice are offered.

Implementing evidence-based practice in community mental health agencies: a multiple stakeholder analysis.

PubMed

Aarons, Gregory A; Wells, Rebecca S; Zagursky, Karen; Fettes, Danielle L; Palinkas, Lawrence A

2009-11-01

We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups. Implementation of EBP is a complex process. Cross-system-level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns.

Building a Consensus on Community Health Workers’ Scope of Practice: Lessons From New York

PubMed Central

Matos, Sergio; Hicks, April L.; Campbell, Ayanna; Moore, Addison; Diaz, Diurka

2012-01-01

Objectives. We evaluated efforts in New York to build a consensus between community health workers (CHWs) and employers on CHWs’ scope of practice, training standards, and certification procedures. Methods. We conducted multiple-choice surveys in 2008 and 2010 with 226 CHWs and 44 employers. We compared CHWs’ and employers’ recommendations regarding 28 scope of practice elements. The participatory ranking method was used to identify consensus scope of practice recommendations. Results. There was consensus on 5 scope of practice elements: outreach and community organizing, case management and care coordination, home visits, health education and coaching, and system navigation. For each element, 3 to 4 essential skills were identified, giving a total of 27 skills. These included all skills recommended in national CHW studies, along with 3 unique to New York: computer skills, participatory research methods, and time management. Conclusions. CHWs and employers in New York were in consensus on CHWs’ scope of practice on virtually all of the detailed core competency skills. The CHW scope of practice recommendations of these groups can help other states refine their scope of practice elements. PMID:22897548

The risky business of being an entomologist: A systematic review.

PubMed

Stanhope, Jessica; Carver, Scott; Weinstein, Philip

2015-07-01

Adverse work-related health outcomes are a significant problem worldwide. Entomologists, including arthropod breeders, are a unique occupational group exposed to potentially harmful arthropods, pesticides, and other more generic hazards. These exposures may place them at risk of a range of adverse work-related health outcomes. To determine what adverse work-related health outcomes entomologists have experienced, the incidence/prevalence of these outcomes, and what occupational management strategies have been employed by entomologists, and their effectiveness. A systematic search of eight databases was undertaken to identify studies informing the review objectives. Data pertaining to country, year, design, work-exposure, adverse work-related health outcomes, incidence/prevalence of these outcomes, and occupational management strategies were extracted, and reported descriptively. Results showed entomologists experienced work-related allergies, venom reactions, infections, infestations and delusional parasitosis. These related to exposure to insects, arachnids, chilopods and entognathans, and non-arthropod exposures, e.g. arthropod feed. Few studies reported the incidence/prevalence of such conditions, or work-related management strategies utilised by entomologists. There were no studies that specifically investigated the effectiveness of potential management strategies for entomologists as a population. Indeed, critical appraisal analysis indicated poor research quality in this area, which is a significant research gap. Entomologists are a diverse, unique occupational group, at risk of a range of adverse work-related health outcomes. This study represents the first systematic review of their work-related health risks. Future studies investigating the prevalence of adverse work-related health outcomes for entomologists, and the effectiveness of management strategies are warranted to decrease the disease burden of this otherwise understudied group. Copyright © 2015 Elsevier Inc. All rights reserved.

Parent and health care provider perspectives related to disclosure of autism spectrum disorder in pediatric emergency departments.

PubMed

Muskat, Barbara; Greenblatt, Andrea; Nicholas, David B; Ratnapalan, Savithiri; Cohen-Silver, Justine; Newton, Amanda S; Craig, William R; Kilmer, Christopher; Zwaigenbaum, Lonnie

2016-11-01

Children and youth with autism spectrum disorder presenting in emergency departments face potential cognitive, sensory, and behavioral challenges, and it is crucial for providers to be aware of their unique needs. However, disclosure of a child's autism spectrum disorder can be complex for parental caregivers and is not well understood. This qualitative study utilized a grounded theory approach and analyzed data from 28 parents and 16 health care providers related to autism spectrum disorder disclosure within two Canadian pediatric emergency departments. Study results indicated that participants identified benefits and risks of disclosure. Encouraging understanding, expediting service, and preparing health care providers for working with children with autism spectrum disorder were identified as benefits of disclosure. Risks related to disclosure included potential negative attributions toward the children and parental discomfort in disclosing a diagnosis in front of the children. Parents discussed the health care encounters they experienced following disclosure and provided recommendations for improving the disclosure process in the emergency department. It is recommended that future research explore the experiences of parents who choose not to disclose their child's autism spectrum disorder. Greater awareness of the disclosure experience and the development of resources and tools to support communication between parents and health care providers are also recommended. © The Author(s) 2016.

Identifying multi-level culturally appropriate smoking cessation strategies for Aboriginal health staff: a concept mapping approach.

PubMed

Dawson, Anna P; Cargo, Margaret; Stewart, Harold; Chong, Alwin; Daniel, Mark

2013-02-01

Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.

International Health Regulations (2005) and the U.S. Department of Defense: building core capacities on a foundation of partnership and trust.

PubMed

Johns, Matthew C; Blazes, David L

2010-12-03

A cornerstone of effective global health surveillance programs is the ability to build systems that identify, track and respond to public health threats in a timely manner. These functions are often difficult and require international cooperation given the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by both humans and animals. As part of the U.S. Armed Forces Health Surveillance Center (AFHSC), the Department of Defense's (DoD) Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) has developed a global network of surveillance sites over the past decade that engages in a wide spectrum of support activities in collaboration with host country partners. Many of these activities are in direct support of International Health Regulations (IHR[2005]). The network also supports host country military forces around the world, which are equally affected by these threats and are often in a unique position to respond in areas of conflict or during complex emergencies. With IHR(2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats.

Perspectives on the strategic uses of concept mapping to address public health challenges.

PubMed

Anderson, Lynda A; Slonim, Amy

2017-02-01

We examine the adaptation of approaches used to plan and implement the steps of concept mapping to meet specialized needs and requirements in several public health projects. Seven published concept mapping projects are detailed to document how each of the phases were modified to meet the specific aims of each project. Concept mapping was found to be a useful tool to complement public health roles such as assessment, program development, and priority setting. The phases of concept mapping allow for a blending of diverse perspectives, which is critical to public health efforts. The adaptability of concept mapping permits the use of multiple modalities such as the addition of face-to-face brainstorming; use of qualitative methods, including structured interviews; and review and use of published literature and guidelines. Another positive aspect of concept mapping for public health practice is its ability to identify program elements, provide a visual map of generated ideas and their relationships to one another, and assist in identifying priorities. Our reflections on the adaptability should help inform another generation in designing concept mapping projects and related products that may benefit from unique adaptations and the rapidly expanding social media technology and platforms. Copyright © 2016 Elsevier Ltd. All rights reserved.

Social marketing's unique contribution to mental health stigma reduction and HIV testing: two case studies.

PubMed

Thackeray, Rosemary; Keller, Heidi; Heilbronner, Jennifer Messenger; Dellinger, Laura K Lee

2011-03-01

Since its inception in 2005, articles in Health Promotion Practice's social marketing department have focused on describing social marketing's unique contributions and the application of each to the practice of health promotion. This article provides a brief review of six unique features (marketing mix, consumer orientation, segmentation, exchange, competition, and continuous monitoring) and then presents two case studies-one on reducing stigma related to mental health and the other a large-scale campaign focused on increasing HIV testing among African American youth. The two successful case studies show that social marketing principles can be applied to a wide variety of topics among various population groups.

Identifying Trajectories of Borderline Personality Features in Adolescence

PubMed Central

Haltigan, John D.

2016-01-01

Objective: To examine trajectories of adolescent borderline personality (BP) features in a normative-risk cohort (n = 566) of Canadian children assessed at ages 13, 14, 15, and 16 and childhood predictors of trajectory group membership assessed at ages 8, 10, 11, and 12. Method: Data were drawn from the McMaster Teen Study, an on-going study examining relations among bullying, mental health, and academic achievement. Participants and their parents completed a battery of mental health and peer relations questionnaires at each wave of the study. Academic competence was assessed at age 8 (Grade 3). Latent class growth analysis, analysis of variance, and logistic regression were used to analyze the data. Results: Three distinct BP features trajectory groups were identified: elevated or rising, intermediate or stable, and low or stable. Parent- and child-reported mental health symptoms, peer relations risk factors, and intra-individual risk factors were significant predictors of elevated or rising and intermediate or stable trajectory groups. Child-reported attention-deficit hyperactivity disorder (ADHD) and somatization symptoms uniquely predicted elevated or rising trajectory group membership, whereas parent-reported anxiety and child-reported ADHD symptoms uniquely predicted intermediate or stable trajectory group membership. Child-reported somatization symptoms was the only predictor to differentiate the intermediate or stable and elevated or rising trajectory groups (OR 1.15, 95% CI 1.04 to 1.28). Associations between child-reported reactive temperament and elevated BP features trajectory group membership were 10.23 times higher among children who were bullied, supporting a diathesis–stress pathway in the development of BP features for these youth. Conclusions: Findings demonstrate the heterogeneous course of BP features in early adolescence and shed light on the potential prodromal course of later borderline personality disorder. PMID:27254092

Identifying Trajectories of Borderline Personality Features in Adolescence: Antecedent and Interactive Risk Factors.

PubMed

Haltigan, John D; Vaillancourt, Tracy

2016-03-01

To examine trajectories of adolescent borderline personality (BP) features in a normative-risk cohort (n = 566) of Canadian children assessed at ages 13, 14, 15, and 16 and childhood predictors of trajectory group membership assessed at ages 8, 10, 11, and 12. Data were drawn from the McMaster Teen Study, an on-going study examining relations among bullying, mental health, and academic achievement. Participants and their parents completed a battery of mental health and peer relations questionnaires at each wave of the study. Academic competence was assessed at age 8 (Grade 3). Latent class growth analysis, analysis of variance, and logistic regression were used to analyze the data. Three distinct BP features trajectory groups were identified: elevated or rising, intermediate or stable, and low or stable. Parent- and child-reported mental health symptoms, peer relations risk factors, and intra-individual risk factors were significant predictors of elevated or rising and intermediate or stable trajectory groups. Child-reported attention-deficit hyperactivity disorder (ADHD) and somatization symptoms uniquely predicted elevated or rising trajectory group membership, whereas parent-reported anxiety and child-reported ADHD symptoms uniquely predicted intermediate or stable trajectory group membership. Child-reported somatization symptoms was the only predictor to differentiate the intermediate or stable and elevated or rising trajectory groups (OR 1.15, 95% CI 1.04 to 1.28). Associations between child-reported reactive temperament and elevated BP features trajectory group membership were 10.23 times higher among children who were bullied, supporting a diathesis-stress pathway in the development of BP features for these youth. Findings demonstrate the heterogeneous course of BP features in early adolescence and shed light on the potential prodromal course of later borderline personality disorder. © The Author(s) 2015.

Ménière's Disease: A CHEER Database Study of Local and Regional Patient Encounter and Procedure Patterns.

PubMed

Crowson, Matthew G; Schulz, Kristine; Parham, Kourosh; Vambutas, Andrea; Witsell, David; Lee, Walter T; Shin, Jennifer J; Pynnonen, Melissa A; Nguyen-Huynh, Anh; Ryan, Sheila E; Langman, Alan

2016-07-01

(1) Integrate practice-based patient encounters using the Dartmouth Atlas Medicare database to understand practice treatments for Ménière's disease (MD). (2) Describe differences in the practice patterns between academic and community providers for MD. Practice-based research database review. CHEER (Creating Healthcare Excellence through Education and Research) network academic and community providers. MD patient data were identified with ICD-9 and CPT codes. Demographics, unique visits, and procedures per patient were tabulated. The Dartmouth Atlas of Health Care was used to reference regional health care utilization. Statistical analysis included 1-way analyses of variance, bivariate linear regression, and Student's t tests, with significance set at P < .05. A total of 2071 unique patients with MD were identified from 8 academic and 10 community otolaryngology-head and neck surgery provider centers nationally. Average age was 56.5 years; 63.9% were female; and 91.4% self-reported white ethnicity. There was an average of 3.2 visits per patient. Western providers had the highest average visits per patient. Midwest providers had the highest average procedures per patient. Community providers had more visits per site and per patient than did academic providers. Academic providers had significantly more operative procedures per site (P = .0002) when compared with community providers. Health care service areas with higher total Medicare reimbursements per enrollee did not report significantly more operative procedures being performed. This is the first practice-based clinical research database study to describe MD practice patterns. We demonstrate that academic otolaryngology-head and neck surgery providers perform significantly more operative procedures than do community providers for MD, and we validate these data with an independent Medicare spending database. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Measuring teamwork and taskwork of community-based “teams” delivering life-saving health interventions in rural Zambia: a qualitative study

PubMed Central

2013-01-01

Background The use of teams is a well-known approach in a variety of settings, including health care, in both developed and developing countries. Team performance is comprised of teamwork and task work, and ascertaining whether a team is performing as expected to achieve the desired outcome has rarely been done in health care settings in resource-limited countries. Measuring teamwork requires identifying dimensions of teamwork or processes that comprise the teamwork construct, while taskwork requires identifying specific team functions. Since 2008 a community-based project in rural Zambia has teamed community health workers (CHWs) and traditional birth attendants (TBAs), supported by Neighborhood Health Committees (NHCs), to provide essential newborn and continuous curative care for children 0–59 months. This paper describes the process of developing a measure of teamwork and taskwork for community-based health teams in rural Zambia. Methods Six group discussions and pile-sorting sessions were conducted with three NHCs and three groups of CHW-TBA teams. Each session comprised six individuals. Results We selected 17 factors identified by participants as relevant for measuring teamwork in this rural setting. Participants endorsed seven functions as important to measure taskwork. To explain team performance, we assigned 20 factors into three sub-groups: personal, community-related and service-related. Conclusion Community and culturally relevant processes, functions and factors were used to develop a tool for measuring teamwork and taskwork in this rural community and the tool was quite unique from tools used in developed countries. PMID:23802766

Educational games for health professionals.

PubMed

Akl, Elie A; Kairouz, Victor F; Sackett, Kay M; Erdley, William S; Mustafa, Reem A; Fiander, Michelle; Gabriel, Carolynne; Schünemann, Holger

2013-03-28

The use of games as an educational strategy has the potential to improve health professionals' performance (e.g. adherence to standards of care) through improving their knowledge, skills and attitudes. The objective was to assess the effect of educational games on health professionals' performance, knowledge, skills, attitude and satisfaction, and on patient outcomes. We searched the following databases in January 2012: MEDLINE, AMED, CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, EPOC Register, ERIC, Proquest Dissertations & Theses Database, and PsycINFO. Related reviews were sought in DARE and the above named databases. Database searches identified 1546 citations. We also screened the reference lists of included studies in relevant reviews, contacted authors of relevant papers and reviews, and searched ISI Web of Science for papers citing studies included in the review. These search methods identified an additional 62 unique citations for a total of 1608 for this update. We included randomized controlled trials (RCT), controlled clinical trials (CCT), controlled before and after (CBA) and interrupted time-series analysis (ITS). Study participants were qualified health professionals or in postgraduate training. The intervention was an educational game with "a form of competitive activity or sport played according to rules". Using a standardized data form we extracted data on methodological quality, participants, interventions and outcomes of interest that included patient outcomes, professional behavior (process of care outcomes), and professional's knowledge, skills, attitude and satisfaction. The search strategy identified a total of 2079 unique citations. Out of 84 potentially eligible citations, we included two RCTs. The game evaluated in the first study used as a reinforcement technique, was based on the television game show "Family Feud" and focused on infection control. The study did not assess any patient or process of care outcomes. The group that was randomized to the game had statistically higher scores on the knowledge test (P = 0.02). The second study compared game-based learning ("Snakes and Ladders" board game) with traditional case-based learning of stroke prevention and management. The effect on knowledge was not statistically different between the two groups immediately and 3 months after the intervention. The level of reported enjoyment was higher in the game-based group. The findings of this systematic review neither confirm nor refute the utility of games as a teaching strategy for health professionals. There is a need for additional high-quality research to explore the impact of educational games on patient and performance outcomes.

Not Waiting for Godot: The Evolution of Health Promotion at PPG Industries.

PubMed

Colombi, Alberto M; Pringle, Janice L; Welsh, George T

2008-04-01

PPG Industries is a manufacturer of coatings, chemicals, optical products, specialty materials, glass, and fiberglass. The company's approach to healthcare combines perhaps 2 disparate concepts. The first is that employee health and behavior change relies to a large degree on employee awareness and ownership of their own health and second that "what gets measured gets done." It is widely acknowledged that one of the best tools for employee awareness is the health risk appraisal tool. Additional components of employee awareness include knowing key individual health metrics and effectively engaging with healthcare providers. As a leading global manufacturer, PPG well understands the critical importance of cost accounting and financial metrics to drive business decisions. PPG's perhaps unique approach comes from the strong marriage of individual health/wellness promotion and frequent, timely, and informative financial metrics on health and the cost of care. Combining capacity building through the mobilization of volunteer wellness teams with expert interventions and financial discipline is a feature of the experience here described. This approach has resulted in both management and employee engagement in the issue and has allowed PPG to bend the curve of ever-increasing healthcare costs and achieve cost increases per employee at one half the reported national average for companies of comparable size. Because this journal is dedicated to health and drug benefits, we gathered an appropriately representative team composed of a physician, an epidemiologist who resides in a pharmacy school, and a benefits manager. The team evolved from a common vision to identify ways of improving employee health and well-being. The team presented both as keynote speakers and as contributors to a breakout session at the National Symposium on Work-Life organized in 2007 by the National Institute for Occupational Safety and Health, a federal agency of the Centers for Disease Control and Prevention in the Department of Health and Human Services. This article is an account of why and how such a unique team was formed.

Not Waiting for Godot: The Evolution of Health Promotion at PPG Industries

PubMed Central

Colombi, Alberto M.; Pringle, Janice L.; Welsh, George T.

2008-01-01

PPG Industries is a manufacturer of coatings, chemicals, optical products, specialty materials, glass, and fiberglass. The company's approach to healthcare combines perhaps 2 disparate concepts. The first is that employee health and behavior change relies to a large degree on employee awareness and ownership of their own health and second that “what gets measured gets done.” It is widely acknowledged that one of the best tools for employee awareness is the health risk appraisal tool. Additional components of employee awareness include knowing key individual health metrics and effectively engaging with healthcare providers. As a leading global manufacturer, PPG well understands the critical importance of cost accounting and financial metrics to drive business decisions. PPG's perhaps unique approach comes from the strong marriage of individual health/wellness promotion and frequent, timely, and informative financial metrics on health and the cost of care. Combining capacity building through the mobilization of volunteer wellness teams with expert interventions and financial discipline is a feature of the experience here described. This approach has resulted in both management and employee engagement in the issue and has allowed PPG to bend the curve of ever-increasing healthcare costs and achieve cost increases per employee at one half the reported national average for companies of comparable size. Because this journal is dedicated to health and drug benefits, we gathered an appropriately representative team composed of a physician, an epidemiologist who resides in a pharmacy school, and a benefits manager. The team evolved from a common vision to identify ways of improving employee health and well-being. The team presented both as keynote speakers and as contributors to a breakout session at the National Symposium on Work-Life organized in 2007 by the National Institute for Occupational Safety and Health, a federal agency of the Centers for Disease Control and Prevention in the Department of Health and Human Services. This article is an account of why and how such a unique team was formed. PMID:25126222

Mass media in Peru promotes "responsible parenthood".

PubMed

Brace, J; Pareja, R

1985-01-01

This article describes a media campaign being carried out in Peru under the auspices of the Ministry of Health. The overall theme of the campaign is Responsible Parenthood, specifically in the areas of family planing, oral rehydration, and immunization. The mass media campaign was based on the results of extensive audience research data that identified knowledge and beliefs in these areas. The research identified 2 target audiences for family planning messages: those who want no more children and those who are using traditional contraceptive methods. In addition to quantitative audience surveys, focus group discussions were held. These groups revealed important information about contraceptive habits, male attitudes toward family planning, and the folk vocabulary used for family planning activities. They further suggested that the quality of services given in health centers affects future use of that service and that the most credible source of information about family planning is considered to be a mature female doctor, herself a mother. Pretesting of television spots for the campaign was valuable for identifying unacceptable or ineffective images. It was also learned that radio and telvision spots cannot be the same; rather, they require unique content.

In their own words? A terminological analysis of e-mail to a cancer information service.

PubMed Central

Smith, Catherine Arnott; Stavri, P. Zoë; Chapman, Wendy Webber

2002-01-01

OBJECTIVE: To better understand the terms used by consumers to describe their health information needs and determine if this "consumer terminology"differs from those used by health care professionals. METHODS: Features and findings identified in 139 e-mail messages to the University of Pittsburgh Cancer Institute's Cancer Information and Referral Service were coded and matched against the 2001 Unified Medical Language System Metathesaurus. RESULTS:504 unique terms were identified. 185 (36%) were exact matches to concepts in the 2001 UMLS Metathesaurus (MTH). 179 (35%) were partial string matches; 119 (24%) were known synonyms for MTH concepts; and 2 (<1%) were lexical variants. Only 19,or 4% of the total terms, were not found to be present in the 2001 MT1H. CONCLUSION: 96% of the clinical findings and features mentioned in e-mail by correspondents who did not self-identify as healthcare professionals were described using terms from controlled healthcare terminologies. The notion of a paradigmatic "consumer" who uses a particular vocabulary specific to her "consumer" status may be ill-founded. PMID:12463914

Prevention of violence in prison - The role of health care professionals.

PubMed

Pont, Jörg; Stöver, Heino; Gétaz, Laurent; Casillas, Alejandra; Wolff, Hans

2015-08-01

The World Health Organization (WHO) classifies violence prevention as a public health priority. In custodial settings, where violence is problematic, administrators and custodial officials are usually tasked with the duty of addressing this complicated issue-leaving health care professionals largely out of a discussion and problem-solving process that should ideally be multidisciplinary in approach. Health care professionals who care for prisoners are in a unique position to help identify and prevent violence, given their knowledge about health and violence, and because of the impartial position they must sustain in the prison environment in upholding professional ethics. Thus, health care professionals working in prisons should be charged with leading violence prevention efforts in custodial settings. In addition to screening for violence and detecting violent events upon prison admission, health care professionals in prison must work towards uniform in-house procedures for longitudinal and systemized medical recording/documentation of violence. These efforts will benefit the future planning, implementation, and evaluation of focused strategies for violence prevention in prisoner populations. Copyright © 2015. Published by Elsevier Ltd.

Dimensions of Perceived Racism and Self-Reported Health: Examination of Racial/Ethnic Differences and Potential Mediators

PubMed Central

Hausmann, Leslie R. M.; Jhalani, Juhee; Pencille, Melissa; Atencio-Bacayon, Jennifer; Kumar, Asha; Kwok, Jasmin; Ullah, Jahanara; Roth, Alan; Chen, Daniel; Crupi, Robert; Schwartz, Joseph

2016-01-01

Background Many details of the negative relationship between perceived racial/ethnic discrimination and health are poorly understood. Purpose The purpose of this study was to examine racial/ ethnic differences in the relationship between perceived discrimination and self-reported health, identify dimensions of discrimination that drive this relationship, and explore psychological mediators. Methods Asian, Black, and Latino(a) adults (N=734) completed measures of perceived racial/ethnic discrimination, self-reported health, depression, anxiety, and cynical hostility. Results The association between perceived discrimination and poor self-reported health was significant and did not differ across racial/ethnic subgroups. Race-related social exclusion and threat/harassment uniquely contributed to poor health for all groups. Depression, anxiety, and cynical hostility fully mediated the effect of social exclusion on health, but did not fully explain the effect of threat. Conclusions Our results suggest that noxious effects of race-related exclusion and threat transcend between-group differences in discriminatory experiences. The effects of race-related exclusion and threat on health, however, may operate through different mechanisms. PMID:21374099

Assessment and longitudinal analysis of health impacts and stressors perceived to result from unconventional shale gas development in the Marcellus Shale region.

PubMed

Ferrar, Kyle J; Kriesky, Jill; Christen, Charles L; Marshall, Lynne P; Malone, Samantha L; Sharma, Ravi K; Michanowicz, Drew R; Goldstein, Bernard D

2013-01-01

Concerns for health and social impacts have arisen as a result of Marcellus Shale unconventional natural gas development. Our goal was to document the self-reported health impacts and mental and physical health stressors perceived to result from Marcellus Shale development. Two sets of interviews were conducted with a convenience sample of community members living proximal to Marcellus Shale development, session 1 March-September 2010 (n = 33) and session 2 January-April 2012 (n = 20). Symptoms of health impacts and sources of psychological stress were coded. Symptom and stressor counts were quantified for each interview. The counts for each participant were compared longitudinally. Participants attributed 59 unique health impacts and 13 stressors to Marcellus Shale development. Stress was the most frequently-reported symptom. Over time, perceived health impacts increased (P = 0·042), while stressors remained constant (P = 0·855). Exposure-based epidemiological studies are needed to address identified health impacts and those that may develop as unconventional natural gas extraction continues. Many of the stressors can be addressed immediately.

A Putative Gene Cluster from a Lyngbya wollei Bloom that Encodes Paralytic Shellfish Toxin Biosynthesis

PubMed Central

Mihali, Troco K.; Carmichael, Wayne W.; Neilan, Brett A.

2011-01-01

Saxitoxin and its analogs cause the paralytic shellfish-poisoning syndrome, adversely affecting human health and coastal shellfish industries worldwide. Here we report the isolation, sequencing, annotation, and predicted pathway of the saxitoxin biosynthetic gene cluster in the cyanobacterium Lyngbya wollei. The gene cluster spans 36 kb and encodes enzymes for the biosynthesis and export of the toxins. The Lyngbya wollei saxitoxin gene cluster differs from previously identified saxitoxin clusters as it contains genes that are unique to this cluster, whereby the carbamoyltransferase is truncated and replaced by an acyltransferase, explaining the unique toxin profile presented by Lyngbya wollei. These findings will enable the creation of toxin probes, for water monitoring purposes, as well as proof-of-concept for the combinatorial biosynthesis of these natural occurring alkaloids for the production of novel, biologically active compounds. PMID:21347365

cual-id: Globally Unique, Correctable, and Human-Friendly Sample Identifiers for Comparative Omics Studies.

PubMed

Chase, John H; Bolyen, Evan; Rideout, Jai Ram; Caporaso, J Gregory

2016-01-01

The number of samples in high-throughput comparative "omics" studies is increasing rapidly due to declining experimental costs. To keep sample data and metadata manageable and to ensure the integrity of scientific results as the scale of these projects continues to increase, it is essential that we transition to better-designed sample identifiers. Ideally, sample identifiers should be globally unique across projects, project teams, and institutions; short (to facilitate manual transcription); correctable with respect to common types of transcription errors; opaque, meaning that they do not contain information about the samples; and compatible with existing standards. We present cual-id, a lightweight command line tool that creates, or mints, sample identifiers that meet these criteria without reliance on centralized infrastructure. cual-id allows users to assign universally unique identifiers, or UUIDs, that are globally unique to their samples. UUIDs are too long to be conveniently written on sampling materials, such as swabs or microcentrifuge tubes, however, so cual-id additionally generates human-friendly 4- to 12-character identifiers that map to their UUIDs and are unique within a project. By convention, we use "cual-id" to refer to the software, "CualID" to refer to the short, human-friendly identifiers, and "UUID" to refer to the globally unique identifiers. CualIDs are used by humans when they manually write or enter identifiers, while the longer UUIDs are used by computers to unambiguously reference a sample. Finally, cual-id optionally generates printable label sticker sheets containing Code 128 bar codes and CualIDs for labeling of sample collection and processing materials. IMPORTANCE The adoption of identifiers that are globally unique, correctable, and easily handwritten or manually entered into a computer will be a major step forward for sample tracking in comparative omics studies. As the fields transition to more-centralized sample management, for example, across labs within an institution, across projects funded under a common program, or in systems designed to facilitate meta- and/or integrated analysis, sample identifiers generated with cual-id will not need to change; thus, costly and error-prone updating of data and metadata identifiers will be avoided. Further, using cual-id will ensure that transcription errors in sample identifiers do not require the discarding of otherwise-useful samples that may have been expensive to obtain. Finally, cual-id is simple to install and use and is free for all use. No centralized infrastructure is required to ensure global uniqueness, so it is feasible for any lab to get started using these identifiers within their existing infrastructure.

Recruiting Women to a Mobile Health Smoking Cessation Trial: Low- and No-Cost Strategies.

PubMed

Abbate, Kristopher J; Hingle, Melanie D; Armin, Julie; Giacobbi, Peter; Gordon, Judith S

2017-11-03

Successful recruitment of participants to mobile health (mHealth) studies presents unique challenges over in-person studies. It is important to identify recruitment strategies that maximize the limited recruitment resources available to researchers. The objective of this study was to describe a case study of a unique recruitment process used in a recent mHealth software app designed to increase smoking cessation among weight-concerned women smokers. The See Me Smoke-Free app was deployed to the Google Play Store (Alphabet, Inc., Google, LLC), where potential participants could download the app and enroll in the study. Users were invited in-app to participate in the study, with no in-person contact. The recruitment activities relied primarily on earned (free) and social media. To determine the relationship between recruitment activities and participant enrollment, the researchers explored trends in earned and social media activity in relation to app installations, examined social media messaging in relation to reach or impressions, and described app users' self-reported referral source. The researchers collected and descriptively analyzed data regarding recruitment activities, social media audience, and app use during the 18-week recruitment period (March 30, 2015-July 31, 2015). Data were collected and aggregated from internal staff activity tracking documents and from Web-based data analytics software such as SumAll, Facebook Insights (Facebook, Inc.), and Google Analytics (Alphabet, Inc., Google, LLC). Media coverage was documented across 75 publications and radio or television broadcasts, 35 of which were local, 39 national, and 1 international. The research team made 30 Facebook posts and 49 tweets, yielding 1821 reaches and 6336 impressions, respectively. From March 30, 2015 to July 31, 2015, 289 unique users downloaded the app, and 151 participants enrolled in the study. Research identifying effective online recruitment methods for mHealth studies remains minimal, and findings are inconsistent. We demonstrated how earned media can be leveraged to recruit women to an mHealth smoking cessation trial at low cost. Using earned media and leveraging social media allowed us to enroll 3 times the number of participants that we anticipated enrolling. The cost of earned media resides in the staff time required to manage it, particularly the regular interaction with social media. We recommend communication and cooperation with university public affairs and social media offices, as well as affiliate programs in journalism and communications, so that earned media can be used as a recruitment strategy for mHealth behavior change interventions. However, press releases are not always picked up by the media and should not be considered as a stand-alone method of recruitment. Careful consideration of an intervention's broad appeal and how that translates into potential media interest is needed when including earned media as part of a comprehensive recruitment plan for mHealth research. ©Kristopher J Abbate, Melanie D Hingle, Julie Armin, Peter Giacobbi Jr, Judith S Gordon. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.11.2017.

Recruiting Women to a Mobile Health Smoking Cessation Trial: Low- and No-Cost Strategies

PubMed Central

Hingle, Melanie D; Armin, Julie; Giacobbi Jr, Peter; Gordon, Judith S

2017-01-01

Background Successful recruitment of participants to mobile health (mHealth) studies presents unique challenges over in-person studies. It is important to identify recruitment strategies that maximize the limited recruitment resources available to researchers. Objective The objective of this study was to describe a case study of a unique recruitment process used in a recent mHealth software app designed to increase smoking cessation among weight-concerned women smokers. The See Me Smoke-Free app was deployed to the Google Play Store (Alphabet, Inc., Google, LLC), where potential participants could download the app and enroll in the study. Users were invited in-app to participate in the study, with no in-person contact. The recruitment activities relied primarily on earned (free) and social media. Methods To determine the relationship between recruitment activities and participant enrollment, the researchers explored trends in earned and social media activity in relation to app installations, examined social media messaging in relation to reach or impressions, and described app users’ self-reported referral source. The researchers collected and descriptively analyzed data regarding recruitment activities, social media audience, and app use during the 18-week recruitment period (March 30, 2015-July 31, 2015). Data were collected and aggregated from internal staff activity tracking documents and from Web-based data analytics software such as SumAll, Facebook Insights (Facebook, Inc.), and Google Analytics (Alphabet, Inc., Google, LLC). Results Media coverage was documented across 75 publications and radio or television broadcasts, 35 of which were local, 39 national, and 1 international. The research team made 30 Facebook posts and 49 tweets, yielding 1821 reaches and 6336 impressions, respectively. From March 30, 2015 to July 31, 2015, 289 unique users downloaded the app, and 151 participants enrolled in the study. Conclusions Research identifying effective online recruitment methods for mHealth studies remains minimal, and findings are inconsistent. We demonstrated how earned media can be leveraged to recruit women to an mHealth smoking cessation trial at low cost. Using earned media and leveraging social media allowed us to enroll 3 times the number of participants that we anticipated enrolling. The cost of earned media resides in the staff time required to manage it, particularly the regular interaction with social media. We recommend communication and cooperation with university public affairs and social media offices, as well as affiliate programs in journalism and communications, so that earned media can be used as a recruitment strategy for mHealth behavior change interventions. However, press releases are not always picked up by the media and should not be considered as a stand-alone method of recruitment. Careful consideration of an intervention’s broad appeal and how that translates into potential media interest is needed when including earned media as part of a comprehensive recruitment plan for mHealth research. PMID:29101091

Exploring Physician Perspectives of Residency Holdover Handoffs: A Qualitative Study to Understand an Increasingly Important Type of Handoff.

PubMed

Duong, Jonathan A; Jensen, Trevor P; Morduchowicz, Sasha; Mourad, Michelle; Harrison, James D; Ranji, Sumant R

2017-06-01

The term "holdover admissions" refers to patients admitted by an overnight physician and whose care is then transferred to a new primary team the next morning. Descriptions of the holdover process in internal medicine are sparse. To identify important factors affecting the quality of holdover handoffs at an internal medicine (IM) residency program and to compare them to previously identified factors for other handoffs. We undertook a qualitative study using structured focus groups and interviews. We analyzed data using qualitative content analysis. IM residents, IM program directors, and hospitalists at a large academic medical center. A nine-question open-ended interview guide. We identified 13 factors describing holdover handoffs. Five factors-physical space, standardization, task accountability, closed-loop verification, and resilience-were similar to those described in prior handoff literature in other specialties. Eight factors were new concepts that may uniquely affect the quality of the holdover handoff in IM. These included electronic health record access, redundancy, unwritten thoughts, different clinician needs, diagnostic uncertainty, anchoring, teaching, and feedback. These factors were organized into five overarching themes: physical environment, information transfer, responsibility, clinical reasoning, and education. The holdover handoff in IM is complex and has unique considerations for achieving high quality. Further exploration of safe, efficient, and educational holdover handoff practices is necessary.

SWATH-based proteomics identified carbonic anhydrase 2 as a potential diagnosis biomarker for nasopharyngeal carcinoma

PubMed Central

Luo, Yanzhang; Mok, Tin Seak; Lin, Xiuxian; Zhang, Wanling; Cui, Yizhi; Guo, Jiahui; Chen, Xing; Zhang, Tao; Wang, Tong

2017-01-01

Nasopharyngeal carcinoma (NPC) is a serious threat to public health, and the biomarker discovery is of urgent needs. The data-independent mode (DIA) based sequential window acquisition of all theoretical fragment-ion spectra (SWATH) mass spectrometry (MS) has been proved to be precise in protein quantitation and efficient for cancer biomarker researches. In this study, we performed the first SWATH-MS analysis comparing the NPC and normal tissues. Spike-in stable isotope labeling by amino acids in cell culture (super-SILAC) MS was used as a shotgun reference. We identified and quantified 1414 proteins across all SWATH-MS analyses. We found that SWATH-MS had a unique feature to preferentially detect proteins with smaller molecular weights than either super-SILAC MS or human proteome background. With SWATH-MS, 29 significant differentially express proteins (DEPs) were identified. Among them, carbonic anhydrase 2 (CA2) was selected for further validation per novelty, MS quality and other supporting rationale. With the tissue microarray analysis, we found that CA2 had an AUC of 0.94 in differentiating NPC from normal tissue samples. In conclusion, SWATH-MS has unique features in proteome analysis, and it leads to the identification of CA2 as a potentially new diagnostic biomarker for NPC. PMID:28117408

Health literacy in childhood and youth: a systematic review of definitions and models.

PubMed

Bröder, Janine; Okan, Orkan; Bauer, Ullrich; Bruland, Dirk; Schlupp, Sandra; Bollweg, Torsten M; Saboga-Nunes, Luis; Bond, Emma; Sørensen, Kristine; Bitzer, Eva-Maria; Jordan, Susanne; Domanska, Olga; Firnges, Christiane; Carvalho, Graça S; Bittlingmayer, Uwe H; Levin-Zamir, Diane; Pelikan, Jürgen; Sahrai, Diana; Lenz, Albert; Wahl, Patricia; Thomas, Malcolm; Kessl, Fabian; Pinheiro, Paulo

2017-04-26

Children and young people constitute a core target group for health literacy research and practice: during childhood and youth, fundamental cognitive, physical and emotional development processes take place and health-related behaviours and skills develop. However, there is limited knowledge and academic consensus regarding the abilities and knowledge a child or young person should possess for making sound health decisions. The research presented in this review addresses this gap by providing an overview and synthesis of current understandings of health literacy in childhood and youth. Furthermore, the authors aim to understand to what extent available models capture the unique needs and characteristics of children and young people. Six databases were systematically searched with relevant search terms in English and German. Of the n = 1492 publications identified, N = 1021 entered the abstract screening and N = 340 full-texts were screened for eligibility. A total of 30 articles, which defined or conceptualized generic health literacy for a target population of 18 years or younger, were selected for a four-step inductive content analysis. The systematic review of the literature identified 12 definitions and 21 models that have been specifically developed for children and young people. In the literature, health literacy in children and young people is described as comprising variable sets of key dimensions, each appearing as a cluster of related abilities, skills, commitments, and knowledge that enable a person to approach health information competently and effectively and to derive at health-promoting decisions and actions. Identified definitions and models are very heterogeneous, depicting health literacy as multidimensional, complex construct. Moreover, health literacy is conceptualized as an action competence, with a strong focus on personal attributes, while also recognising its interrelatedness with social and contextual determinants. Life phase specificities are mainly considered from a cognitive and developmental perspective, leaving children's and young people's specific needs, vulnerabilities, and social structures poorly incorporated within most models. While a critical number of definitions and models were identified for youth or secondary school students, similar findings are lacking for children under the age of ten or within a primary school context.

Public health education for midwives and midwifery students: a mixed methods study.

PubMed

McNeill, Jenny; Doran, Jackie; Lynn, Fiona; Anderson, Gail; Alderdice, Fiona

2012-12-07

Current national and international maternity policy supports the importance of addressing public health goals and investing in early years. Health care providers for women during the reproductive and early postnatal period have the opportunity to encourage women to make choices that will impact positively on maternal and fetal health. Midwives are in a unique position, given the emphasis of the philosophy of midwifery care on building relationships and incorporating a holistic approach, to support women to make healthy choices with the aim of promoting health and preventing ill health. However, exploration of the educational preparation of midwives to facilitate public health interventions has been relatively limited. The aim of the study was to identify the scope of current midwifery pre registration educational provision in relation to public health and to explore the perspectives of midwives and midwifery students about the public health role of the midwife. This was a mixed methods study incorporating a survey of Higher Educational Institutions providing pre registration midwifery education across the UK and focus groups with midwifery students and registered midwives. Twenty nine institutions (53% response) participated in the survey and nine focus groups were conducted (59 participants). Public health education was generally integrated into pre registration midwifery curricula as opposed to taught as a discrete subject. There was considerable variation in the provision of public health topics within midwifery curricula and the hours of teaching allocated to them. Focus group data indicated that it was consistently difficult for both midwifery students and midwives to articulate clearly their understanding and definition of public health in relation to midwifery. There is a unique opportunity to impact on maternal and infant health throughout the reproductive period; however the current approach to public health within midwifery education should be reviewed to capitalise on the role of the midwife in delivering public health interventions. It is clear that better understanding of midwifery public health roles and the visibility of public health within midwifery is required in order to maximise the potential contribution of midwives to achieving short and long term public health population goals.

The application of a biometric identification technique for linking community and hospital data in rural Ghana

PubMed Central

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

Background The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information. PMID:26993473

The application of a biometric identification technique for linking community and hospital data in rural Ghana.

PubMed

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

Improving Patient Safety: Avoiding Unread Imaging Exams in the National VA Enterprise Electronic Health Record.

PubMed

Bastawrous, Sarah; Carney, Benjamin

2017-06-01

In the current digital and filmless age of radiology, rates of unread radiology exams remain low, however, may still exist in unique environments. Veterans Affairs (VA) health care systems may experience higher rates of unread exams due to coexistence of Veterans Health Information Systems and Technology Architecture (VistA) imaging and commercial picture archiving and communication systems (PACS). The purpose of this patient safety initiative was to identify any unread exams and causes leading to unread exams. Following approval by departmental quality assurance committee, a comprehensive review was performed of all radiology exams within VistA imaging from July 1, 2009 to June 30, 2014 to identify unread radiology exams. Over the 5-year period, the total unread exam rate was calculated to be 0.17%, with the highest yearly unread exam rate of 0.25%. The leading majority of unread exam type was plain radiographs. Analysis revealed unfinished dictations, unassociated accession numbers, technologist errors, and inefficient radiologist work lists as top contributors to unread exams. Once unread radiology exams were discovered and the causes identified, valuable process changes were implemented within our department to ensure simultaneous tracking of all unread exams in VistA imaging as well as the commercial PACS.

Best Practices and Innovations for Managing Codeine Misuse and Dependence.

PubMed

Norman, Ian J; Bergin, Michael; Parry, Charles D; Van Hout, Marie Claire

Promoting and ensuring safe use of codeine containing medicines remains a public health issue given the rise in reporting of misuse and dependence particularly in countries where available over-the-counter (OTC). The aim of this unique study was to identify best practices in management of opioid abuse and dependence, particularly codeine, and innovations to meet challenges surrounding safe and compliant use, patient awareness-raising, reducing health harms and enhancing successful treatment of dependence. A mixed methods approach using three data points was used that included : (1) analysis of data from existing scoping reviews to identify potential areas for innovation (2) interviews with key national stakeholders from public health, pharmaceutical, regulatory, primary care and addiction practice in three distinct regulatory regimes (Ireland, United Kingdom and South Africa); and (3) a circular email request for information on potential innovations to members of the European Medicine's Agency European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP). Data from these three sources were analysed to identify best practices and opportunities for innovation. Best practices and potential innovations were identified under the nine headings: (1) manufacture; (2) product information and public education; (3) responsible prescribing; (4) monitoring and surveillance; (5) dispensing, screening and brief interventions in community pharmacies; (6) safety in the workplace and on the road; (7) internet supply of codeine and online support; (8) treatment of codeine dependence; and (9) learning resources and training for health professionals. Challenges ensuring availability of codeine containing medicines for legitimate therapeutic use, while minimising misuse, dependence and related health harms warrant consideration of new innovations. Most promising innovative potential lies across the products' retail lifecycle from manufacture to prescriber and community pharmacy practitioner.This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

Pragmatists, positive communicators, and shy enthusiasts: three viewpoints on Web conferencing in health sciences education.

PubMed

Valaitis, Ruta; Akhtar-Danesh, Noori; Eva, Kevin; Levinson, Anthony; Wainman, Bruce

2007-12-31

Web conferencing is a synchronous technology that allows coordinated online audio and visual interactions with learners logged in to a central server. Recently, its use has grown rapidly in academia, while research on its use has not kept up. Conferencing systems typically facilitate communication and support for multiple presenters in different locations. A paucity of research has evaluated synchronous Web conferencing in health sciences education. McMaster University Faculty of Health Sciences trialed Wimba's Live Classroom Web conferencing technology to support education and curriculum activities with students and faculty. The purpose of this study was to explore faculty, staff, and student perceptions of Web conferencing as a support for teaching and learning in health sciences. The Live Classroom technology provided features including real-time VoIP audio, an interactive whiteboard, text chat, PowerPoint slide sharing, application sharing, and archiving of live conferences to support student education and curriculum activities. Q-methodology was used to identify unique and common viewpoints of participants who had exposure to Web conferencing to support educational applications during the trial evaluation period. This methodology is particularly useful for research on human perceptions and interpersonal relationships to identify groups of participants with different perceptions. It mixes qualitative and quantitative methods. In a Q-methodology study, the goal is to uncover different patterns of thought rather than their numerical distribution among the larger population. A total of 36 people participated in the study, including medical residents (14), nursing graduate students (11), health sciences faculty (9), and health sciences staff (2). Three unique viewpoints were identified: pragmatists (factor 1), positive communicators (factor 2A), and shy enthusiasts (factor 2B). These factors explained 28% (factor 1) and 11% (factor 2) of the total variance, respectively. The majority of respondents were pragmatists (n = 26), who endorsed the value of Web conferencing yet identified that technical and ease-of-use problems could jeopardize its use. Positive communicators (N = 4) enjoyed technology and felt that Web conferencing could facilitate communication in a variety of contexts. Shy enthusiasts (N = 4) were also positive and comfortable with the technology but differed in that they preferred communicating from a distance rather than face-to-face. Common viewpoints were held by all groups: they found Web conferencing to be superior to audio conferencing alone, felt more training would be useful, and had no concerns that Web conferencing would hamper their interactivity with remote participants or that students accustomed to face-to-face learning would not enjoy Web conferencing. Overall, all participants, including pragmatists who were more cautious about the technology, viewed Web conferencing as an enabler, especially when face-to-face meetings were not possible. Adequate technical support and training need to be provided for successful ongoing implementation of Web conferencing.

The Diabetes Disparity and Puerto Rican Identified Individuals.

PubMed

Johnson, Jalil A; Cavanagh, Stephen; Jacelon, Cynthia S; Chasan-Taber, Lisa

2017-04-01

Purpose The purpose of this systematic review was to describe what is known about the diabetes disparity affecting Puerto Rican identified adults living in the continental United States as well as illuminate areas that merit further investigation. Methods The CINAHL and PubMed databases were searched using the keywords Hispanic, Puerto Rican, and type 2 diabetes. Search limits included < 10-year-old, peer-reviewed, systematic reviews, available in the English language. The abstracts of 124 articles were reviewed, and 7 articles were reviewed in depth. Results The Puerto Rican identified Hispanic subgroup is disproportionately affected by diabetes-the diabetes disparity. Puerto Rican identified Hispanic adults are less affected by citizenship status, may be less affected by English proficiency, use health care services differently, and have contextually different fatalistic views of diabetes compared with other Hispanic identified people. Spiritual/religious influences, associated mental health problems, and general cultural practices related to diabetes self-care are understudied in this group. Conclusion Ambiguous use of the term Hispanic should be avoided when describing Hispanic subgroups. Stronger, more robust studies are needed to understand the unique cultural forces influencing the poor diabetes outcomes and individual behaviors that contribute to generally suboptimal diabetes self-care for Puerto Rican adults with type 2 diabetes.

Experiences of Latinos with limited English proficiency with patient registration systems and their interactions with clinic front office staff: an exploratory study to inform community-based translational research in North Carolina.

PubMed

Calo, William A; Cubillos, Laura; Breen, James; Hall, Megan; Rojas, Krycya Flores; Mooneyham, Rachel; Schaal, Jennifer; Hardy, Christina Yongue; Dave, Gaurav; Jolles, Mónica Pérez; Garcia, Nacire; Reuland, Daniel S

2015-12-23

Health services research of Latinos with limited English proficiency (LEP) have largely focused on studying disparities related to patient-provider communication. Less is known about their non-provider interactions such as those with patient registration systems and clinic front office staff; these interactions precede the encounter with providers and may shape how comfortable patients feel about their overall health services experience. This study explored Latino patients with LEP experiences with, and expectations for, interactions with patient registration systems and front office staff. We conducted 20 in-depth interviews with Latinos with LEP (≥ 18 years of age) who seek health services in the Piedmont Triad region, North Carolina. We analyzed participants' quotes and identified themes by using a constant comparison method. This research was conducted by a community-academic partnership; partners were engaged in study design, instrument development, recruitment, data analysis, and manuscript writing. Qualitative analysis allowed us to identify the following recurring themes: 1) inconsistent registration of multiple surnames may contribute to patient misidentification errors and delays in receiving health care; 2) lack of Spanish language services in front office medical settings negatively affect care coordination and satisfaction with health care; and 3) perceived discrimination generates patients' mistrust in front office staff and discomfort with services. Latino patients in North Carolina experience health services barriers unique to their LEP background. Participants identified ways in which the lack of cultural and linguistic competence of front office staff negatively affect their experiences seeking health services. Healthcare organizations need to support their staff to encourage patient-centered principles.

Why it's important for it to stop: Examining the mental health correlates of bullying and ill-treatment at work in a cohort study.

PubMed

Butterworth, Peter; Leach, Liana S; Kiely, Kim M

2016-11-01

There is limited Australian information on the prevalence and mental health consequences of bullying and ill-treatment at work. The aims of this study were to use data from an ongoing Australian longitudinal cohort study to (1) compare different measures of workplace bullying, (2) estimate the prevalence of bullying and ill-treatment at work, (3) evaluate whether workplace bullying is distinct from other adverse work characteristics and (4) examine the unique contribution of workplace bullying to common mental disorders in mid-life. The sample comprised 1466 participants (52% women) aged 52-58 from wave four of the Personality and Total Health (PATH) through Life study. Workplace bullying was assessed by a single item of self-labelling measure of bullying and a 15-item scale of bullying-related behaviours experienced in the past 6 months. Factor analysis the identified underlying factor structure of the behavioural bullying scale. Current bullying was reported by 7.0% of respondents, while 46.4% of respondents reported that they had been bullied at some point in their working life. Person-related and work-related bullying behaviours were more common than violence and intimidation. The multi-dimensional scale of bullying behaviours had greater concordance with a single item of self-labelled bullying (Area Under the Curve = 0.88) than other adverse work characteristics (all Area Under the Curves < 0.67). Self-labelled bullying and scales reflecting person-related and work-related bullying were independent predictors of depression and/or anxiety. This study provides unique information on the prevalence and mental health impacts of workplace bullying and ill-treatment in Australia. Workplace bullying is a relatively common experience, and is associated with increased risk of depression and anxiety. Greater attention to identifying and preventing bullying and ill-treatment in the workplace is warranted. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Health needs and priorities of Syrian refugees in camps and urban settings in Jordan: perspectives of refugees and health care providers.

PubMed

Al-Rousan, Tala; Schwabkey, Zaker; Jirmanus, Lara; Nelson, Brett D

2018-06-10

The United Nations has declared the Syrian refugee crisis to be the biggest humanitarian emergency of our era. Neighbouring countries, such as Jordan, strain to meet the health needs of Syrian refugees in addition to their own citizens given limited resources. This study aimed to determine the perspectives of Syrian refugees in Jordan, Jordanian health care providers and other stakeholders in addressing the public health issues of the refugee crisis. Qualitative and quantitative methodologies were used to explore Syrian refugee health needs and services in camp and urban settings in Jordan. Focus group discussions and key informant interviews were used to identify needs, challenges and potential solutions to providing quality health care to refugees. By-person factor analysis divided refugee participants into 4 unique respondent types and compared priorities for interventions. Focus group discussions and key informant interviews revealed a many different problems. Cost, limited resources, changing policies, livelihoods and poor health literacy impeded delivery of public and clinical health services. Respondent Type 1 emphasized the importance of policy changes to improve Syrian refugee health. Type 2 highlighted access to fresh foods and recreational activities for children. For Type 3, poor quality drinking-water was the primary concern, and Type 4 believed the lack of good, free education for Syrian children exacerbated their mental health problems. Syrian refugees identified cost as the main barrier to health care access. Both refugees and health care providers emphasized the importance of directing more resources to chronic diseases and mental health. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

What is Known About Health and Morbidity in the Pediatric Population of Muslim Bedouins in Southern Israel: A Descriptive Review of the Literature from the Past Two Decades.

PubMed

Treister-Goltzman, Yulia; Peleg, Roni

2015-06-01

The Bedouins comprise one of the ethnic groups in Israeli society. They are Muslims, most of who live in the Negev desert region of southern Israel and live by their unique traditions and customs. At the present they are going through a period of "society in transition", a unique condition that has ramifications for health and morbidity. In recent years the number of publications on the health of Bedouins in the Negev has increased. Recognition of unique socio-economic features, characteristics of health and diseases can help the medical team treat various health problems in this population as well as other populations with similar characteristics. In the present paper we survey and discuss publications on the health of Bedouin children over the past 20 years.

Commercial Sexual Exploitation and Sex Trafficking of Children and Adolescents: A Narrative Review.

PubMed

Barnert, Elizabeth; Iqbal, Zarah; Bruce, Janine; Anoshiravani, Arash; Kolhatkar, Gauri; Greenbaum, Jordan

Commercial sexual exploitation and sex trafficking of children and adolescents represent a severe form of child abuse and an important pediatric health concern. Youth who are commercially sexually exploited have a constellation of clinical risk factors and high rates of unmet physical and mental health needs, including conditions that directly result from their victimization. Common physical health needs among commercially sexually exploited children and adolescents include violence-related injuries, pregnancy, sexually transmitted infections, and other acute infections. Common mental health conditions include substance use disorders, post-traumatic stress disorder, depression and suicidality, and anxiety. The existing literature indicates that trauma-informed approaches to the care of commercially sexually exploited youth are recommended in all aspects of their health care delivery. Additionally, medical education that attunes providers to identify and appropriately respond to the unique needs of this highly vulnerable group of children and adolescents is needed. The available research on commercial sexual exploitation and sex trafficking of children and adolescents remains fairly limited, yet is expanding rapidly. Especially relevant to the field of pediatrics, future research to guide health professionals in how best to identify and care for commercially sexually exploited children and adolescents in the clinical setting signifies a key gap in the extant literature and an important opportunity for future study. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Understanding identifiability as a crucial step in uncertainty assessment

NASA Astrophysics Data System (ADS)

Jakeman, A. J.; Guillaume, J. H. A.; Hill, M. C.; Seo, L.

2016-12-01

The topic of identifiability analysis offers concepts and approaches to identify why unique model parameter values cannot be identified, and can suggest possible responses that either increase uniqueness or help to understand the effect of non-uniqueness on predictions. Identifiability analysis typically involves evaluation of the model equations and the parameter estimation process. Non-identifiability can have a number of undesirable effects. In terms of model parameters these effects include: parameters not being estimated uniquely even with ideal data; wildly different values being returned for different initialisations of a parameter optimisation algorithm; and parameters not being physically meaningful in a model attempting to represent a process. This presentation illustrates some of the drastic consequences of ignoring model identifiability analysis. It argues for a more cogent framework and use of identifiability analysis as a way of understanding model limitations and systematically learning about sources of uncertainty and their importance. The presentation specifically distinguishes between five sources of parameter non-uniqueness (and hence uncertainty) within the modelling process, pragmatically capturing key distinctions within existing identifiability literature. It enumerates many of the various approaches discussed in the literature. Admittedly, improving identifiability is often non-trivial. It requires thorough understanding of the cause of non-identifiability, and the time, knowledge and resources to collect or select new data, modify model structures or objective functions, or improve conditioning. But ignoring these problems is not a viable solution. Even simple approaches such as fixing parameter values or naively using a different model structure may have significant impacts on results which are too often overlooked because identifiability analysis is neglected.

Binge drinking and perceived ethnic discrimination among Hispanics/Latinos: Results from the Hispanic community health study/study of Latinos sociocultural ancillary study.

PubMed

Ornelas, India J; Lapham, Gwen T; Salgado, Hugo; Williams, Emily C; Gotman, Nathan; Womack, Veronica; Davis, Sonia; Penedo, Frank; Smoller, Sylvia; Gallo, Linda C

2016-01-01

The study assessed whether overall perceived ethnic discrimination and four unique discrimination types were associated with binge drinking in participants from the Hispanic Community Health Study/Study of Latinos who also completed the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (n = 5,313). In unadjusted analyses that were weighted for sampling strategy and design, each unit increase in discrimination type was associated with a 12-63% increase in odds of binge drinking; however, after adjusting for important demographic variables including age, sex, heritage group, language, and duration of U.S. residence, there was no longer an association between discrimination and binge drinking. Further research still needs to identify the salient factors that contribute to increased risk for binge drinking among Hispanics/Latinos.

Application of person-centered analytic methodology in longitudinal research: exemplars from the Women's Health Initiative Clinical Trial data.

PubMed

Zaslavsky, Oleg; Cochrane, Barbara B; Herting, Jerald R; Thompson, Hilaire J; Woods, Nancy F; Lacroix, Andrea

2014-02-01

Despite the variety of available analytic methods, longitudinal research in nursing has been dominated by use of a variable-centered analytic approach. The purpose of this article is to present the utility of person-centered methodology using a large cohort of American women 65 and older enrolled in the Women's Health Initiative Clinical Trial (N = 19,891). Four distinct trajectories of energy/fatigue scores were identified. Levels of fatigue were closely linked to age, socio-demographic factors, comorbidities, health behaviors, and poor sleep quality. These findings were consistent regardless of the methodological framework. Finally, we demonstrated that energy/fatigue levels predicted future hospitalization in non-disabled elderly. Person-centered methods provide unique opportunities to explore and statistically model the effects of longitudinal heterogeneity within a population. © 2013 Wiley Periodicals, Inc.

The Risks to Patient Privacy from Publishing Data from Clinical Anesthesia Studies.

PubMed

O'Neill, Liam; Dexter, Franklin; Zhang, Nan

2016-06-01

In this article, we consider the privacy implications of posting data from small, randomized trials, observational studies, or case series in anesthesia from a few (e.g., 1-3) hospitals. Prior to publishing such data as supplemental digital content, the authors remove attributes that could be used to re-identify individuals, a process known as "anonymization." Posting health information that has been properly "de-identified" is assumed to pose no risks to patient privacy. Yet, computer scientists have demonstrated that this assumption is flawed. We consider various realistic scenarios of how the publication of such data could lead to breaches of patient privacy. Several examples of successful privacy attacks are reviewed, as well as the methods used. We survey the latest models and methods from computer science for protecting health information and their application to posting data from small anesthesia studies. To illustrate the vulnerability of such published data, we calculate the "population uniqueness" for patients undergoing one or more surgical procedures using data from the State of Texas. For a patient selected uniformly at random, the probability that an adversary could match this patient's record to a unique record in the state external database was 42.8% (SE < 0.1%). Despite the 42.8% being an unacceptably high level of risk, it underestimates the risk for patients from smaller states or provinces. We propose an editorial policy that greatly reduces the likelihood of a privacy breach, while supporting the goal of transparency of the research process.

Gender Dysphoria in the Military.

PubMed

Ford, Shannon; Schnitzlein, Carla

2017-11-07

With the announcement that members of the military who identify as transgender are allowed to serve openly, the need for Department of Defense behavioral health providers to be comfortable in the assessment, diagnosis, and treatment of this population becomes quickly evident. This population has been seeking care in the community and standards have been developed to help guide decision-making, but a comparable document does not exist for the military population. Previously published papers were written in anticipation of the policy allowing for open service. The civilian sector has treatment guidelines and evidence supporting the same for reference. There is no similar document for the military population, likely due to the recent change and ongoing development. This paper attempts to provide an overview of the recent Department of Defense policy and walks the reader through key considerations when providing care to a transgender member of the military as it relates to those who are currently serving in the military through the use of a case example. The military transgender population faces some unique challenges due to the need to balance readiness and deployability with medically necessary health care. Also complicating patient care is that policy development is ongoing-as of this publication, the decision has not yet been made regarding how people who identify as transgender will access into the military nor is there final approval regarding coverage for surgical procedures. Unique circumstances of this population are brought up to generate more discussion and encourage further evaluation and refinement of the process.

HIPAA Privacy 101: essentials for case management practice.

PubMed

DiBenedetto, Deborah V

2003-01-01

The Health Insurance Portability and Accountability Act (HIPAA) has significant impact on the delivery of healthcare in the United States. The Administrative Simplification (AS) requirements of HIPAA are aimed at reducing administrative costs and burdens in the healthcare industry. The core components of HIPAA's AS requirements address healthcare transactions, code sets, security, unique identifiers, and privacy of health information. HIPAA's privacy standard limits the nonconsensual use and release of private health information, gives patients new rights to access their medical records and to know who else has accessed them, restricts most disclosure of health information to the minimum needed for the intended purpose, establishes new criminal and civil sanctions for improper use or disclosure, and establishes new requirements for access to records by researchers and others. This article focuses on HIPAA's privacy requirements as related to case management of workers compensation populations, the treatment of protected health information, and how case managers can ensure they provide appropriate services while navigating the requirements of HIPAA's privacy standard.

Treat and Teach Our Students Well: College Mental Health and Collaborative Campus Communities.

PubMed

Downs, Nancy S; Alderman, Tracy; Schneiber, Katharina; Swerdlow, Neal R

2016-09-01

This article presents a selective review of best practices for the psychiatric care of college student populations. It describes psychiatric advances in evidence-based practice for college students and offers a brief compendium for college health practitioners. College mental health services are delivered in a specialized milieu, designed to address many of the unique needs of college students and to support their successful scholastic advancement and graduation. Practical steps for implementing these best practices within the college community setting are identified, with a focus on the initial student evaluation, risk assessment, treatment planning and goal setting, and steps to optimize academic functioning during psychopharmacologic and nonpharmacologic treatment. At the center of these practices is the use of a collaborative team and psychoeducation that engages students to actively learn about their mental health. By applying common sense and evidence-based practices within interdisciplinary and student-centered services, college communities can effectively meet the mental health needs of their students and empower them to reach their educational goals.

Bridging the gap between evidence-based innovation and national health-sector reform in Ghana.

PubMed

Awoonor-Williams, John Koku; Feinglass, Ellie S; Tobey, Rachel; Vaughan-Smith, Maya N; Nyonator, Frank K; Jones, Tanya C

2004-09-01

Although experimental trials often identify optimal strategies for improving community health, transferring operational innovation from well-funded research programs to resource-constrained settings often languishes. Because research initiatives are based in institutions equipped with unique resources and staff capabilities, results are often dismissed by decisionmakers as irrelevant to large-scale operations and national health policy. This article describes an initiative undertaken in Nkwanta District, Ghana, focusing on this problem. The Nkwanta District initiative is a critical link between the experimental study conducted in Navrongo, Ghana, and a national effort to scale up the innovations developed in that study. A 2002 Nkwanta district-level survey provides the basis for assessing the likelihood that the Navrongo model is replicable elsewhere in Ghana. The effect of community-based health planning and services exposure on family planning and safe-motherhood indicators supports the hypothesis that Navrongo effects are transferable to impoverished rural settings elsewhere, confirming the need for strategies to bridge the gap between Navrongo evidence-based innovation and national health-sector reform.

Engaging communities to tackle anti-social behaviour: a health impact assessment of a citizens' jury.

PubMed

Haigh, F A; Scott-Samuel, A

2008-11-01

To carry out a health impact assessment (HIA) of the Netherley Valley Citizens' Jury that was set up to develop recommendations for how anti-social behaviour should be addressed in their community. Concurrent HIA based on the Merseyside Guidelines for HIA and the European Policy HIA Guidelines. Literature reviews, community profiling, and interviews and workshops with stakeholders and key informants were undertaken. A wide range of positive and negative impacts were identified, and 20 recommendations were developed to suggest ways of maximizing the potential positive impacts on health and wellbeing and minimizing the negative impacts. This HIA provided a unique opportunity to compare predicted and actual health impacts, which illustrates the importance of assessing the potential impacts of processes as well as intended outcomes. It also highlighted some of the potential risks involved in engaging with communities, and reinforced the value of assessing the potential impacts on health of policies, programmes and projects that may intuitively appear to be beneficial to all involved.

[Scoping review about working conditions and health of immigrant workers in Spain].

PubMed

Ronda-Pérez, Elena; Agudelo-Suárez, Andrés A; López-Jacob, María José; García, Ana M; Benavides, Fernando G

2014-01-01

The relationship between immigration, work, and health is one of the most important challenges in occupational health at current, particularly in Spain, by the significant increase in the migrant workers in the labor market occurred. This investigation aims to know the relationship betwen working conditions and their effects on migrant workers. Scoping review of scientific papers on this topic at the Medline and Medes databases in Spanish and English (1998-2012). The articles included were full text reviewed. 20 studies were included, 13 with quantitative methodology and 7 qualitative. The topics address specific health problems related to work (primarily occupational accidents), disability, and differences in working conditions and employment. The findings of the studies show a higher incidence of injury accidents, lower rates of disability, higher prevalence of work presenteeism, exposure to psychosocial factors, and precariousness. Despite the uniqueness of the demographic process migration happened in Spain, health problems and determinants identified no different from those referenced in other countries, in other contexts and in other times.

HIV is Now a Manageable Long-Term Condition, But What Makes it Unique? A Qualitative Study Exploring Views About Distinguishing Features from Multi-Professional HIV Specialists in North West England.

PubMed

Jelliman, Pauline; Porcellato, Lorna

HIV is evolving from a life-threatening infection to a long-term, manageable condition because of medical advances, radical changes in health and social care policy, and the impact of an aging population. However, HIV remains complex, presenting unique characteristics distinguishing it from other long-term conditions (LTCs). Our aim in this qualitative descriptive study was to identify and explore these features in the context of LTCs. A focus group (FG) method was used to gather the views and experiences of multi-professional HIV specialists who worked in North West England. Twenty-four staff participated in FGs (n = 3), which were audio recorded, manually transcribed, and thematically analyzed. We found four main themes: (a) stigma, (b) challenges faced by HIV specialists, (c) lack HIV-related knowledge, and (d) unique features, termed "stand alone." We concluded that these distinguishing features hindered full recognition and acceptance of HIV as an LTC. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Misconceptions about high-fructose corn syrup: is it uniquely responsible for obesity, reactive dicarbonyl compounds, and advanced glycation endproducts?

PubMed

White, John S

2009-06-01

Misconceptions about high-fructose corn syrup (HFCS) abound in the scientific literature, the advice of health professionals to their patients, media reporting, product advertising, and the irrational behavior of consumers. Foremost among these is the misconception that HFCS has a unique and substantive responsibility for the current obesity crisis. Inaccurate information from ostensibly reliable sources and selective presentation of research data gathered under extreme experimental conditions, representing neither the human diet nor HFCS, have misled the uninformed and created an atmosphere of distrust and avoidance for what, by all rights, should be considered a safe and innocuous sweetener. In the first part of this article, common misconceptions about the composition, functionality, metabolism, and use of HFCS and its purported link to obesity are identified and corrected. In the second part, an emerging misconception, that HFCS in carbonated soft drinks contributes materially to physiological levels of reactive dicarbonyl compounds and advanced glycation endproducts, is addressed in detail, and evidence is presented that HFCS does not pose a unique dietary risk in healthy individuals or diabetics.

Avenues of Influence: the Relationship between Health Impact Assessment and Determinants of Health and Health Equity.

PubMed

Sohn, Elizabeth Kelley; Stein, Lauren J; Wolpoff, Allison; Lindberg, Ruth; Baum, Abigail; Simoncelli, Arielle Mc-Innis; Pollack, Keshia M

2018-06-11

This study aims to identify perceived impacts of Health Impact Assessment (HIA) on decision-making, determinants of health, and determinants of health equity and outline the mechanisms through which these impacts can occur. The research team conducted a mixed-methods study of HIAs in the USA. First, investigators collected data regarding perceived HIA impacts through an online questionnaire, which was completed by 149 stakeholders representing 126 unique HIAs. To explore in greater depth the themes that arose from the online survey, investigators conducted semi-structured interviews with 46 stakeholders involved with 27 HIAs related to the built environment. This preliminary study suggests that HIAs can strengthen relationships and build trust between community and government institutions. In addition, this study suggests that HIA recommendations can inform policy and decision-making systems that determine the distribution of health-promoting resources and health risks. HIA outcomes may in turn lead to more equitable access to health resources and reduce exposure to environmental harms among at-risk populations. Future research should further explore associations between HIAs and changes in determinants of health and health equity by corroborating findings with other data sources and documenting potential impacts and outcomes of HIAs in other sectors.

Human and animal evidence of potential transgenerational inheritance of health effects: An evidence map and state-of-the-science evaluation.

PubMed

Walker, Vickie R; Boyles, Abee L; Pelch, Katherine E; Holmgren, Stephanie D; Shapiro, Andrew J; Blystone, Chad R; Devito, Michael J; Newbold, Retha R; Blain, Robyn; Hartman, Pamela; Thayer, Kristina A; Rooney, Andrew A

2018-06-01

An increasing number of reports suggest early life exposures result in adverse effects in offspring who were never directly exposed; this phenomenon is termed "transgenerational inheritance." Given concern for public health implications for potential effects of exposures transmitted to subsequent generations, it is critical to determine how widespread and robust this phenomenon is and to identify the range of exposures and possible outcomes. This scoping report examines the evidence for transgenerational inheritance associated with exposure to a wide range of stressors in humans and animals to identify areas of consistency, uncertainty, data gaps, and to evaluate general risk of bias issues for the transgenerational study design. A protocol was developed to collect and categorize the literature into a systematic evidence map for transgenerational inheritance by health effects, exposures, and evidence streams following the Office of Health Assessment and Translation (OHAT) approach for conducting literature-based health assessments. A PubMed search yielded 63,758 unique records from which 257 relevant studies were identified and categorized into a systematic evidence map by evidence streams (46 human and 211 animal), broad health effect categories, and exposures. Data extracted from the individual studies are available in the Health Assessment Workspace Collaborative (HAWC) program. There are relatively few bodies of evidence where multiple studies evaluated the same exposure and the same or similar outcomes. Studies evaluated for risk of bias generally had multiple issues in design or conduct. The evidence mapping illustrated that risk of bias, few studies, and heterogeneity in exposures and endpoints examined present serious limitations to available bodies of evidence for assessing transgenerational effects. Targeted research is suggested to addressed inconsistencies and risk of bias issues identified, and thereby establish more robust bodies of evidence to critically assess transgenerational effects - particularly by adding data on exposure-outcome pairs where there is some evidence (i.e., reproductive, metabolic, and neurological effects). Copyright © 2017. Published by Elsevier Ltd.

Clinical and Public Health Considerations in Urine Drug Testing to Identify and Treat Substance Use.

PubMed

Barthwell, Andrea G

2016-05-11

To expand appropriate use of substance use testing, practitioners must increase their knowledge of the appropriate methodology, scope, and frequency. Yet, there is a current lack of accepted guidelines on clinical testing to identify and treat substance use. This article (1) conveys the importance of substance use testing as a clinical and public health response to trends of prescription drug abuse and increased access to medical and commercialized marijuana; (2) summarizes central features of the rapidly evolving science and the practice of patient-centered substance use testing in a clinical setting; and (3) provides recommendations that balance costs and benefits and serve as a starting point for appropriate testing to prevent, identify, and treat substance use disorders. The author conducted a search of peer-reviewed and government-supported articles and books in electronic databases and used her own knowledge and clinical experience. The author makes recommendations for determining the methodology, scope, and frequency of testing in each stage of care based on clinical considerations and methodological factors. Conclusion/Importance: Integrating sensible substance use testing broadly into clinical health care to identify substance use, diagnose substance use disorders, and guide patients into treatment can improve health outcomes and reduce the costs of substance use and addiction. No single testing regimen is suitable for all clinical scenarios; rather, a multitude of options, as discussed herein, can be adapted to meet a patient's unique needs. Ultimately, the practitioner must combine patient-specific information with knowledge of test technologies, capabilities, limitations, and costs.

Structural health monitoring to detect the presence, location and magnitude of structural damage in cadaveric porcine spines.

PubMed

Kawchuk, Gregory Neil; Decker, Colleen; Dolan, Ryan; Carey, Jason

2009-01-19

Structural health monitoring has been used successfully to identify defects in civil infrastructure and aerospace applications. Given that the majority of low back pain is thought to be mechanical in nature, our objective was to determine if structural health monitoring techniques could be employed successfully to identify the presence, location and magnitude of structural alterations within the spine. In six eviscerated cadaveric pigs, bone screws were drilled into the anterior bodies of L1-L5 and tri-axial accelerometers fixed to each spinous process. Vibration was then applied to the L3 spinous and frequency response functions obtained from each sensor axis before and after specific alterations of spinal structure. These alterations were produced at four unique locations and included (1) use of a cable tie to link anterior bone pins together and (2) progressive disc sectioning. Eighty percent of all data were used to train a neural network while the remaining data were used to test the network's ability to distinguish between structural states. The presence, location and magnitude of structural change within the spine was identified correctly in 5030/5040 possible neural network decisions. The diagnostic sensitivity and specificity of this technique ranged from 0.994 to 1.000. These results indicate that there is sufficient information embedded in frequency response data to identify the presence, location and magnitude of specific structural changes in the spine. If these techniques can be evolved for human use, structural health monitoring may provide a new approach toward understanding the underlying relations between spinal structure and function.

Developing the public health workforce: training and recognizing specialists in public health from backgrounds other than medicine: experience in the UK.

PubMed

Gray, Selena F; Evans, David

2018-01-01

There is increasing recognition that improving health and tackling inequalities requires a strong public health workforce capable of delivering key public health functions across systems. The World Health Organization in Europe has identified securing the delivery of the Essential Public Health Operations and strengthening public health capacities within this as a priority.It is acknowledged that current public health capacities and arrangements of public health services vary considerably across the World Health Organization in European Region, and investment in multidisciplinary workforce with new skills is essential if public health services are to be delivered. This paper describes the current situation in the UK where there are nationally funded multidisciplinary programmes for training senior public health specialists. Uniquely, the UK provides public health registration for multidisciplinary as well as medical public health specialists. The transition from a predominantly medical to a multidisciplinary public health specialist workforce over a relatively short timescale is unprecedented globally and was the product of a sustained period of grass roots activism aligned with national policy innovation. the UK experience might provide a model for other countries seeking to develop public health specialist workforce capacity in line with the Essential Public Health Operations.

Validation of an algorithm to identify children with biopsy-proven celiac disease from within health administrative data: An assessment of health services utilization patterns in Ontario, Canada

PubMed Central

Chan, Jason; Mack, David R.; Manuel, Douglas G.; Mojaverian, Nassim; de Nanassy, Joseph

2017-01-01

Importance Celiac disease (CD) is a common pediatric illness, and awareness of gluten-related disorders including CD is growing. Health administrative data represents a unique opportunity to conduct population-based surveillance of this chronic condition and assess the impact of caring for children with CD on the health system. Objective The objective of the study was to validate an algorithm based on health administrative data diagnostic codes to accurately identify children with biopsy-proven CD. We also evaluated trends over time in the use of health services related to CD by children in Ontario, Canada. Study design and setting We conducted a retrospective cohort study and validation study of population-based health administrative data in Ontario, Canada. All cases of biopsy-proven CD diagnosed 2005–2011 in Ottawa were identified through chart review from a large pediatric health care center, and linked to the Ontario health administrative data to serve as positive reference standard. All other children living within Ottawa served as the negative reference standard. Case-identifying algorithms based on outpatient physician visits with associated ICD-9 code for CD plus endoscopy billing code were constructed and tested. Sensitivity, specificity, PPV and NPV were tested for each algorithm (with 95% CI). Poisson regression, adjusting for sex and age at diagnosis, was used to explore the trend in outpatient visits associated with a CD diagnostic code from 1995–2011. Results The best algorithm to identify CD consisted of an endoscopy billing claim follow by 1 or more adult or pediatric gastroenterologist encounters after the endoscopic procedure. The sensitivity, specificity, PPV, and NPV for the algorithm were: 70.4% (95% CI 61.1–78.4%), >99.9% (95% CI >99.9->99.9%), 53.3% (95% CI 45.1–61.4%) and >99.9% (95% CI >99.9->99.9%) respectively. It identified 1289 suspected CD cases from Ontario-wide administrative data. There was a 9% annual increase in the use of this combination of CD-associated diagnostic codes in physician billing data (RR 1.09, 95% CI 1.07–1.10, P<0.001). Conclusions With its current structure and variables Ontario health administrative data is not suitable in identifying incident pediatric CD cases. The tested algorithms suffer from poor sensitivity and/or poor PPV, which increase the risk of case misclassification that could lead to biased estimation of CD incidence rate. This study reinforced the importance of validating the codes used to identify cohorts or outcomes when conducting research using health administrative data. PMID:28662204