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PubMed2005

Limited take-up of health coverage tax credits: a challenge to future tax credit design.

The Trade Act of 2002 created federal tax credits to subsidize health coverage for certain early retirees and workers displaced by international trade. Though small, this program offers the opportunity to learn how to design future tax credits for larger groups of uninsured. During September 2004, the most recent month for which there are data about all forms of Trade Act credits, roughly 22 percent of eligible individuals received credits. The authors find that health insurance tax credits are more likely to reach their target populations if such credits: 1) limit premium costs for the low-income uninsured and do not require full premium payments while applications are pending; 2) provide access to coverage that beneficiaries value, including care for preexisting conditions; 3) are combined with outreach that uses easily understandable, multilingual materials and proactive enrollment efforts; and 4) feature a simple application process involving one form filed with one agency.

Community-Institutional Relations↗
PubMed2003

Students with chronic illnesses: guidance for families, schools, and students.

Developed by a work group representing several nonprofit and federal health and education organizations, Students with Chronic Illnesses: Guidance for Families, Schools, and Students provides cross-cutting action steps to facilitate full participation in learning and other school activities by students with chronic diseases. Between 10% and 15% of children in the United States are affected by at least one chronic disease. This guide offers practical tips to help ensure that schools are responsive to the health needs of children with chronic illnesses. Children with chronic health conditions are more likely to miss days from school, need specialized health care, and require special education services or homebound teaching. School health advocates agree that meeting the needs of these children requires collaboration among the students, their families, school personnel, and community health care providers. Such efforts can help students establish better attendance, improve their alertness and physical stamina, and face fewer restrictions on physical activity at school and fewer medical emergencies. The guide addresses issues such as routine and urgent care needs of students, medication access and administration, and school personnel training to ensure compliance with applicable local, state, and federal regulations. While emphasizing the value of adopting general policies for supporting students with chronic conditions, the guide also encourages schools to develop and implement condition-specific and individualized protocols. The responsibilities of family members, school district officials, teachers and school administrators, and students are outlined to help each constituent fulfill these objectives.

Child↗
PubMed2005

Recruitment and communication process for participation in the 2005 AEM Consensus Conference on the Ethical Conduct of Resuscitation Research: methodology, challenges, lessons learned.

The 2005 Academic Emergency Medicine Consensus Conference, "Ethical Conduct of Resuscitation Research," was designed with the goal of developing consensus on important issues for human subjects and researchers surrounding the 1996 federal regulations jointly published by the Department of Health and Human Services and the Food and Drug Administration and known as the Final Rule. These regulations, which guide the conduct of research using the emergency exception from informed consent or waiver of informed consent, have been the subject of much debate in the resuscitation research community. Therefore, the editorial board of Academic Emergency Medicine chose this topic as the subject of their annual consensus conference. This report outlines the methods by which individuals and organizations were recruited to participate, how the conference was advertised, and the way in which participants and nonparticipants were encouraged to communicate before and after the conference. The limitations and potential biases of these methods and activities are also presented.

Committee Membership↗
PubMedDate not supplied

Advance directives. Hospitals learn how to apply PSDA via research and education.

The Health Care Financing Administration (HCFA) published its final interim rule covering the Patient Self-Determination Act (PSDA) in the March 6 Federal Register, more than two months after the law went into effect. The following articles summarize the AHA's response to the interim rule, how a children's hospital applies the PSDA, some research on how aging parents relinquish decision making to their adult children, how Minnesota applies the PSDA to the mentally ill, and how one hospital conducted an educational program on advance directives.

Advance Directives↗
PubMed2003

AHEC in West Virginia: a case study. Area health education centers.

This case study describes the area health education centers (AHEC) program in West Virginia, spanning 30 years from a first-generation project at Charleston in 1972 (AHEC 1) to a newly funded statewide program (AHEC 2). The outcome is an evolving university-community partnership designed to meet changing work-force and community health needs in the heart of rural Appalachia. West Virginia University's (WVU's) application of the original Carnegie Commission AHEC recommendations (1970) resulted in the Charleston AHEC, now part of the Robert C. Byrd Health Sciences Center of WVU. AHEC today trains more than 135 residents and interns, and one-third of the third-year and fourth-year WVU medical students. Charleston offers clinical and continuing education for nurses, dentists, pharmacists, and allied health professionals. A health sciences library, distance learning, and a network of primary care clinics help define Charleston's unique AHEC role. This AHEC hub continues to meet the classic Carnegie goals of recruiting and retaining health professionals, and providing access to care in the original service area and statewide. Based on the Charleston experience, four new federally funded AHECs are being developed to link rural primary care residencies with the state-funded West Virginia rural health education partnerships. These rural consortia AHECs are applying the concept of community competency, a performance-based methodology, to integrate learning while achieving the goals of Healthy People 2010.

Academic Medical Centers↗
PubMed1991

Schooling without learning: thirty years of cheating in high school.

A survey instrument, developed in 1968 and administered to 1,629 high school students in 1969, 1,100 students in 1979, and 1,291 students in 1989, asked them to respond to items regarding the following: (1) the amount of cheating believed going on, (2) who was most guilty, (3) reasons given for cheating, (4) the courses in which most cheating occurred, (5) how to punish cheaters and by whom, (6) beliefs regarding dishonesty in society, and (7) confessions of their own dishonest behaviors in school. Between 1969 and 1989, student responses reflected increasingly pessimistic opinions about dishonesty in school and society. Fear of failure remained the most common reason for cheating. Math and science were the courses in which cheating most often occurred. The home was considered the best place and school the worst place to inculcate honesty. Over the three decades covered by this study, dishonesty was viewed as increasingly necessary, more people believed advertising was suspect, and success in business was attributed to fraudulent activities. More students admitted to cheating on tests and homework. More parents were not aiding and abetting students in avoidance of school rules. Polls, studies, and reports recently published by state, federal, and private agencies appear to confirm these findings.

Adolescent↗
PubMed2005

Out-of-school settings as a developmental context for children and youth.

Since the 1990s, there has been a growing recognition of the importance of the out-of-school context for children and adolescents. Fueled in part by family demographics that include substantial numbers of employed mothers and single mothers, in part by concerns about poor academic performance and problem behaviors, and in part by intensified efforts to find ways to promote positive youth development, researchers and practitioners have focused their attention on two particular out-of-school settings: after-school programs and structured activities. The research findings pertaining to full-time (i.e., 5 days a week) after-school programs are mixed, which may reflect the substantial heterogeneity of the programs in terms of children being served, the types of activities offered, and the training and background of the staff. The federal funding of the 21st Century CLCs and various state and local initiatives has increased the numbers of low-income and English-learning students participating in after-school programs. A substantial number of programs are becoming more school-like. The available research suggests that (under some conditions) attending after-school programs is linked to improved social and academic outcomes. Children are more likely to show academic and social benefits when staff-child relationships are positive and nonconflictual, when programs offer a variety of age-appropriate activities from which children can select those of interest, and when children attend on a regular basis. The research findings about voluntary structured activities are more straightforward. Participation in these activities has been consistently linked to positive academic and social developmental outcomes in numerous studies. What appears to be key is that the activities are voluntary, are characterized by sustained engagement and effort, and provide opportunities to build or develop skills. Although the available research has begun to inform our understanding of the out-of-school context, further research is sorely needed. First, there is a need for research to identify the social, cognitive, and linguistic processes by which participation in programs and structured activities influences child and youth developmental outcomes. For example, researchers need to consider the competitiveness of sport activities in relation to children's social and emotional functioning. Researchers also might examine after-school experiences as settings in which complex thought processes can develop. Heath (1999) has conducted initial work in the area of language development by obtaining language samples during voluntary structured activities and analyzing their content. In the initial samples, students engaged in few sustained conversations on a topic and they frequently changed topics. After 3-4 weeks at the program, however, Heath noted substantial changes in the students' conversations and language. The use of conditionals (should, would, could) increased. She also noted increases in strategies to obtain clarifications from others and increases in the use of shifted registers and genres. Heath's (1999) linguistic analyses in conjunction with research that considers social and motivational processes underscore the broader point that the out-of-school context is complex and multi-layered and likely to be of substantial importance in the lives of children and youth. Research is needed to identify other important developmental processes in programs and structured activities. A promising procedure for identifying these processes is experience sampling (Csikszentmihalyi & Larson, 1987; Larson, 1989). Experience sampling methodology allows researchers to collect systematic data about an individual's activities, thoughts, and affective states by obtaining reports from participants at multiple randomly sampled points in time. Participants are signaled to provide a report in a variety of ways, such as with beepers or alarm watches. This record of experiences is not usually captured by other data collection methods. For example, program observations provide data on observed activities, interactions, and program climate, but do not offer insights into students' feelings and experiences within the after-school environment. Questionnaire and survey data are retrospective, asking respondents to recall past experiences and feelings regarding their after-school activities. Experience sampling could be used to examine any number of processes in after-school programs and structured activities. A better understanding of the effects of program content also is needed. Whether after-school programs should focus exclusively on enrichment activities or exclusively on academic activities, or include both enrichment and academic components, is the subject of heated debate. Some after-school scholars (Halpern, 1999; Heath, 1999; Eccles, in press) have argued forcefully that a focus on academics undermines the unique strengths and role of programs, and that programs should emphasize extracurricular enrichment activities. Others (Noam, 2004) have supported the move by policy makers and educators to make programs more academic, with an emphasis on homework help, tutoring, and preparation for academic achievement tests. The effects of different approaches to after-school programming have not been evaluated systematically. Research that describes, compares, and then tests effects of different program content models is needed to determine which types of programs are successful in attracting and keeping students (a necessary condition for programs to effect change), and to determine whether different types of programs are differentially associated with improvements in student outcomes such as school attendance, academic achievement, social competencies, and behavioral adjustment. A related question is whether structured activities that are obligatory or required have the same effects as voluntary structured activities do. Researchers also should further examine the impact of different attendance patterns on child developmental outcomes. We do not have solid information about optimal intensity and duration of attendance in terms of outcomes. There are suggestions in the literature that long-term, frequent attendance at programs is associated with positive outcomes for low-income children. Research needs to examine whether these results hold for middle-income children and youth as well. Finally, experimental studies should be conducted in which children and adolescents are randomly assigned to after-school programs and structured activities. All of the research to date on structured activities, and most of the research on after-school programs, has been nonexperimental, so questions about selection bias remain. Experimental studies in which children and adolescents are randomly assigned to participation in programs and activities would be a valuable next step in understanding relations between participation and child and youth outcomes. Such research should not be conducted until we have more information about the components of high-quality programming in terms of program content and developmental processes, however.

Adolescent↗
PubMedDate not supplied

Nurse anesthesia education in the new millennium: outcomes of a federally funded advanced nursing education grant.

Graduate nursing education is evolving in response to multiple societal influences affecting higher education. Nurse anesthesia education has also been affected by these forces. This article describes the planning, implementation, and evaluation of a new graduate track in nurse anesthesia made possible by an academic partnership, and the positive impact that a federally funded grant had on the venture. The excellent academic outcomes, the changes in diversity of the student body, the innovative curriculum, and lessons learned from the project are described.

Anesthesiology↗
PubMedDate not supplied

Choosing among alternative programs for poor children.

Many public programs serve poor children. By setting budgets, benefit levels, and program rules, policymakers decide how many children will receive benefits and which benefits they will receive. Making these choices in a rational way is difficult, given the noncomparability of different types of program benefits and the limited information available about the effects these programs have on poor children. This article suggests four criteria (efficiency, return on investment, incentives, and equity) for evaluating and comparing public programs for poor children, and provides an overview of the patchwork of information that is currently available about the effects of eight large federal programs using these criteria. Some broad themes emerge. First, several programs that target specific benefits directly to children have been shown to have positive effects on a range of outcomes. Second, even before the current round of welfare reform, the mix of federal support available to poor children had changed in a way that put more emphasis on providing benefits in kind. Finally, more must be learned about the effects of programs for poor children before sweeping policy recommendations can be made. This article concludes with policy recommendations that can be supported by the available evidence.

Child↗
PubMed2002

The basic principles of building an ergonomic component of automated training systems.

In recent years, in view of the transformation in education in the Russian Federation, it has been necessary to introduce different technical facilities and new educational methods into the educational process. An introduction of training systems into the educational process concerns every educational method. New methods use various results from such fields as pedagogy, psychology, cybernetics, mathematics, and linguistics. Automated training systems consist of 3 components: informational, didactic, and ergonomic. This paper considers 2 components: didactic and ergonomic. They provide maximum learning with minimum energy consumption on the part of the trainee, in acceptable working conditions. As an example, this paper considers educational systems of calculus mathematics and mathematical geophysics realized in the Novosibirsk State University and Institute, Russian Federation.

Automation↗
PubMed2000

Dietary supplements and lessons to be learned from GRAS.

The demand for dietary supplements by the public has transformed this once cottage industry into a 12-billion-dollar-per-year business. Restrictive actions against dietary supplements by the Food and Drug Administration (FDA) prompted Congress to enact new and more permissive amendments governing dietary supplements (Dietary Supplement Health and Education Act, DSHEA) to the Federal Food, Drug and Cosmetic (FFD&C) Act in 1994. A comparison is made between the present status of dietary supplement regulation and the concept of general recognition of safety (GRAS) under conditions of intended use as set forth by the landmark 1958 Food Additive Amendment to the FFD&C Act. An argument is posited for use of applicable principles learned in nearly 40 years of experience with determining the GRAS status for hundreds of substances to problems posed by dietary supplements.

Dietary Supplements↗
PubMedDate not supplied

Regulating U.S. nursing homes: are we learning from experience?

The quality of care in U.S. nursing homes has been a recurrent matter of public concern and policy attention for more than thirty years. A complex regulatory system of state licensure and federal certification is in place, but problems of poor quality and neglect and abuse of patients still appear to be endemic. This paper describes how the current system of regulation developed, examines its impact, and draws on the wider literature on regulation to outline some characteristics that may have detracted from its effectiveness and contributed to its disappointing results. Future regulatory reform should pay more attention to the lessons of regulation in other settings and make more use of research and formative evaluation.

Aged↗
PubMed2002

A statewide school tobacco policy review: process, results, and implications.

The federal Pro-Children's Act of 1994 and other public health laws prompted most schools to create policies that address tobacco issues. To date, however, the literature is devoid of research that assesses the quality of a district's tobacco policy. This article describes the process and results from a large-scale, tobacco policy review. An Interagency Tobacco Task Group requested that tobacco policies of all New York State Schools be reviewed. A policy rubric was developed using the documents Fit, Healthy, and Ready to Learn and the School Health Index. The rubric assessed five policy components. Aggregate data were calculated for each policy component and for the final score. School policies also were evaluated for compliance with state and federal laws. Overall policy review scores were quite low, suggesting greater effort be placed on helping schools to develop more effective tobacco policies. Initial efforts included sending letters and a "tobacco tool kit" to schools containing recommendations and resources to improve their district's tobacco policy.

Adolescent↗
PubMed2003

[Actual situation of medical checkups carried out by Industrial Health Organizations in Japan--manpower and service].

Japanese Industrial Health Organizations (IHOs) have been taking part in medical checkups for employees in accordance with the law of industrial safety and health in Japan. We carried out a questionnaire survey for each IHO in order to learn the actual number of full-time doctors and their proportion of work time. We sent a questionnaire to 112 IHOs (members of International Federation of Industrial Health Organizations) by mail, of which 77 replied (68.8%). In addition, we carried out an interview survey in 3 IHOs. The actual number of full-time doctors was 0 to 51, about half of IHOs have less than 5 doctors/each. Regarding the proportion of work time, among full-time doctors, half of them take part in general health checkups. About 70% of nurses' work time is taken up doing health checkups. The results revealed that the number and the proportion of work time of full-time doctors depends on the characteristics of the area and the background of the organization, for instance, what kind of hygiene services they provide. Depending on the doctors' work style (e.g. full-time or part-time) and their specialities and experience, their work may be shared. Japanese employers are required to report the number of workers with abnormal findings found by medical checkups to the Labor Standards Office. Many IHOs provide service to employers in filling out their reports. Thus, we also asked each IHO about this service. Forty out of the 77 IHOs (51.9%) answered that they are providing statistical analysis and the filling-out service. They count the number of workers with abnormal findings in each company and helped the employer to fill out the report form. Twenty-nine of those 40 IHOs responded that they decided which findings were "abnormal" by using only items that are set by law. However, 7 IHOs reported the fact that they also add some optional items when making the decision. The prevalence of workers with abnormal findings in annual medical checkups, which is one of the msot important indices of the state of occupational health, should be measured by using an objective definition and by being compatible with future systems of medical checkups for all Japanese workers. Although IHOs are endeavoring to improve their level, it will be difficult, and because of diversities in the way of periodical medical checkups among IHOs, there are still many problems to be solved.

Data Collection↗
PubMedDate not supplied

[Standards, Options and Recommendations 2000: non metastatic endometrial cancer].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Cancer Centers, and specialists from French Public Universities, General Hospitals and Private Clinics, and some specialists learned societies. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The SORs are developed using a methodology based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for the management of patients with carcinoma of the endometrium according to the definitions of the Standards, Options and Recommendations project. METHODS: Data were identified by searching Medline , web sites, and using the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 63 independent reviewers. RESULTS: The main recommendations for the management of carcinoma of the endometrium are: 1) The diagnosis of carcinoma of the endometrium is based on biopsy and histological examination. However, as first intention, the first elements for diagnosis can be obtain from a hysterography, or particularly, a endovaginal ultrasound examination. Ultrasound allows locoregional metastases to be detected, the CT scan allows the lymph node involvement to be assessed and magnetic resonance imaging allows the myometrium invasion to be evaluated. 2) For the majority of patients, surgery is the initial treatment, both for localised and advanced-stage carcinomas. The excised sample can be used for pathological analysis and tumour staging, using the FIGO (Fédération internationale de gynécologie obstétrique) classification. Surgery for patients with stage I and II carcinomas involves total extrafascial hysterectomy with bilateral salpingo-oophorectomy., In patients with stage III and IV carcinomas radical surgery should be performed, when possible. If this is not possible, then surgery should be as complete as possible and be associated with a complementary treatment. In patients with the most advanced carcinomas, tumour reduction by surgery should be performed. 3) Complementary treatment includes external-beam radiotherapy and brachytherapy. The decision concerning the extent and type of irradiation should be taken taking into consideration the stage and the prognostic factors present. For patients with stage I and II carcinoma, complementary treatment with brachytherapy can be performed, if the myometrium invasion is not deep, or if the carcinoma is grade 2 or 3. Patients with stage III carcinomas can be treated with pelvic or abdominal-pelvic complementary irradiation. In patients that cannot undergo surgery, exclusive radiotherapy can be performed. 4) In the absence of any symptoms, surveillance should include a general clinical and gynaecological examination. All patients with symptoms should undergo an additional work-up.

Endometrial Neoplasms↗
PubMed1981

Reintegration: the slow march of progress--towards a reality-oriented concept of health education.

The essay sets out to plead for a basic reassessment of many of the implicit or explicit "conceptual props and crutches" upholding traditional health education. Its main thrust is to reconstruct the many disparate bits and pieces of theoretical assumption which have come into being through the various historical phases of health education and, in doing so, to rebuild an image of social reality in which health educators can hope to operate more meaningfully and, possibly, more effectively. The general theory behind the call for an integrated approach to health education is that this art can only thrive when openly confronted with its traditional limitations determined both by limits of social awareness and social structure. These have to be made the subject of discussion on health education "theory" in order to affect change. Examples of an alternate approach applied in the Federal Republic of Germany are quoted to stimulate discussion.

Goals↗
PubMed1995

[Reorganization of the graduate course in pediatric nursing at the nursing school at the Federal University at Minas Gerais. Evaluation of the process].

In this paper, the faculty from the Pediatric Nursing Subject (Undergraduate Course) at the Nursing School of Universidade Federal de Minas Gerais evaluate a teaching project. Its main purpose was to reorganize the Subject based on ABATT; MCMAHON's approach to the teaching-learning process. The authours evaluate the results and highlight the positive aspects occurred due to the reorganization and confirm the need to continue the process.

Curriculum↗