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Center provides research, treatment for Hansen's disease.

The National Hansen's Disease Center is a unique research, training, and treatment complex at Carville, LA, for Hansen's disease (leprosy), a chronic illness affecting an estimated 15 million people worldwide. The Daughters of Charity of St. Vincent de Paul helped establish it in 1896, and in 1921 the center became a federally funded institution. SUlfone drug treatment, a major advance, was begun there. Scientists at Carville study the disease's unknown mode of transmission; training administrators conduct learning seminars; and laboratory researchers produce bacteria samples to be distributed as possible vaccines. Some patients receive treatment and leave, whereas others reside at the self-contained community. Reconstructive surgery is performed there, and special footwear is made. Some patients work on The Star, a magazine dedicated to correcting misconceptions about the disease and its communicability. The center includes a school and a pool and golf course. Hansen's disease care programs are available in many states and are expanding to other areas.

Hospital Bed Capacity, 300 to 499↗

Availability of additional HRSA competitive grants. Health Resources and Services Administration, HHS. Notice of availability of funds.

The Health Resources and Services Administration (HRSA) announces the availability of funds for several HRSA programs. This Notice lists several programs that are announcing competitions for fiscal year (FY) 1999 funds but were not published in the fall 1998 HRSA Preview. This Notice includes funding for HRSA discretionary authorities and programs as follows: (1) Special Projects of National Significance, HIV/AIDS Bureau; (2) Extramural Support Program for Projects to Increase Organ and Tissue Donation, HIV/AIDS Bureau; (3) Cooperative Agreement for Emergency Medical Services for Children and Quality Improvement Center, Maternal and Child Health Bureau; and (4) Basic Nurse Education and Practice: Baccalaureate Nursing Education Using Distance Learning Methodologies for Rural RNs, Bureau of Health Professions. These programs were not published in the fall 1998 HRSA Preview and will only appear in the Federal Register and on the HRSA Home Page at: http://www.hrsa.dhhs.gov/. The next edition of the HRSA Preview is scheduled to be published by early summer 1999. The purpose of the HRSA Preview is to provide the general public with a single source of program and application information related to the Agency's competitive grant reviews. The HRSA Preview is designed to replace multiple Federal Register notices which traditionally advertised the availability of HRSA's discretionary funds for its various programs.

Financing, Government↗

The path to policy change: practical steps and lessons from health funders.

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, on November 3, 2005, Grantmakers In Health (GIH) convened nearly 80 grantmakers and a diverse group of individuals with expertise in different types of public policy work to discuss the challenges and opportunities for health funders who seek to bring about change in federal, state, and local public policies. The program was designed to address funders' desire to go beyond the basics of funding public policy work and to learn from peers and others about how to improve the effectiveness of their public policy efforts. It was structured as a series of small-group discussions on key topics including advocacy infrastructure, communications, community organizing, data development and analysis, evaluation, working with foundation boards, and working with policymakers.

Communication↗

Safety of modern oral contraception: the options for women: lessons to be learned.

The relatively short history of hormonal contraception has been marked by a series of 'pill scares', all of which--after creating panic among users--were proven to be unfounded in terms of public health impact. The latest pill scare, provoked by regulatory action in the United Kingdom and the Federal Republic of Germany in response to the publication of a series of articles indicating a doubling of risk of deep venous thrombosis in users of oral contraceptives containing third-generation progestins, seems finally settled: both the British and the German Drug Regulatory Authorities have now reverted their verdict. The damage unfortunately stays: hundreds of thousands of women have been compelled to abandon the pill of their choice, often deciding to drop contraception altogether, thereby exposing themselves to unwanted pregnancy and--in a number of cases--to pregnancy termination. This latest episode should be turned into something positive: we need to learn that, in the case of drugs in widespread use, before restrictive action is taken--and except for very rare and specific instances--the scientific community must carry out an exhaustive debate on the reality and importance of the observed effects. Although the public should, in each instance, be properly informed, it is only after this process has been completed that restrictive action should be taken. It is hoped that, after this last episode, all concerned have learned this simple principle and will accept being guided by it from now on.

Contraceptives, Oral↗

Insect odour perception: recognition of odour components by flower foraging moths.

Odours emitted by flowers are complex blends of volatile compounds. These odours are learnt by flower-visiting insect species, improving their recognition of rewarding flowers and thus foraging efficiency. We investigated the flexibility of floral odour learning by testing whether adult moths recognize single compounds common to flowers on which they forage. Dual choice preference tests on Helicoverpa armigera moths allowed free flying moths to forage on one of three flower species; Argyranthemum frutescens (federation daisy), Cajanus cajan (pigeonpea) or Nicotiana tabacum (tobacco). Results showed that, (i) a benzenoid (phenylacetaldehyde) and a monoterpene (linalool) were subsequently recognized after visits to flowers that emitted these volatile constituents, (ii) in a preference test, other monoterpenes in the flowers' odour did not affect the moths' ability to recognize the monoterpene linalool and (iii) relative preferences for two volatiles changed after foraging experience on a single flower species that emitted both volatiles. The importance of using free flying insects and real flowers to understand the mechanisms involved in floral odour learning in nature are discussed in the context of our findings.

Acetaldehyde↗

Leadership Opportunities with Communities, the Medically Underserved, and Special Populations (LOCUS).

OBJECTIVES: The Leadership Opportunities with Communities, the Underserved, and Special Populations (LOCUS) Program aims to improve medical students' leadership knowledge and skills, to improve self-awareness and motivation for community service, and to provide models for students to integrate community service into their medical careers. DESCRIPTION: The LOCUS program was established as a longitudinal, extracurricular student opportunity at the University of Wisconsin Medical School in the fall of 1998. Up to 15 new students each year are selected for the program through an application and interview process during their first or second year of medical school. Students remain in the program from acceptance until graduation from medical school. Nearly 50 students have enrolled in the program to date. LOCUS fellows are matched with a physician mentor, participate in core curriculum activities, and complete a longitudinal community service project. Mentors are community generalist physicians who have integrated community service into their own careers. Students participate in their mentors' clinical practices one afternoon a month during the first two years, and mentors serve as role models and provide guidance for students' projects and career development. The program administration and staff are supported through federal predoctoral training and Area Health Education Centers (AHEC) grants. The LOCUS core curriculum is delivered through a series of retreats, workshops, and seminars that emphasize active learning methods and include approximately 20 hours of scheduled activities per academic year. The curriculum addresses concepts of leadership in relation to one's self and in relation to others. Students are introduced to methods of self-reflection and develop their own vision and mission statements. Students also discuss the importance of compassion, self-care, striving for balance, avoiding burnout, and being realistic about what they can accomplish. Students practice strategies for working with teams, organizing meetings, working with media, taking political action, and resolving conflicts. They acquire community health skills such as assessing the health needs of a defined population; engaging community members' participation in health program development; and selecting priorities, designing interventions, and measuring the progress of community health care. Working in small teams, LOCUS fellows apply and refine their leadership skills through design and completion of a community health service project. Students can design their own projects or work on projects designed by community partners. The projects have addressed a variety of community health needs, such as parenting support for teen mothers, teaching health education for residents of group homes, and providing free sports physical exams for uninsured youth. DISCUSSION: This pilot program demonstrates that motivated students can develop leadership skills and address unmet community health needs while they progress through medical school. LOCUS students, staff, and physicians provide a social network that includes opportunities, encouragement, reflection, and problem solving. Student and mentor satisfaction with the program has been high. Future challenges include securing long-term funding, refining the core curriculum, assessing the impact of the program on participants, and improving the quality of projects through community partnerships. LOCUS strives to kindle the fires of altruism and community service so they are not extinguished as students progress through medical training.

Community Health Services↗

Incentives to disability in federal disability insurance and supplemental security income.

Between 1989 and 1994, Disability Insurance and Supplemental Security Income, the 2 federal programs that provide disability benefits, expanded rapidly. The largest growth has been among recipients with mental disorders in the Disability Insurance program and among children with learning disabilities in the Supplemental Security Income program. The expansion was partly due to changes in eligibility rules and partly to other factors including outreach efforts by the Social Security Administration and a lack of funds to review and terminate cases. Factors that keep many of the disabled from seeking work include a fear of being unable to obtain health insurance, which is provided to beneficiaries under Disability Insurance and Social Security Insurance, and the fear of being unable to obtain and keep stable employment. Although children's Supplemental Security Income benefits have reduced poverty in families with disabled children, there is some evidence that parents are encouraging their children to behave poorly so they can qualify. Replacing present welfare and disability programs with national health insurance and a guaranteed annual income would eliminate the work disincentives, but such dramatic restructuring is unlikely in the context of present political debates.

Eligibility Determination↗

Theoretical perspectives on public communication preparedness for terrorist attacks.

The experience of federal health authorities in responding to the mailed anthrax attacks in the Fall of 2001 sheds light on the challenges of public information dissemination in emergencies. Lessons learned from the Fall of 2001 have guided more recent efforts related to crisis communication and preparedness goals. This article applies theories and evidence from the field of communication to provide an orientation to how public health communication can best contribute to the preparedness effort. This theoretical orientation provides a framework to systematically assess current recommendations for preparedness communication.

Bioterrorism↗

Enhancing nursing competence with substance abusing clients.

Alcohol and other drug abuse, major threats to health, pose challenges for nurses in virtually every practice setting. Progress toward increasing nursing competence in the addictions field is being made through the development of practice standards and model curricula and through federal initiatives to increase faculty expertise in this field. The next critical step is to forge creative collaborative links with practice settings, links that assure that requisite learning is reality-based and in step with the future of health care. This article outlines progress toward improving nursing competence in substance abuse and suggests reality-based learning strategies as a future direction for this important goal for nursing education. Two successful models of collaboration between education and practice, designed to augment basic curriculum and improve nursing knowledge, skills and attitudes related to substance abuse, are described.

Alcoholics Anonymous↗

Iowa's National Laboratory for the study of Rural Telemedicine: a description of a work in progress.

As the federal administration advances the idea of the "information superhighway," many disciplines are being challenged to find ways to use advanced telecommunications to improve access to information, enhance learning opportunities, and achieve higher levels of international competitiveness. Telemedicine, the use of communications technology in the practice of medicine, may change the way rural health care is provided by improving access to medical information, diagnostic tools, and consultations. The information and health care services required by health care professionals are rapidly changing, and dissemination of this information to isolated practitioners has proven to be difficult. By providing support electronically from a central site, the most current information is more readily available. Using test-bed hospitals in rural and urban settings, the National Library of Medicine-funded National Laboratory for the Study of Rural Telemedicine at the University of Iowa is currently developing the necessary infrastructure to support targeted projects studying how telemedicine applications can be made more effective and readily available.

Clinical Laboratory Information Systems↗

Disclosing doctors' incentives: will consumers understand and value the information?

As part of a broader movement toward accountability in health care, federal and state governments have required health plans to disclose physicians' financial incentives. Available data suggest that patients have poor comprehension of the incentives and significant barriers to learning, including high trust in their physicians, reluctance to think of the physician/patient relationship in financial terms, and failure to understand the relevance of the information to their health care choices and treatment. Disclosure that conveys clearly what is at stake will increase the salience of incentive information but is also more likely to erode trust.

Attitude to Health↗

A review of the federal government's health activities in response to asbestos-contaminated ore found in Libby, Montana.

Vermiculite ore is a naturally occurring fibrous mineral widely used in various consumer products, such as attic insulation, lawn and garden products, and fireproofing material. While most vermiculite ore and products do not pose a health hazard, the vermiculite mined from Libby, MT was contaminated with naturally occurring asbestos. The federal Agency for Toxic Substances and Disease Registry (ATSDR) has documented a significant number of asbestos-related deaths among Libby residents. Additionally, as part of the ongoing investigation, ATSDR has learned that this contaminated ore was shipped to hundreds of locations around the United States for processing. While the Libby mine is now closed, studies from ATSDR and elsewhere show that people who worked in the Libby mine or vermiculite processing facilities may have been exposed to hazardous levels of asbestos while the facilities were in operation. People who lived or worked near these sites also may have been exposed to asbestos if they came into contact with contaminated vermiculite. Prolonged exposure to asbestos can cause serious and life-threatening health conditions, including asbestosis, lung cancer, and mesothelioma. In response, ATSDR has initiated 10 different activities to help evaluate the potential health effects among Libby residents and populations throughout the United States who might have been exposed to the asbestos-contaminated ore found in Montana. Some of these activities include conducting environmental exposure evaluations, health statistics reviews, community screenings, and disease-specific surveillance. This article presents the various follow-up activities that have been conducted to date by ATSDR and partnering state health departments.

Aluminum Silicates↗

Continuing education meets the learning organization: the challenge of a systems approach to patient safety.

Since the release of the report of the Institute of Medicine on medical errors and patient safety in November 1999, health policy makers and health care leaders in several nations have sought solutions that will improve the safety of health care. This attention to patient safety has high-lighted the importance of a learning approach and a systems approach to quality measurement and improvement. Balanced with the need for public disclosure of performance, confidential reporting with feedback is one of the prime ways that nations such as the United States, Canada, the United Kingdom, and Australia have approached this challenge. In the United States, the Quality Interagency Coordination Task Force has convened federal agencies that are involved in health care quality improvement for a coordinated initiative. Based on an investment in a strong research foundation in health care quality measurement and improvement, there are eight key lessons for continuing education if it is to parlay the interest in patient safety into enhanced continuing education and quality improvement in learning health care systems. The themes for these lessons are (1) informatics for information, (2) guidelines as learning tools, (3) learning from opinion leaders, (4) learning from the patient, (5) decision support systems, (6) the team learning together, (7) learning organizations, and (8) just-in-time and point-of-care delivery.

Education, Continuing↗

Ocular side effects associated with dietary supplements and herbal medicines.

Dietary supplements are prevalent worldwide and play a significant role in the treatment of human disease. In the United States, allopathic physicians are at the early stage of learning how to treat patients with natural remedies and other forms of alternative medicine. Elsewhere, however, alternative remedies have been embraced more fully. In Germany, for example, the German Federal Health Agency created Commission E, which has allowed for a more sophisticated approach to assessing the efficacy and safety of dietary supplements and herbal medicines. Health insurance in Germany frequently covers costs for doctor-prescribed herbal remedies. While there is strong evidence that many herbal products have therapeutic effects, there are also a large number of cases of severe adverse reactions due to some of the many thousands of herbal products. One of the first signs of potential toxicity is in the visual system, as in many cases patients notice loss of vision more than systemic side effects. In addition, ophthalmologists are able to detect objective findings through external eye exams and dilated fundus exams. Presented here are some of the more common ocular side effects from frequently prescribed dietary supplements. In most instances, stopping the treatment or decreasing the dose allows for full resolution of symptoms. In addition, comment is made on the regulatory confusion that exists for this industry, especially in the United States.

Dietary Supplements↗

Reducing the rate of teen pregnancy in Canada: a framework for action.

In partnership with the Young/Single Parent Support Network of Ottawa-Carleton and Timmin's Native Friendship Centre, the Canadian Institute of Child Health has completed a framework to reduce the rate of teen pregnancy in Canada. The final document is called Pro-Action, Postponement, and Preparation/Support: A Framework for Action to Reduce the Rate of Teen Pregnancy in Canada. The objectives were to learn what is currently being done and what needs to be done on this issue across the country, and to explore the potential role of projects funded by the federal Canada Action Program for Children (CAPC) and Canada Prenatal Nutrition Program (CPNP) in reducing the rate of teen pregnancy. Being an extremely complex and sensitive issue, the report was a culmination of a number of research methods: over 40 key informants from diverse backgrounds and expertise were interviewed to determine the scope of the problem and potential solutions; a detailed literature review identified existing date and documentation on the topic, using both Canadian and international studies; youth surveys and focus groups were conducted in both on-reserve Aboriginal communities and non-Aboriginal communities.

Adolescent↗

[Neurology in adolescence]

OBJECTIVE: To provide pediatricians with updated information about the neurological problems that most frequently affect adolescents, allowing doctors to diagnose, investigate and treat migraine headaches and seizures, and other conditions. METHODS: Non-systematic review of medical literature combined with clinical experience acquired at the Martagão Gesteira Institute of Child Care and Pediatrics, Universidade Federal do Rio de Janeiro. RESULTS: Neurological conditions account for an increased frequency of medical appointments among adolescents. A significant number of these patients have seizures, and behavioral and learning disorders. CONCLUSIONS: Most cases can be assessed by non-specialists. This articles aims at supplying pediatricians with tools that will help them diagnose and treat a great number of the situations.

Journal Article↗