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PubMed2005

Health-related quality of life surveillance--United States, 1993-2002.

PROBLEM/CONDITION: Population-based surveillance of health-related quality of life (HRQOL) is needed to promote the health and quality of life of U.S. residents and to monitor progress in achieving the two overall Healthy People 2010 goals: 1) increase the quality and years of healthy life and 2) eliminate health disparities. REPORTING PERIOD: This report examines surveillance-based HRQOL data from 1993 through 2002. DESCRIPTION OF SYSTEM: Survey data from a validated set of HRQOL measures (CDC HRQOL-4) were analyzed for 1993-2001 from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for the 50 states and the District of Columbia (DC) and for 2001-2002 from the National Health and Nutrition Examination Survey (NHANES). These measures assessed self-rated health; physically unhealthy days (i.e., the number of days during the preceding 30 days for which physical health, including physical illness and injury, was not good); mentally unhealthy days (i.e., the number of days during the preceding 30 days for which mental health, including stress, depression, and problems with emotions, was not good); and days with activity limitation (i.e., number of days during the preceding 30 days that poor physical or mental health prevented normal daily activities). A summary measure of overall unhealthy days also was computed from the sum of a respondent's physically unhealthy and mentally unhealthy days, with a maximum of 30 days. RESULTS AND INTERPRETATION: During 1993-2001, the mean number of physically unhealthy days, mentally unhealthy days, overall unhealthy days, and activity limitation days was higher after 1997 than before 1997. During 1993-1997, the percentage of respondents with zero overall unhealthy days was stable (51%-53%) but declined to 48% by 2001. The percentage of respondents with >/=14 overall unhealthy days increased from 15%-16% during 1993-1997 to 18% by 2001. Adults increasingly rated their health as fair or poor and decreasingly rated it as excellent or very good. Women, American Indians/Alaska Natives, persons of "other races," separated or divorced persons, unmarried couples, unemployed persons, those unable to work, those with a <$15,000 annual household income, and those with less than a high school education reported worse HRQOL (i.e., physically unhealthy days, mentally unhealthy days, overall unhealthy days, and activity limitation days). Older adults reported more physically unhealthy days and activity limitation days, whereas younger adults reported more mentally unhealthy days. A seasonal pattern was observed in physically unhealthy days and overall unhealthy days. During 1993-2001, BRFSS respondents in 13 states reported increasing physically unhealthy days; respondents in 13 states and DC reported increasing mentally unhealthy days; respondents in Alabama, Connecticut, Maine, New Jersey, New Mexico, North Carolina, and Oregon reported both increasing physically and mentally unhealthy days; and respondents in 16 states and DC reported increasing activity limitation days. During 2001-2002, NHANES respondents with one or more medical conditions (e.g., arthritis or stroke) reported worse HRQOL than those without such conditions, and those with an increasing number of medical conditions reported increasingly worse HRQOL. PUBLIC HEALTH ACTION: Policy makers and researchers should continue to monitor HRQOL and its correlates in the U.S. population. In addition, public health professionals should expand monitoring to populations currently missed by existing surveys, including institutionalized and homeless persons, adolescents, and children. A key aspect is to study and identify the personal and community determinants of HRQOL in prevention research and population studies, to understand how to improve HRQOL, and to reduce HRQOL disparities. In addition, population health assessment professionals should continue to refine and validate HRQOL, functional status, and self-reported health measures.

Adult↗
PubMedDate not supplied

Narrowing the gap in childhood immunization disparities.

The reduction of health disparities among all people in the United States is a national health priority. Although immunization rates have improved in the past 20 years, disparities continue to exist among ethnic and racial groups, across different socioeconomic classes, and in different geographic locations. Pediatric health care providers can play a key role in helping to narrow the gap in immunization coverage rates, thus reducing disparities. The purpose of this article is to (1) provide a review of the literature on disparities in immunization rates of children and adolescents, (2) provide suggestions for intervention to minimize immunization disparities, and (3) set an agenda for future research in this area.

Child Welfare↗
PubMed2005

Management studies in medical education.

In 1977, the World Health Assembly (WHA) set the social target--the "Health For All" goal and in 1995, urged member states to "re-orientate medical education and medical practice for "Health For All" (resolution WHA 48.8). This led to World Health Organisation to enunciate the "5-star doctor" needing skills in healthcare management, quality assurance and health economics. The Faculty of Medicine, University of Malaya introduced the New Integrated Curriculum (NIC) in 1995. The objective was aimed at producing a competent doctor with a holistic approach to the practice of medicine. This was to be achieved by having 3 strands of studies i.e. The Scientific Basis of Medicine (SBM), the Doctor, Patient, Health and Society (DPHS), and Personal and Professional Development (PPD) over the 5-year programme, split into 3 phases. Elements of the "5-star doctor" were introduced in strand 2--DPHS and strand 3--PPD. Management studies were introduced in the Personal and Professional Development (PPD) strand. This led to an instructional module--"Principles of Management in Health Care Services (PMGT)" comprising of the Management of Self, Resources and People and incorporating a three week field programme. Evaluation is undertaken at the end of the phase IIIA of the studies. This NIC approach will be able to produce a "5-star doctor", a team player, leader, communicator and an effective manager.

Competency-Based Education↗
PubMed1992

The role of the laboratory in the prevention and detection of chronic disease.

Laboratory Initiative For The Year 2000 (LIFT), the laboratory response to the Healthy People 2000 program, includes the following in its definition of chronic disease: cancer, diabetes, hypertension, end-stage renal disease, stroke, and cardiovascular disease. All are priority health targets for which the laboratory must play an active support role if we are to achieve the goal of controlling these diseases by the year 2000. What are the laboratory procedures needed to assist in the prevention and detection of chronic disease? In this review I consider the traditional tests now used in these efforts, emphasize how and where screening for diabetes, cardiovascular disease, and cancer is now done, and describe the current status of the clinical laboratory in supporting these activities, including new and promising procedures that may be useful in identifying individuals at high risk for disease. It is important to initiate good clinical laboratory practice for these new tests as they are transferred from the research laboratory to the clinical laboratory. The laboratory will be required to provide for this need rapidly and at the same time comply with federal and state controls and regulations.

Cardiovascular Diseases↗
PubMed2006

Vision 2020 and prevention of blindness: is it relevant or achievable in the modern era?

We are living in exciting times with many challenges and new opportunities to overcome diseases. The concept and definition of blindness and their major causes worldwide are discussed with reference to the Vision 2020 initiatives launched in 1999 for blindness prevention, with an updated summary. The peculiar problems that exists in Singapore are also presented. Yet, if the world's major causes of blindness: cataracts, onchocerciasis, trachoma, refractive errors and low vision, and childhood blindness (inherent problems of the Third and Fourth World) can be overcome with international concerted efforts by year 2020, there will emerge new causes as yet unknown. Noble as our aims may be to achieve short- and long-term targets, we have to face the continuous reality of our inability to fulfil them.

Blindness↗
PubMed2005

Maternal health in the eastern Mediterranean region of the World Health Organization.

Globally, progress in improving the survival and well-being of mothers has been slow, and this holds true for the Eastern Mediterranean Region. Thus at the current pace, it is unlikely that the Millennium Development Goal related improving maternal health will be achieved in the Region by the year 2015. This paper outlines the factors contributing to maternal mortality and poor health in the Region and the challenges faced. The action needed to redress the situation and improve maternal health, and hence achieve the fourth Millennium Development Goal, is presented.

Developing Countries↗
PubMed2005

Reducing maternal mortality in the eastern Mediterranean region.

Current efforts in some countries of the Eastern Mediterranean Region are still insufficient to achieve the fifth Millennium Development Goal on improving maternal health. Strong commitment, intensive efforts and effective national policies and strategies are now urgently required in order to translate vision into action. Such efforts and plans should target the strengthening of health systems, the expansion in the coverage of effective integrated interventions, and the recognition of the essential role of individuals, families and communities in making pregnancy safer. This article provides a background on the current situation of maternal health in the Eastern Mediterranean Region, including underlying causes and contributing factors, and describes strategic directions aimed at accelerating the reduction of maternal mortality in the Region and moving closer to the achievement of the Millennium Development Goals.

Causality↗
PubMed2006

Improving health care in the 21st century: focus on Medicaid.

This report contains information from the Health Policy Summit, held in conjunction with the Fifth Annual Primary Care Conference and the Tenth Annual HeLa Women's Health Conference. During the Summit's presentation, the Honorable Newt Gingrich offered key elements of his "Vision for a 21st Century Medicaid Solution." The vision focuses on developing a "21st Century Responsible Citizen Medicaid Act," which will provide improved health outcomes, decreased healthcare spending, and dramatically reduced health disparities.

Health Care Reform↗
PubMed2005

Creating and validating a pneumococcal vaccination registry.

Healthy People 2010 set a goal of 90% vaccination rate for pneumococcal vaccine in elderly patients. We developed a keyword search, using pharmacy orders for Pneumovax as a gold standard, to determine patient eligibility for a computerized pneumococcal vaccination registry. The keyword search captured 98% of vaccinations in the validation dataset. A total of 4,768 patients matched at least one keyword in the search and were added to the immunization registry. Through our search, we found a 63% vaccination rate in the primary care patient population older than 65, leaving 37% of the high risk population still needing vaccinations.

Aged↗
PubMed2006

Conceptual framework for the provision of culturally competent services in public health settings.

To develop a conceptual framework for the provision of culturally competent services in public health based on literature and expert panel reviews. Public health professionals conducted expert panel reviews for face and content validity of the conceptual framework. Results from the panel and theories from public health literature were used to strengthen the framework. Based on an ecological perspective, the framework consists of systems, sub-systems, concepts, and characteristics, including the context, individual provider, organization, service, and client. This framework is viable for the provision of culturally competent services in a variety of public health settings.

Attitude of Health Personnel↗