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PubMedDate not supplied

The High-Performance Computing and Communications program, the national information infrastructure and health care.

The High-Performance Computing and Communications (HPCC) program is a multiagency federal effort to advance the state of computing and communications and to provide the technologic platform on which the National Information Infrastructure (NII) can be built. The HPCC program supports the development of high-speed computers, high-speed telecommunications, related software and algorithms, education and training, and information infrastructure technology and applications. The vision of the NII is to extend access to high-performance computing and communications to virtually every U.S. citizen so that the technology can be used to improve the civil infrastructure, lifelong learning, energy management, health care, etc. Development of the NII will require resolution of complex economic and social issues, including information privacy. Health-related applications supported under the HPCC program and NII initiatives include connection of health care institutions to the Internet; enhanced access to gene sequence data; the "Visible Human" Project; and test-bed projects in telemedicine, electronic patient records, shared informatics tool development, and image systems.

Computer Communication Networks↗
PubMed2003

[Partnership experiences of Japanese family].

I belong to the Mental Health and Welfare Association of Chiba Prefecture in which the professionals and the families of the consumers work as partners. This association is a member of the Chiba Federation of Family Associations. It is made up of 34 local association members. I believe that families should be able to look at their situation with positive attitudes. For that, education for family members, especially for fathers is essential. I myself could only change my attitude and behaviors toward my son with the help of social skills training for families. Now we have much better relationships and enjoy our family life together. Right now I am promoting among the family associations a program in which the family could learn about the illness and how to communicate and solve problems that happen from the situation of living with the mentally ill person. We hope psychiatrists and other mental health professionals will have more interest in rehabilitation and support us in our daily lives. In order to build up a trustworthy system of support for the consumers even after we passed away, we as family members want to play an active role and to work more closely with lawyers, social workers, and volunteer citizens.

Family↗
PubMed2006

[Education in palliative care. An overview].

In recent years, the development of new educational concepts in palliative care was necessary due to (1) the growing number of institutions providing palliative care, (2) the introduction of the supplementary term palliative medicine and (3) the integration of palliative care modules in other educational programs in medicine and nursing. Already in the 1990s, dedicated professional societies devised learning target and objective catalogues that are widely acknowledged. In German law, these developments became visible with the introduction of the medical degree 'palliative medicine' in 2003 as well in the nursing law of 2004, where palliative care became part of all nursing education. Together with the existing objective catalogues, these laws stimulated recent publication activities of training manuals, which allow efficient and high quality teaching in palliative care. This paper gives an overview on the development and the current situation of education and training in palliative care in the Federal Republic of Germany.

Curriculum↗
PubMedDate not supplied

A five-phase model for clinical-outcome research.

UNLABELLED: Through a variety of approaches, speech-language pathologists and audiologists have produced strong evidence that treatments are generally potent. However, we have largely ignored the accepted standards for clinical-outcome testing used throughout the broader research community (e.g., by other clinical disciplines, federal regulators, and third-party payers). Several clinical professions recognize a comprehensive model for organizing and scaffolding the many forms of clinical-outcome research. An adaptation of this five-phase model of clinical-outcome research is examined as a means for structuring forms of clinical research throughout audiology and speech-language pathology. Within the organizing structure, relationships become apparent between types and grades of scientific evidence and the processes underpinning evidence-based practice which ultimately lead to decisions on the status of intervention protocols. LEARNING OUTCOMES: Readers will be able to distinguish the phases of clinical-outcome research in a comprehensive model. Readers will be able to identify relationships between the structure of the model and broadly recognized concepts associated with the terms 'efficacy' and 'effectiveness.' Readers will be able to identify indicators of quality for controlled clinical trials.

Biomedical Research↗
PubMedDate not supplied

Hepatitis C and HIV in incarcerated populations: fights, bites, searches, and syringes!

Implications of hepatitis C (HCV) infection in corrections settings and learning needs of nurses whose primary expertise is care of HIV-infected individuals will be presented. This target group of nurses who provide care for HCV-infected patients includes nurses working in corrections settings, and community settings, whose clients have been or will be incarcerated, and advanced practice nurses working in a variety of settings. For nurses who work in the community setting, background information is presented on characteristics of the incarcerated and the environments of some different settings where incarceration occurs, such as county, state, juvenile, and federal institutions. Barriers to HCV prevention, testing, and treatment for incarcerated people are unique and different than for those living in the community. These distinctions are an important area of knowledge for nurses caring for patients who are HCV positive or at risk, whether they are practicing in a community or correctional setting.

HIV Infections↗
PubMed2006

Grassroots activities, national initiatives and HIV prevention: clues to explain Australia's dramatic early success in controlling the HIV epidemic.

During the mid-1980s Australia experienced a remarkable decline in HIV incidence that can rightly be considered a public health milestone of global importance. The effects of this decline lasted for about 20 years and greatly benefited all Australians. In contrast, as we enter the mid-2000s, we see the global epidemic continues to intensify, HIV vaccines remain a distant possibility, and Australia is experiencing rising HIV incidence again. Clearly, better understanding of HIV prevention has important implications both for Australia and the world. Therefore, we believe, it is timely to revisit Australian experiences of the mid-1980s in order to understand those early events better. To gauge the influence (if any) of government strategies, funding levels and other events during a period of dramatic decline in HIV transmission, incidence figures are mapped against Federal HIV/AIDS funding patterns and the occurrence of key national interventions and events. The analysis reveals that the greatest decline in HIV preceded almost all substantive initiatives undertaken at the national level, which are often held responsible for Australia's successful early containment of HIV. In particular, dramatic declines were already well advanced and/or preceded (i) substantive growth in national HIV/AIDS prevention education funding, (ii) publication of the first National AIDS Strategy, (iii) establishment of key national HIV/AIDS bodies and (iv) promulgation of the 'Ottawa Charter'. Explanations for, and lessons learned from Australia's dramatic early declines in HIV incidence are discussed.

Australia↗
PubMed2002

[Health effects of the Chernobyl disaster. Fifteen years afterwards].

The Chernobyl nuclear accident of 1986 released large quantities of radioactive material causing heavy contamination in widespread areas of the former Soviet Union. Each summer, several hundred children visit Spain from Chernobyl. In this article we describe the accident, the environmental contamination, the mechanisms of radiation injury and the dose-response relationships. We review the health effects of exposure to ionizing radiation and the health impact of the Chernobyl catastrophe. We propose guidelines for the medical management and evaluation of children on temporary visits. The health status of adults and especially that of children in Belarus, Ukraine and the Russian Federation has been adversely affected. According to present knowledge, Chernobyl has given rise to a marked increase in the incidence of papillary thyroid cancer, psychological consequences and socioeconomic disruption. Many studies report that the incidence of other diseases has increased, but not all health problems seen after the nuclear accident can be attributed to radiation. Given the long latency period for diseases induced by radiation exposure, long-term follow-up of all potentially affected individuals is important. Fifteen years after the Chernobyl accident the international community is still learning scientific, medical and humanitarian lessons.

Adolescent↗
PubMedDate not supplied

Bridging refugee youth and children's services: a case study of cross-service training.

Bridging Refugee Youth and Children's Services(BRYCS), a public-private partnership between the federal Office of Refugee Resettlement, Lutheran Immigration and Refugee Service, and the United States Conference of Catholic Bishops, provides national technical assistance to public child welfare. After a series of "community conversations," BRYCS identified a lack of knowledge among child welfare staff about newcomer refugees, negative stereotypes, and a fear of child protective services among refugees. BRYCS initiated a number of technical assistance initiatives, including a pilot cross-service training project in St. Louis to strengthen collaboration between child welfare and refugee-serving agencies. This article details the lessons learned from this training and recommends changes in policy and practice.

Adolescent↗
PubMedDate not supplied

Public health response actions and the use of emergency operations centers.

In the wake of 11 September 2001, many public health agencies are reassessing their institutional capabilities and procedures to respond to mass-casualty incidents involving weapons of mass destruction. Prior to the fall of 2001, planning by the public health and other sectors addressed more conventional or naturally occurring events such as earthquakes, hurricanes, tornados, and chemical spills, although attacks with weapons of mass destruction were a growing concern. While the nature of natural versus intentional events differs, the management and coordination of response activities to them follows the same incident command system. A major lesson learned during the response operations to the 11 September 2001 attacks in New York City was the value of disaster planning, conducting exercises, and developing relationships among the various response agencies. Although New York City's physical Emergency Operations Center (EOC) at 7 World Trade Center was destroyed in the attack, the medical and health response community was able to react effectively to the possibility of mass casualties as well as to the more usual needs. This was enabled by the pre-existing relationships that had been developed between city, state, federal, and non-governmental agencies while planning and exercising for such events and their aftermaths.

Disaster Planning↗
PubMed1986

[Medical responsibility for disclosure in legal cases of the German federal court].

The principles herein discussed show yet again that in determining the physician's duty of disclosure, courts rely on general standards and statutory provisions which they then apply more particularly to the facts of the individual case. Physicians, however, are apprehensive of such flexibel criteria, and perhaps even prejudiced against "the lawyers" who, rather than directing their attention to the needs of the individual doctor-patient relationship, tend to think in terms of the principles involved. To quote a distinguished English judge, "It is always easy to be wise after the event". This, of course, is one thing the physician cannot afford to be. Although courts may have the benefit of hindsight, a physician must assess the patient's informational needs at the outset: a problem he has to learn to live with and for which the lawyer must develop a greater understanding. But in so doing, the lawyer must not lose sight of the patient, who is at the mercy of the physician and can easily fall victim to his lack of diligence. In summary, in defining the extent of the physician's duty to inform, particularly in respect of possible or as yet unknown side effects, the general standards referred to above must be applied, bearing in mind the facts of the individual case, such as the urgency of the proposed treatment, its severity and inherent risks, possible side effects, and the patient's educational background, as well as the possible effect of disclosure on his mental and emotional well-being.

Germany, West↗
PubMed1982

Identifying school children with behavior disorders.

Behavioral screening criteria were developed through the collaborative efforts of multidisciplinary professionals to enable teachers to identify school children with behavior disorders within the school setting. The criteria which were developed provide a step towards a practical means of implementing the legislative mandate of PL 94-142 in a medically and psychologically sound manner. An analysis of the criteria presented in the federal guidelines and working criteria proposed by experts in the field is presented. Increased liaison between professionals of all involved disciplines is encouraged for the identification, evaluation, treatment and placement of behavior disorder children. The background and process of developing the criteria is described.

Affective Symptoms↗
PubMed2000

A profile of the population enrolled in New York State's Child Health Plus.

BACKGROUND: The recently enacted State Children's Health Insurance Program (SCHIP), designed to provide affordable health insurance for uninsured children, was modeled in part on New York State's Child Health Plus (CHPlus), which was implemented in 1991. All SCHIP programs involve voluntary enrollment of eligible children. Little is known about characteristics of children who enroll in these programs. OBJECTIVES: To provide a profile of children enrolled in CHPlus between 1993 and 1994 in the 6-county upstate New York study area, and to estimate the participation rate in CHPlus. Methods. A parent interview was conducted to obtain information about children, 0 to 6.9 years old, who enrolled in CHPlus in the study area. Two school-based surveys and the Current Population Survey were used to estimate health insurance coverage. Enrollment data from New York State's Department of Health, together with estimates of the uninsured, were used to estimate participation rates in CHPlus. RESULTS: Most children enrolled in CHPlus in the study area were white. Although 17% of all children in the study area who were <13 years old and living in families with incomes below 160% of the federal poverty level were black, only 9% of CHPlus-enrolled children were black. Twenty-one percent of enrolled children were uninsured during the entire year before enrollment and 61% of children had a gap in coverage lasting >1 month. Children were generally healthy; only 4% had fair or poor health. Eighty-eight percent of parents of enrolled children had completed high school or a higher level of education. Parents reported that loss of a job was the main reason for loss of prior health insurance for their child. Most families learned about CHPlus from a friend (30%) or from their doctor (26%). The uninsured rate among children in the study area was approximately 4.1%. By 1993, the participation rate in CHPlus was about 36%. CONCLUSION: Blacks were underrepresented in CHPlus. Because the underlying uninsured rate was relatively low and parental education and family income were relatively high, the effects of CHPlus observed in this evaluation may be conservative in comparison to the potential effects of CHPlus for other populations of children. Participation rates during the early years of the program were modest.

Child↗
PubMedDate not supplied

Accessing population health information through interactive systems: lessons learned and future directions.

In the mid-1990s, several state and county public health departments implemented interactive software systems that provided easy access to public health-related data for local boards of health, other public health agencies, health care providers, community groups, and other interested members of the public. Based on their experiences with two well-established state interactive systems and one well-established county system, the authors summarize lessons that could prove useful to state and local public health agencies interested in developing new interactive systems or adapting existing ones. The article addresses issues such as: basing interactive systems on a broad definition of health, designing systems to incorporate user preferences, moving from data warehouses to information warehouses, and fostering prevention communities. Finally, the article provides recommendations to assist federal, state, and local public health agencies in developing the next generation of interactive data access systems.

Computer Communication Networks↗
PubMed2000

Introducing computer-aided instruction into a traditional histology course: student evaluation of the educational value.

Both the World Health Organisation and the World Federation for Medical Education have endorsed integration of computer technology into medical education. In line with this and for more practical reasons, second-year medical students were introduced to commercial and in-house computer-aided instruction (CAI) packages in the traditional histology course. Although CAI was well received, light microscopy was still regarded as a valuable skill in the undergraduate curriculum. Its application was viewed to be important in future medical studies, as well as in general practice. It was also perceived to be a more self-directed form of learning than CAI. Students' use of CAI packages was related to CAI meeting course objectives and the level of interactivity.

Attitude of Health Personnel↗
PubMed2005

Environmental monitoring of remedial dredging at the New Bedford Harbor, MA, Superfund site.

New Bedford Harbor (NBH), MA, is a Superfund site because of high polychlorinated biphenyl (PCB) concentrations in the sediment. From April 1994 to September 1995, a remedial dredging operation (termed the "Hot Spot") removed the most contaminated sediments (PCB concentrations greater than 4000 microg/g) from the upper harbor. During remediation, a monitoring program assessed the potential environmental impacts to NBH and adjacent Buzzards Bay. The monitoring program was developed with input from federal, state, and local authorities. Site-specific decision criteria were established to assess net PCB transport, water column toxicity, and PCB bioaccumulation in blue and ribbed mussels (Mytilus edulis and Geukensia demissa, respectively). The remediation was completed without exceeding PCB net transport or acute toxicity effects specified in the decision criteria. In addition, PCB bioaccumulation in mussels during this time period was not significantly greater than pre- or post-operational measurements. The results indicated that approximately 14000 cubic yards of highly PCB contaminated sediment were permanently removed with minimal environmental effects. The lessons learned during this operation, as well as previous pilot studies at the site, will be used to make full-scale remedial efforts in NBH more efficient and environmentally protective.

Animals↗
PubMed2002

Bioastronautics: optimizing human performance through research and medical innovations.

A strategic use of resources is essential to achieving long-duration space travel and understanding the human physiological changes in space, including the roles of food and nutrition in space. To effectively address the challenges of space flight, the Bioastronautics Initiative, undertaken in 2001, expands extramural collaboration and leverages unique capabilities of the scientific community and the federal government, all the while applying this integrated knowledge to Earth-based problems. Integral to the National Aeronautics and Space Administration's missions in space is the reduction of risk of medical complications, particularly during missions of long duration. Cumulative medical experience and research provide the ability to develop evidence-based medicine for prevention, countermeasures, and treatment modalities for space flight. The early approach applied terrestrial clinical judgment to predict medical problems in space. Space medicine has evolved to an evidence-based approach with the use of biomedical data gathered and lessons learned from previous space flight missions to systematically aid in decision making. This approach led, for example, to the determination of preliminary nutritional requirements for space flight, and it aids in the development of nutrition itself as a countermeasure to support nutritional mitigation of adaptation to space.

Adaptation, Physiological↗
PubMed1996

News from the future: health care summit caps decade of transformation, 1996-2005.

Many in academic medicine agree that its future will be very different from its past. Transformation, not tinkering, is needed if academic health science centers are to survive the challenges posed by federal and state budget constraints, the intense price competition of managed care, and the wide dispersion of information via the Internet. Academic medicine is like an ocean liner, stately and slow to turn from its charted course. But those who captain the huge, slow ship have seen the tip of the iceberg that looms in its path, and must turn to a new course now. The author presents a possible scenario of the future that describes new relationships among academic health centers, new roles for deans and department chairs, and a more collaborative approach to learning. In the scenario, set in the year 2002, the writer looks back on the changes of the period 1996-2005 and describes the relationships, management, priorities, and reward systems of the institutions responsible for health care, medical education, and biomedical research.

Academic Medical Centers↗
PubMed2003

The foot-and-mouth disease epidemic of 2001 in the UK: implications for the USA and the ""war on terror".

While there is no evidence to suggest that the recent epidemic of foot-and-mouth disease (Fmd) in the Uk and its subsequent spread to continental Europe were caused by bioterrorism, the extent of the epidemic shows that Fmd could be a very powerful weapon for a bioterrorist wishing to cause widespread disease in livestock and economic disruption for the targeted country. This paper describes the epidemic. It then examines the contentious issues that arose through the use of extensive slaughter to control the epidemic and explores how, in turn, the concerns of society are being translated into a radical change in policy within the European Union with respect to the control of Fmd and other foreign animal diseases. The crisis generated by the Fmd epidemic in Europe in 2001 provides many lessons to be learned for the US and highlights the need for creative thinking in research and teaching within colleges of veterinary medicine to more effectively address the threat of epidemic diseases under the "new world order." There is general agreement that the veterinary profession in the US plays a unique role in protecting the nation against epidemic livestock diseases, whether caused naturally or through bioterrorism. The profession also has a significant role in protecting the public's health, since several epidemic diseases of animals, such as rift valley fever, are zoonotic. However, improved financial support at the federal and state levels is urgently needed to support epidemic-diseases research and teaching in colleges of veterinary medicine.

Animals↗