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PubMed2004

Public/private boundaries in Canadian healthcare: some clarification.

Most Canadians think that "medicare"/our healthcare system (for the differentiation is certainly not clear) is "public," meaning universal and pre-paid by their taxes. Those who have heard of the five conditions of the Canada Health Act (CHA), or at least the phrase, "public administration," are doubly confirmed in their belief. It comes as a surprise to concerned citizens to learn that, to get federal funding, a province has to set up a "single payer" for health services to fall under medicare, that is, hospitals and physicians. Then, if more information is introduced to distinguish between funding and delivery of services, and it is stated how the former is public, while the latter is mainly private, the audience starts challenging the speaker. Explaining that the delivery of services is private because doctors or nurses are not civil servants, for example, comes across as one more great Canadian fiction. "After all, they are fully remunerated by public funds--my taxes." All of this to recognize that, in Canada, discussions around the public/private divide, from whatever angle, are surrounded by preconceived, often common-sense, ideas rejected mainly by students of healthcare systems.

Canada↗
PubMed2004

Alternative approaches to the definition and identification of learning disabilities: some questions and answers.

Recent consensus reports concur in suggesting major changes in the federal regulatory approach to the identification of learning disabilities (LD). These reports recommend abandoning the IQ-discrepancy model and the use of IQ tests for identification, and also recommend incorporation of response to instruction (RTI) as one of the identification criteria. These changes are also recommended to states in the current reauthorization of the U.S. Individuals with Disabilities in Education Act (IDEA). While not mandatory, states that follow these recommendations will experience major changes in identification and treatment of students served under the LD category. This paper reviews the basis for these recommendations, summarizing four recent consensus group reports on special education that concur in suggesting these changes. Seventeen commonly asked questions about these changes are presented, with responses. In order to ensure adequate instruction for students with LD, it is essential that identification practices focus on assessments that are directly related to instruction, that any services for students who are struggling prioritize intervention over eligibility, and that special education be permitted to focus more on results and outcomes and less on eligibility and process. Identification models that incorporate RTI represent a shift in special education toward the goals of better achievement and behavioral outcomes for students identified with LD, as well as those students at risk for LD.

Child↗
PubMedDate not supplied

Managing terror. Public health officials learn lessons from bioterrorism attacks.

When a photo-journalist presented with the first case of inhalation anthrax in the United States in 23 years, it marked the worse case of biological terrorism in our nation's history. It also marked a significant management challenge for numerous local, state and federal officials. Review what was learned and how we can better prepare for future attacks.

Anthrax↗
PubMed2002

Empowerment as a dynamically developing concept for practice: lessons learned from organizational ethnography.

This article describes the process of developing an empowerment approach in a comprehensive child development program that defined its mission as empowerment of families living in poverty. This description is derived from a seven-year organizational ethnographic research project that included data from participant observation, agency documents, individual interviews of staff and family participants, and focus group interviews with staff. Findings concerning empowerment are presented in two areas: (1) resolution of contrasts and dichotomies related to the nature of services, understanding staff roles, and working with the federal government; and (2) lessons learned forprogram effectiveness. Implications for empowerment-oriented social work practice and policy are offered.

Child Development↗
PubMedDate not supplied

The transition from high school to postsecondary education for students with learning disabilities: a survey of college service coordinators.

Federal legislation requires that students with disabilities receive services to assist them in the transition from high school to post-secondary life. Transition services must address students' understanding of their disability, learning strengths and weaknesses, career decision-making skills, and preparation for the increased demands of postsecondary education. This study surveyed coordinators of special services for students with disabilities at 74 colleges and universities in New York state. Respondents provided their perceptions of how well the students they served had been prepared by the transition services they had received in high school. Overall, little satisfaction with transition services was expressed. Respondents were most satisfied with high schools' provision of updated evaluations for students prior to enrollment in college, and they rated students' preparation for self-advocacy as the greatest weakness of current transition services.

Adolescent↗
PubMed2000

Successful control of epidemic diphtheria in the states of the Former Union of Soviet Socialist Republics: lessons learned.

Epidemic diphtheria reemerged in the Russian Federation in 1990 and spread to all Newly Independent States (NIS) and Baltic States by the end of 1994. Factors contributing to the epidemic included increased susceptibility of both children and adults, socioeconomic instability, population movement, deteriorating health infrastructure, initial shortages of vaccine, and delays in implementing control measures. In 1995, aggressive control strategies were implemented, and since then, all affected countries have reported decreases of diphtheria; however, continued efforts by national health authorities and international assistance are still needed. The legacy of this epidemic includes a reexamination of the global diphtheria control strategy, new laboratory techniques for diphtheria diagnosis and analysis, and a model for future public health emergencies in the successful collaboration of multiple international partners. The reemergence of diphtheria warns of an immediate threat of other epidemics in the NIS and Baltic States and a longer-term potential for the reemergence of vaccine-preventable diseases elsewhere. Continued investment in improved vaccines, control strategies, training, and laboratory techniques is needed.

Adult↗
PubMed2006

[Rectal cancer Information dedicated to cancer patients and relatives].

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program. The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The handbook SOR SAVOIR PATIENT Understanding rectal cancer is an adapted version of the clinical practice guidelines (CPG) Standards, Options and Recommendations for rectal cancer. It is meant to provide a basis for the explanation of the disease and treatments and to facilitate discussions with the healthcare team. It is available from the FNCLCC (101, rue de Tolbiac, 75013 Paris, Tel. (0033) 1 44 23 04 68, www.fnclcc.fr). This document has been validated at the end of 2004 and published in 2005. SOR SAVOIR PATIENT guides are systematically updated when new research becomes available. Information leaflets, extracted from the handbook SOR SAVOIR PATIENT Understanding rectal cancer and published in this edition of the Bulletin du cancer, allow patients to better understand colonoscopy and colostomy, which represent an important patient information need. These articles are meant to inform patients and relatives about the disease and its treatments. It also offers health professionals a synthetic evidence-based patient information source which facilitates discussions with the patient.

Colonoscopy↗
PubMed2005

[Social aspects and cancer: information dedicated to cancer patients and relatives].

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program (SSP). The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The information and dialogue handbook SOR SAVOIR PATIENT Social aspects & cancer partly published in this edition of the Bulletin du cancer, provides specific information regarding patient social rights and benefits extracted from the texts of laws currently in force in France. It also relies on the handbook A "Prévoir Demain, La réinsertion des patients traités pour cancers A", realised in partnership with the FNCLCC, the Coloplast foundation for quality of life and the National League against Cancer. This document is available from the FNCLCC (101, rue de Tolbiac, 75013 Paris, Tel. (0033) 1 44 23 04 68, www.fnclcc.fr). The handbook A "Social aspects & cancer A" was worked out and published in 2004. Information may change with new legal regulations. It is therefore strongly advised to refer to the texts of laws in force to check for possible amendments. This article aims to help patients and relatives to be better aware of their social rights, to locate the different social and administrative services concerned (CAF, Cotorep, etc.) and to turn to the right person and the appropriate agency in the event of social difficulties during and after the disease. This document is designed to offer health professionals a validated information digest of all resources available in order to better communicate with the patient on social aspects of cancer.

Family↗
PubMed2006

[Understanding nephroblastoma. Information dedicated to parents and relatives].

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program. The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information developed in this program is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres,the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The handbook SOR SAVOIR PATIENT Understanding nephroblastoma is an adapted version of various scientific publications and international clinical practice guidelines, validated by oncology experts and by the Nephroblastoma Committee of the French Society against Cancers and Leukaemias in children and adolescents (SFCE). It was elaborated with the active participation of parents and other family members. It is meant to provide a basis for the explanation of the disease, to help parents asking questions, and to facilitate discussions with the healthcare team. It is available from the FNCLCC (101, rue de Tolbiac, 75013 PARIS, Tel. (0033)1 76 64 78 00, www.fnclcc.fr). This document was validated at the end of 2005 and published in May 2006. SOR SAVOIR PATIENT guides are systematically updated when new research becomes available. Information leaflets, extracted from the handbook SOR SAVOIR PATIENT Understanding nephroblastoma and published in this edition of the Cancer et Radiothérapie, describe the physiopathology of nephroblastoma, as well as treatments and follow-up. The guide allows parents and relatives to better understand the disease and the treatments proposed. It also offers health professionals a synthetic evidence-based patient information source which facilitates discussions with the patient.

Child↗
PubMed2005

[Understanding positon emission tomography (PET) with [18F]-FDG in clinical oncology. Informations dedicated to patients and relatives].

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives, the SOR SAVOIR PATIENT program (SSP). The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals, the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The guidelines, "Standards, Options: Recommendations" (SOR) are used as primary information sources. The handbook SOR SAVOIR PATIENT Understanding positron emission tomography (PET) with [18F]-FDG in clinical oncology, integrally published in this issue of the Bulletin du Cancer, is an adapted version of the clinical practice guidelines (CPG) Standards, Options and Recommendations for positron emission tomography (PET) with [18F]-FDG in clinical oncology. The main objectives of this article are to allow persons affected by cancer and their close relatives to better understand this medical imaging technique and its implementation. This document also offers health professionals a synthetic evidence-based patient information source that should help them communicate that information during the physician-patient encounter. Positron emission tomography (PET) is a scintigraphy technique using a radiotracer, [18F]-fluorodeoxyglucose (abbreviated [18F]-FDG), administered intravenously into the patient's arm. This tracer, similar to glucose (sugar), binds to cancer cells and temporarily emits radiations that can be recorded by a special camera in the PET scanner. PET scanning can be used to obtain complementary information at different stages of the disease, whether for assessing diagnosis, treatment evolution or follow-up. By 2007, in the framework of the government plan against cancer, about seventy-five PET scanners are expected to be installed in France. Twenty-four are currently in use; a similar number is under installation. At the end of this process, all French regions should have at least one PET imaging equipment. The SOR SAVOIR PATIENT guide: Understanding positron emission tomography (PET) with [18F]-FDG in clinical oncology and the integral report of CPG SOR 2003: Standards, Options and Recommendations for positron emission tomography (PET) with [18F]-FDG in clinical oncology can be downloaded from the FNCLCC website: http:\\www.fnclcc.fr.

Decision Making↗
PubMed2006

[SOR SAVOIR PATIENT Cancer and fatigue. Information dedicated to cancer patients and relatives].

In response to the evolution of the information-seeking behaviour of patients and concerns from health professionals regarding cancer patient information, the French National Federation of Comprehensive Cancer Centres (FNCLCC) introduced, in 1998, an information and education program dedicated to patients and relatives,the SOR SAVOIR PATIENT program. The methodology of this program adheres to established quality criteria regarding the elaboration of patient information. Cancer patient information, developed in this program, is based on clinical practice guidelines produced by the FNCLCC and the twenty French regional cancer centres, the National League against Cancer, The National Cancer Institute, the French Hospital Federation, the National Oncology Federation of Regional and University Hospitals,the French Oncology Federation of General Hospitals, many learned societies, as well as an active participation of patients, former patients and caregivers. The handbookSOR SAVOIR PATIENT Cancer and Fatigue is an adapted version of different publications regarding fatigue in oncology. It is meant to provide a basis for the explanationof the disease and to facilitate discussions with the healthcare team. It is available from the FNCLCC (101, rue de Tolbiac, 75013 Paris, Tel. (0033) 1, 01 76 64 78 00,www.fnclcc.fr). This document has been validated at the end of 2005 and published in January 2006. SOR SAVOIR PATIENT guides are systematically updated when new research becomes available. This article is extract from the handbook SOR SAVOIR PATIENT Cancer and Fatigue and concerns the causes and effects of fatigue and how to cope with fatigue. This information allow patients to better understand the causes and effects of fatigue, how to cope fatigue...which represent important patient information needs. This article is meant to inform patients and relatives about the disease and its treatments. It also offers health professionals a synthetic evidence-based patient information source which facilitates discussions with the patient.

Activities of Daily Living↗
PubMed2005

The federal initiative to halt the sale of tobacco to children--the Synar Amendment, 1992-2000: lessons learned.

BACKGROUND: The Synar Amendment was enacted by the US Congress in 1992 to require states and territories to establish and enforce laws prohibiting the sale of tobacco to minors. OBJECTIVE: To describe state and federal efforts to comply with the Synar mandate. METHODS: State and federal actions were examined for the eight years following enactment. DATA SOURCES: Federal documents from 1992-2003, annual block grant applications from 59 states and territories describing activities during federal fiscal years 1995-2000. MEASURES: Whether applicants made a good faith effort to comply by enacting a law, enforcing it with inspections and penalties, conducting a valid survey and meeting violation rate targets set by the Department of Health and Human Services (DHHS). RESULTS: Between 1996 and 2000, 26 states had made a good faith effort to comply with Synar every year. In 2000, 57 jurisdictions (excluding Maryland and Montana) had established laws without loopholes, 57 conducted a valid survey, and 54 actively enforced their laws. By 2002, violation rates had dropped substantially everywhere but Alaska and a few small territories. No state reached the violation rate goal of 20% without penalising violators. CONCLUSIONS: The Synar Amendment has resulted in the universal adoption of laws prohibiting tobacco sales to minors and almost universal enforcement of those laws, resulting in dramatically reduced violation rates. Implementation was slowed significantly by a lack of good faith effort in many states and by DHHS's decision not to require states to enforce their laws by penalising lawbreakers.

Adolescent↗
PubMed1989

The paradox of hunger and economic prosperity in America.

Within a period of twenty years, America discovered that many of its citizens were hungry, acted to greatly reduce this problem through an array of federal programs, and, in the 1980s, learned that hunger has reappeared in epidemic proportions. The return of hunger to the U.S. is associated with economic and tax policies that have reallocated income distribution from poor and middle-income groups to the wealthy, and with a corresponding failure to utilize the federal government to protect high-risk population groups from undernutrition associated with growing economic deprivation in the nation.

Humans↗
PubMed2003

Business models for cost effective use of health information technologies: lessons learned in the CHCS II project.

The Department of Defense (DoD) has embarked on an initiative to create an electronic medical record for all of its eligible beneficiaries. The Clinical Information Technology Program Office (CITPO) is the joint-service program office established to centrally manage this multi-year project. The Composite Health Care System II (CHCS II) is the name of the system under development. Given the historical failure rate of large-scale government information system projects, CITPO has employed an incremental acquisition approach and striven to use industry best practices to the greatest degree possible within the constraints of federal acquisition law. Based on lessons learned during the concept exploration phase of this project, CITPO, in partnership with Integic Corporation, the prime integration contractor, has reengineered its software acquisition process to include industry best practices. The result of this reengineering process has resulted in a reduction of the total projected life cycle costs for CHCS II from the original estimate of $7.6 billion over a 14-year period to between $3.9 and $4.3 billion.

Cost-Benefit Analysis↗
PubMed2005

[Chances and successes of vocational training of disabled youth in occupational and vocational school--findings of the BAR-pilot study "Regional Networks for Vocational Rehabilitation of (Learning-) Disabled Juvenile (REGINE)"].

The pilot study "REGINE" was realized on initiative of the Federal Rehabilitation Council (BAR) to test the opportunities of vocational training of learning-disabled youth under "normal" conditions: That means the young people are trained in firms and regular vocational schools, and -- while doing so -- are supported by educational institutions. The project was finished successfully. The results of the evaluation, realized by the Institute for Empirical Sociology at the University of Erlangen-Nürnberg were already published in December 2003. They encourage making use of the opportunities of in-firm vocational training of disabled youth more frequently. More than half of the participants of the first REGINE-cohort successfully finished their vocational training. Nearly 40 % were taken over by the firm that provided vocationally trained, and 12.8 % found a job in another company. The second cohort showed even better results: the corresponding rates are 47.1 and 32.4 %. This success speaks in favour of this place of vocational training, particularly considering the difficult job situation. It seems to be possible, that disabled youth are successfully and cost-effectively trained vocationally, if an individual support of both youth and firms can be provided. Prerequisite for this is a conscientious preparation of the vocational training, which may already begin in the last classes of school. "Achilles heel" of the new place of vocational training for disabled youth is the theoretical training in regular vocational schools which usually can not meet the needs of the learning-disabled. These shortcomings had to be compensated by special educational institutions which are not financed by educational administration but by employment agencies (which actually have no jurisdiction over this kind of duties).

Adolescent↗