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At least 541 records · Page 30Linked to original sources
PubMedDate not supplied

Planning a sexual health promotion intervention with homeless adolescents.

BACKGROUND: Homeless adolescents are at very high risk for sexually transmitted diseases (STDs), but few street-based interventions have been developed, tested, and made available to reduce risk and promote sexual health within this growing population. OBJECTIVES: This study, part of a larger study of the sexual health practices of homeless adolescents, explores participants' perceived need for more knowledge about sexual health and their ideas about developing a brief intervention to promote positive sexual health practices that would reflect their perspective. METHODS: Four focus groups with five to six participants each were conducted with 22 youth aged 16-20 years, randomly selected from the study sample of 425 homeless youth. Most participants (82%) were White, one was American Indian, two were Hispanic, and one did not indicate ethnicity. Local groups were audiotape recorded, transcribed, and analyzed for manifest and latent content. RESULTS: Participants were knowledgeable about symptoms, transmission, prevention, and treatment of STDs, but perceived the need for more knowledge about types of hepatitis, cancer, and long-term sequelae of untreated STDs. Participants identified barriers to seeking diagnosis and treatment for symptoms of STDs including cost, not knowing where to go, and lack of services specifically for females. They suggested developing a sexual health intervention based on respect that would provide concrete examples of how to promote their sexual health. CONCLUSIONS: Homeless adolescents were generally knowledgeable about symptoms and prevention of STDs and thought that street outreach interventions should be (a) brief, (b) gender-specific, (c) focused on the unique vulnerabilities and strengths of homeless youth, and (d) accessible.

Adolescent↗
PubMedDate not supplied

Guidelines for evaluating tools for clinical decision making.

Managed care is designed to reduce healthcare costs by controlling use of services and by improving quality outcomes. Preparation of nurses to practice in a health management environment mandates clear understanding of this new environment Nursing educators should focus on the spectrum of health services and enhance the nurses'ability to assess patients independently, implement health plans, and be responsible for outcomes. Nurses must understand how clinical decision-making tools facilitate planning care to maximize use of resources. The authors describe the construction and evaluation of a learning strategy that involves the use of guidelines to evaluate clinical decision-making tools. Two examples are presented: evaluating clinical pathways in a case management project and evaluating algorithm (practice guideline) outcome data from a prenatal population case study from a local health maintenance organization.

Algorithms↗
PubMed1998

Removing barriers and improving choices: a case study in reproductive health services and managed care.

Managed care contains inherent structural features that can create obstacles to time-sensitive, confidential reproductive health services. Such structural impediments often exacerbate the sociocultural barriers that have historically affected low-income women--the population that has been targeted for mandatory enrollment in Medicaid managed care plans in many states. This article recommends public policy strategies to overcome and prevent multiple barriers that were identified in a New York-based study in 1995, which focused on access to reproductive health services in managed care settings. This article also includes updated evidence supporting the study's findings and its relevance to other states.

Adolescent↗
PubMed2004

Vaccination for pandemic influenza: a six point agenda for interpandemic years.

BACKGROUND: The demand for influenza vaccine is driven by recognition of its health and economic benefits. Vaccine reduces all cause mortality in the elderly by 30 to 50% and prevents > or =30% of hospital admissions for influenza-related respiratory disease, heart disease and stroke. However, because most influenza vaccine (85%) is produced in only eight countries, adequate production and equitable distribution of vaccine throughout the world will pose a serious challenge when the next influenza pandemic appears. METHODS: This article reviews a six point agenda for pandemic vaccination that should be undertaken during interpandemic years. The agenda includes preparing vaccine seed strains using reverse genetics, determining the characteristics of a pandemic vaccine and vaccination schedule, considering global registration of pandemic vaccines, increasing vaccination in interpandemic years, documenting the epidemiology of vaccine use and addressing political issues that will affect the global supply of pandemic vaccines. CONCLUSIONS: Planning for pandemic vaccination must begin during the interpandemic period to ensure a vaccine supply that will be adequate to meet demand in all countries. This will require the skills not only of experts in virology, epidemiology and public health but also those in politics, economics and law. The task will be complex, but its promised benefits will be immense.

Disease Outbreaks↗
PubMed2005

Dissemination of an evidence-based multicomponent fall risk-assessment and -management strategy throughout a geographic area.

OBJECTIVES: To report on the penetration of, and identified barriers to and facilitators of, efforts to incorporate evidence-based fall risk assessment and management into clinical practice throughout a defined geographic area. DESIGN: Dissemination project. SETTING: North central Connecticut. PARTICIPANTS: Hospitals, home care agencies, primary care providers, and outpatient rehabilitation facilities. INTERVENTION: Multiple professional behavior-change strategies were used to encourage providers to incorporate evidence-based fall assessment and management into their practices. MEASUREMENTS: Penetration of dissemination efforts over 36 months; barriers and facilitators identified by provider working groups during the first 2 years of the project. RESULTS: All seven hospitals and 26 home care agencies in the area, 119 of 130 rehabilitation facilities, and 138 of 212 primary care offices participated. Most provider working groups expressed similar barriers and facilitating factors. Reported barriers specific to fall risk management included lack of awareness of fall morbidity and preventability, perceived lack of expertise and Medicare coverage, inadequate referral patterns among providers, and lack of a federal mandate for physicians. Facilitating factors specific to falls included the opportunity to market new services and to develop new networks of professional relationships across disciplines and the Medicare mandate that home care agencies focus on functional outcomes. CONCLUSION: Dissemination efforts showed notable successes as well as challenges. Although many of the barriers were general to diffusing new practices, several were specific to fall assessment and management that span disciplines and sites. Project results have implications for efforts to diffuse evidence-based practices for multifactorial geriatric conditions such as falls.

Accidental Falls↗
PubMed2005

Accessibility assessment of the Health Care Improvement Program in rural Taiwan.

CONTEXT: An experimental Health Care Improvement Program (HCIP) was initiated by the Bureau of National Health Insurance in 1997 to improve the accessibility of health care in several rural, mountainous districts. PURPOSE: This longitudinal study evaluated service availability, utilization patterns, and effectiveness of services under the HCIP in the A-Li Mountain District. METHODS: Outpatient claims made by residents in the A-Li Mountain District were extracted from the database of the National Health Insurance program. Changes in utilization pattern and volume were analyzed. Satisfaction levels were assessed by 2-stage face-to-face interviews with local residents. FINDINGS: After the HCIP, the average population served by each doctor decreased 75%, and total outpatient visits increased 15.4%. The total number of in-district outpatient visits increased 83.6%. The proportion of in-district outpatient visits to all visits increased from 22.1% to 35.1%. The total in-district outpatient visit fee claimed increased 100.2%, and the total out-of-district outpatient visit fee claimed increased only 7.2%. About 60.4% of the residents were not satisfied with overall health care services before the HCIP. The proportion decreased to 32.4% after the HCIP. CONCLUSIONS: The HCIP improved accessibility, enriched local medical care resources, changed the utilization pattern of some residents, and increased residents' satisfaction level. A well-managed program with stabilized financial resources is more likely to succeed if it also respects cultural differences and responds to community needs.

Adult↗
PubMed1998

Health action zones.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMed2001

Regional access to acute ischemic stroke intervention.

BACKGROUND AND PURPOSE: Benefit-risk ratios from recombinant tissue plasminogen activator (rtPA) therapy for acute ischemic stroke demonstrate lack of efficacy if intravenous administration is commenced beyond 3 hours of symptom onset. We undertook to enhance therapeutic effectiveness by ensuring equitable access to rtPA for patients affected by acute ischemic stroke within a 20 000 km(2) population referral base served by a tertiary facility. METHODS: Representatives of all provider groups involved in emergency medical services developed a Regional Acute Stroke Protocol (RASP), a coordinated regional system response by dispatch personnel, paramedics, physicians, community service providers, emergency and inpatient staff in community hospitals, and the tertiary facility acute stroke team. RESULTS: As of July 26, 1999, all ambulance services in Southeastern Ontario began bypassing the closest hospital to deliver patients meeting the criteria for the RASP to the Kingston General Hospital. At 12 months, approximately 403 ischemic strokes have occurred in the region, the RASP has been activated 191 times, and 42 patients have received rtPA. CONCLUSIONS: We conclude that (1) acute stroke patients in Southeastern Ontario have improved access to interventions for stroke care; (2) geography of the region is not a barrier to access to interventions for patients with acute stroke; and (3) acute ischemic stroke patients treated with rtPA account for 5% of all acute strokes and 10% of all ischemic strokes in this region.

Aged↗
PubMed2001

Collaboration among the education, mental health, and public health systems to promote youth mental health.

The authors discuss the growing movement in the United States to develop expanded school mental health programs. These programs represent partnerships between schools and community mental health agencies to expand the range of mental health services provided by schools. Such programs emphasize effective prevention, assessment, and intervention. The authors describe efforts that have been undertaken to improve the fragmented and incomplete nature of children's services and to proactively identify and address children's emotional and behavioral problems. They also discuss a strategy to improve youth mental health programs, which includes needs assessments and an analysis of existing programs in a community. They describe the augmenting roles played by the mental health and public health systems in expanding and improving school-based mental health services. The authors outline steps to minimize or avoid the turfism and negative attitudes that may arise among professionals from different disciplines when they collaborate to expand and improve school-based programs.

Adolescent↗