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At least 559 records · Page 31Linked to original sources
PubMed2002

An exploratory study of what clients like least about assertive community treatment.

As part of a larger interview, clients of assertive community treatment programs answered an open-ended question about what they liked least about assertive community treatment. Of 182 clients, 44 percent reported that they disliked nothing; 21 percent said that they disliked features that are considered specific to assertive community treatment, such as home visits, or that have been criticized in the literature, such as intrusiveness; 16 percent said that they were dissatisfied with underimplementation of elements thought to characterize assertive community treatment, such as frequency of visits; and 19 percent said that they were dissatisfied with general aspects of mental health service delivery, such as an inconvenient office location. Compared with clients of programs with low levels of fidelity to assertive community treatment, clients of high-fidelity programs had fewer complaints overall and fewer complaints about features considered to be specific to assertive community treatment.

Behavior Therapy↗
PubMed2006

Collaborative care for bipolar disorder: Part II. Impact on clinical outcome, function, and costs.

OBJECTIVE: The study addressed whether a collaborative model for chronic care, described in part I (this issue), improves outcome for bipolar disorder. METHODS: The intervention was designed to improve outcome by enhancing patient self-management skills with group psychoeducation; providing clinician decision support with simplified practice guidelines; and improving access to care, continuity of care, and information flow via nurse care coordinators. In an effectiveness design veterans with bipolar disorder at 11 Veterans Affairs hospitals were randomly assigned to three years of care in the intervention or continued usual care. Blinded clinical and functional measures were obtained every eight weeks. Intention-to-treat analysis (N=306) with mixed-effects models addressed the hypothesis that improvements would accrue over three years, consistent with social learning theory. RESULTS: The intervention significantly reduced weeks in affective episode, primarily mania. Broad-based improvements were demonstrated in social role function, mental quality of life, and treatment satisfaction. Reductions in mean manic and depressive symptoms were not significant. The intervention was cost-neutral while achieving a net reduction of 6.2 weeks in affective episode. CONCLUSIONS: Collaborative chronic care models can improve some long-term clinical outcomes for bipolar disorder. Functional and quality-of-life benefits also were demonstrated, with most benefits accruing in years 2 and 3.

Adult↗
PubMed2000

Issues facing TB control (2.1). Tuberculosis control in refugee populations: a focus on developing countries.

Today's worldwide tuberculosis epidemic and the movement of a growing number of refugees overlap geographically and have made tuberculosis control in refugee populations an issue of increasing importance. However, in developing countries, where both of these problems are concentrated, tuberculosis control in refugee populations remains a largely unmet need. Experience shows that despite difficult field conditions, tuberculosis control programs can be managed successfully in this setting. The analysis of information available from previous experiences served as the basis for formulating the main policies which, if applied consistently, will reduce morbidity, mortality and transmission of tuberculosis among refugee populations living in camps. The recommendations given are in line with those of the guideline recently produced by the World Health Organization.

Communicable Disease Control↗
PubMed2003

Polymorphisms and the pocketbook: the cost-effectiveness of cytochrome P450 2C19 genotyping in the eradication of Helicobacter pylori infection associated with duodenal ulcer.

The clinical outcome of duodenal ulcer treated with proton pump inhibitor (PPI)-based, anti-Helicobacter pylori (H.p.) regimens varies according to cytochrome P450 2C19 (CYP2C19) genotype. CYP2C19 genotypes differ markedly in peoples of Pacific Rim descent compared with another ethnicity. The authors sought to determine the specific impact that these factors have on the cost-effectiveness of duodenal ulcer management. Their model consisted of two patient cohorts with Helicobacter pylori and duodenal ulcer, trichotomized into CYP2C19 homozygous extensive metabolizers (EMs), heterozygous EMs, and poor metabolizers (PMs), altering the anti-H.p. regimen in the genotyped cohort only. The authors took the perspective of a third-party payer, and the denominator was ulcer episode prevented. In the reference case, the use of CYP2C19 genotyping prior to initiating anti-H.p. therapy was dominant (costs were saved with each ulcer episode prevented) in all geographic regions of the United States. The subsequent break-even analysis showed a range of 89.20 dollars to 118.96 dollars--from Hawaii to the Midwest, respectively--required to eliminate the cost-savings from each genotype test performed. Using probabilities most unfavorable to genotyping, the variation of peoples with Pacific Rim origins from 0% to 100% altered the cost-effectiveness from 495 dollars to 2125 dollars per ulcer event prevented, respectively. The results suggest that treatment decisions for H.p. infection that are based on a patient's CYP2C19 genotype decreases expenses for health plans implementing testing. This analysis provides an economic basis to support recent calls to expand this technology into routine clinical care to prevent toxicity of narrow therapeutic index drugs.

Aryl Hydrocarbon Hydroxylases↗
PubMedDate not supplied

Preconceptional wellness as a routine objective for women's health care: an integrative strategy.

Preconceptional health promotion should not be approached as an isolated activity. Instead, a new approach to women's wellness is needed. Rather than targeting care to women based on their pregnancy status or desires, health promotion and disease prevention should be integrated into a continuum of care throughout the life cycle. When care for women is viewed as an integrated continuum approach to health, rather than as a series of episodic events, higher levels of women's wellness will be achieved. This approach is likely to result in healthier women, pregnancies, and offspring. These outcomes are consistent with the goals of preconceptional health promotion. Using several case illustrations, this article highlights the benefits of integrating care into a continuum model.

Attitude of Health Personnel↗
PubMed2001

Enhancing wellness in a high school: a community partnership.

Meeting the wellness needs of high school students reporting high-risk behaviors above national averages was the purpose of a community partnership between the county school district and West Virginia University School of Nursing. Although the school district and School of Nursing were the primary partners, other programs in the university provided additional support. The school nurse, school of nursing faculty, and nursing students provided wellness programs to students, faculty, and staff. Positive evaluations and high demand for the services demonstrated the school community's need for the program and the success of the partnership.

Adolescent↗
PubMed1994

Health promotion and empowerment: reflections on professional practice.

Recent reformulations of health promotion focus on empowerment as both a means and an end in health promotion practice. Both concepts, however, are rarely examined for their assumptions about social change processes or the potential of community groups, professionals, and institutions to create healthier living situations. This article attends to some of these assumptions, expressing ideas generated during 6 years of professional training workshops with over 2,500 community health practitioners in Canada, New Zealand, and Australia. The article first argues that health promotion is not a social movement but a professional and bureaucratic response to the new knowledge challenges of social movements. As such, it has both empowering and disempowering aspects. The article analyzes empowerment as a dialectical relation in which power is simultaneously given and taken, and illustrates this in the context of health promotion programs. A model of an empowering professional (institutional) health promotion practice is presented, in which linkages among personal services, small group supports, community organizing, coalition advocacy, and political action are made explicit. Practice examples are provided to illustrate each level of the empowering relation, and the article concludes with a brief discussion of the model's educational and organizational utility.

Canada↗
PubMed1994

Health promotion and the discourse on culture: implications for empowerment.

To invoke the primacy of culture in health education activities is not only to challenge approaches to health education that overlook or downplay this domain, but to also deepen and extend the possibilities of progressive approaches that focus on culture. Border pedagogy, which seeks to establish a countervoice to Eurocentrism and patriarchy, enhances and magnifies the possibilities that were opened up when critical pedagogy invoked the engagement of students in the production of knowledge. This process of engaging the teacher/interventionists and the students/audiences in the production of meaning, value, pleasure, and knowledge should be central to the mission of health education. It is only through such dialogue where varied cultural expressions are affirmed and centralized that the production of cultural identity can be legitimating and empowering relative to health promotion.

Communication↗
PubMed1998

Disease prevention and health promotion in urban areas: CDC's perspective.

The mission of the Centers for Disease Control and Prevention (CDC) is to prevent disease, injury, and premature death and to promote quality of life. This mission applies to all Americans, especially to the poor and underserved. As so many people who are impoverished live in America's urban areas, the CDC has a unique and specific interest in the health problems of our urban population. The CDC has established five priorities: (1) strengthen essential public health services, (2) enrich capacity to respond to urgent threats to health, (3) develop a nationwide prevention network and program, (4) promote women's health, and (5) invest in our nation's youth. Each of these priorities will contribute to improving the health of people living in urban areas. The CDC has recently undertaken numerous initiatives to address health promotion and disease prevention issues in the urban setting. Future directions for the CDC lie in better understanding the role of socioeconomic and cultural factors in promoting health and how resources within urban areas can be used to promote health. The CDC needs to explore potential relationships with various types of partners. Solving urban health problems requires actions from many federal agencies as well as from state and local organizations.

Adolescent↗
PubMed1998

Identifying and defining the dimensions of community capacity to provide a basis for measurement.

Although community capacity is a central concern of community development experts, the concept requires clarification. Because of the potential importance of community capacity to health promotion, the Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention (CDC), convened a symposium in December 1995 with the hope that a consensus might emerge regarding the dimensions that are integral to community capacity. This article describes the dimensions that the symposium participants suggested as central to the construct, including participation and leadership, skills, resources, social and interorganizational networks, sense of community, understanding of community history, community power, community values, and critical reflection. The dimensions are not exhaustive but may serve as a point of departure to extend and refine the construct and to operationalize ways to assess capacity in communities.

Communicable Disease Control↗
PubMed1998

Measuring community capacity: where do we go from here?

Goodman et al. have set us off on our journey to articulate and measure the dimensions of community capacity. While we have tried to identify some of the areas for future exploration, it is clear that this should be an ongoing process. Moreover, it is important that the process used to develop measures, assess capacity, and use the information to intervene be consistent with the intended outcome--building community capacity. In other words, at a minimum, the process should be cognizant of the history of the community, be participatory (i.e., incorporate the multitude of voices involved, particularly those of the community members themselves) and use the skills and resources available in professional, academic, and community settings. Perhaps most important, this dialogue must begin from a place of respect for the multitude of perspectives that need to be brought to bear to enhance community capacity to create healthful changes.

Community Networks↗
PubMed1999

"Out-of-the-mainstream" youth as partners in collaborative research: exploring the benefits and challenges.

Forming collaborations between university-based researchers and community-based organizations (CBOs) serves to improve health promotion research and service. Unfortunately, members of the targeted populations are typically not included in such collaborations. This article describes the development and maintenance of a successful university-CBO collaboration that was formed to explore HIV-related risk rates and prevention strategies for suburban street youth and discusses the benefits and challenges of including out-of-the-mainstream youth as full collaborative partners in the research. Specific benefits included population-specific modifications of the research methods and instruments, recruitment of hard-to-reach youth, greater ease in tracking participants, and increased project acceptability and credibility. Among the challenges were issues related to boundaries, confidentiality, commitment, and burnout. Although such collaborations require increased time and commitment, the synergistic knowledge and experience of university researchers, community-based service providers, and out-of-the-mainstream youth can result in the development of unique and informative research and service programs.

Adolescent↗
PubMed2006

Understanding facilitators of and barriers to health promotion practice.

The health promotion best practices literature is imbued with hope for knowledge mobilization, enhanced practice, and improved population health. Given constrained medical care systems, health promotion is key to reducing the significant burden of chronic disease. However, we have seen little evidence of change. This article investigates facilitators of, and barriers to, three stages of health promotion practice in public health organizations, interagency coalitions, and volunteer committees. The article focuses not on what works but why it does or does not, drawing on five case studies within the Canadian Heart Health Initiative. Results indicate that the presence or absence of appropriately committed and/or skilled people, funds and/or resources, and priority and/or interest are the most common factors affecting all stages of health promotion practice. The article extends the literature on internal and external factors affecting health promotion and highlights strategic influences to consider in support of effective health promotion practice.

Canada↗
PubMed1998

Exceptionalism as the rule? U.S. health policy innovation and cross-national learning.

American health care reformers, who often look to other nations for models of desirable health systems, are often surprised nowadays by cross-national infatuation with health policy innovations minted in the United States. American innovations appeal to policy makers abroad as they struggle with cost pressures, distinguish knowledge about how health systems work, and deal with changing images of what constitutes good public policy. These strategems are adapted, not adopted; however, the premises and practices with which other nations follow American directions differ deeply from those in the United States. Ironically, even cross-national experiments may end up offering instructive policy "rules" to the exceptionalist United States.

Cost Control↗