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PubMed1995

The power of special friends: addressing the risk of child abuse through mentoring.

Since 1989 two Saint Paul, Minnesota agencies have carried on a collaborative effort called the Befriender Volunteer Project. This project is designed to address the risk factors associated with child abuse which are often inherent in families headed by an adolescent. Between November of 1993 and October of 1994 a self-study of this project was conducted. An important objective of this study was to determine how the positive elements of a successful relationship affected the risk factors in these young families. Consistent with what we know about the effects of successful helping relationships, most significant improvements in young mothers were found in the areas of hopefulness, self-esteem, and parenting skills. Of significant note was the observation of the various ways the Befriender/young mother relationship enhanced the young mothers' potential for breaking the generational cycle of risk for child abuse and neglect.

Adolescent↗
PubMed1991

Support in a time of need. The team approach at Mercy Medical Hospice addresses medical, emotional, and spiritual needs.

Mercy Medical Hospice, Daphne, AL, uses an interdisciplinary team approach, which includes medical, nursing, social work, pastoral care, pharmacy, therapies, volunteer, and bereavement services. Mercy Medical has two home care offices and offers inpatient respite care for short periods, which is helpful for those who have an inadequate care giver system or need time to work out a better alternative to care in the home. An assessment of medical and nursing care needs, mental and emotional state, and psychological and spiritual needs is the first step after patients enter hospice. The entire team develops a care plan for the patient and family. Among the issues they address are education about the disease process, medication for pain control and symptom management, and how the patient and family cope with the patient's imminent death. Working with the dying and their families can be stressful for staff members, and they offer each other a lot of support. Working in hospice requires good stress management techniques, but staff feel that it is a calling that enriches their lives.

Alabama↗
PubMed1995

VNA of Boston addresses cultural barriers in home-based care.

Home care professionals know that communication is the key to successful treatment. But what if the patient speaks a different language? One home care agency addresses this problem with a culturally diverse staff and access to interpretation services.

Boston↗
PubMed1996

How well will HEDIS 3.0 address the Medicaid population?

State Medicaid agencies have been looking for a standardized method to address the performance of managed care plans with which they contract. Although the recent release of the Health Plan Employer Data and Information Set for Medicaid plans was intended to satisfy this need, in the current and rapid evolution of performance measurement, it may be too little and too late. The author, one of the members of the original Medicaid HEDIS work group, describes some of the core challenges HEDIS 3.0 will face in improving on the Medicaid data set.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1996

Addressing a neglected coronary heart disease risk factor in an HMO: exercise counseling and fitness testing at group health cooperative.

Group Health Cooperative, following the lead of the American Heart Association (AHA), the Centers for Disease Control (CDC), and the US Preventive Services Task Force (USPSTF), has identified inactivity as one of the most significant risk factors for the prevention of coronary heart disease (CHD). This paper reports on the programs being developed at Group Health Cooperative to address inactivity. A clinical tool designed to make fitness testing and comprehensive exercise counseling practical in routine primary care was designed and piloted. The fitness test was based on the One-Mile Walk Test, with computerization of the results analysis and reporting. The test helped the physician assess the patient's current exercise habits and physical fitness in terms of Vo2max (maximal oxygen consumption). The computer program showed the patient and the physician how the individual's Vo2max compared to norms for the patient's age and gender. The program provided comprehensive written exercise counseling and individualized advice about activity and fitness based on the patient's current exercise habits. The test cost little to administer, and helped reduce the time and effort of the primary physician in providing exercise counseling, while making optimal use of the physician's power to motivate. Exercise counseling is a very cost-effective preventive intervention. We believe that an organized and systematic exercise counseling program, together with a program for measuring fitness, would be the most effective intervention. Evidence indicates that effective exercise counseling should result in substantial reduction in disease in our population.

Adult↗
PubMedDate not supplied

The state of NZ's health services and how Labour would address the problems.

Controversy over the funding and provision of health services has escalated again in recent weeks. The following, an abridged version of an address by Labour leader Helen Clark on October 15 at the Dunedin School of Medicine, surveys present directions and sets out Labour's prescription for change.

Financing, Government↗
PubMedDate not supplied

Assessing spirituality. Healthcare organizations must address their employees' spiritual needs.

Catholic institutions need to respond to their managers, physicians, and other employees experiencing deep pain about the meaning and purpose of life. Initial approaches to people in spiritual distress include "tough love", codependence, and assistance programs, along with prayer and compassion. But a different approach that gives people the space and freedom to pursue their spiritual search and ask questions to discover deeper meaning in life may be more effective. It allows them to accept that they are where they need to be on their spiritual journey, even if that place is painful. Healthcare organizations can, through their structures and culture, create environments that promote this spiritual work. The entire organization must be spiritually grounded. Organizations can develop specific programs to address employees' spiritual yearnings, including: Private spiritual direction or companionship Formal mentoring Renewal days or retreats Spirituality programs for professionals Organizations must consider spirituality in recruiting, uphold policies on spirituality, and ensure physicians receive the same spiritual support as other employees. Resources should be allocated for expanded spiritual services, quiet places for reflection, meditation and related classes, traditional retreats, and qualified personnel.

Catholicism↗
PubMed1995

Tuberculosis treatment through directly observed therapy in a large multisite methadone maintenance treatment program: addressing the public health needs of a high-risk population.

The rate of tuberculosis in patients receiving methadone treatment is significantly greater than the general population. The stabilization of former injection drug users occurs within methadone maintenance treatment programs, indicating the suitability of these sites for directly observed therapy (DOT). There are formidable barriers to the success of DOT, some are institutional, others patient-related. Strategies to address these obstacles need to be implemented. The integration of DOT into existing programs required support from the New York State Department of Health, institutional commitment, as well as continued staff and patient education and training.

Adult↗
PubMedDate not supplied

Health care cost containment: how Pittsburgh is addressing the challenge.

Rapidly escalating health care costs have the public and private sectors searching for methods to provide health care benefits in a more efficient manner. Efforts have also been underway at the community level with the development of health care coalitions created to build consensus toward a fair solution for all parties affected. With the assistance of the Robert Wood Johnson Foundation and many local co-sponsors, the Pittsburgh Program for Affordable Health Care (PPAHC) was organized to address health care cost containment issues in the greater Pittsburgh area. One of the means by which PPAHC chose to achieve this was through the development of a Model Utilization Management Program. This is a document containing community-sanctioned administrative and clinical standards for utilization review which take into consideration the needs and concerns of providers, purchasers, and consumers, and which have a goal of reducing medically unnecessary inpatient hospitalization while concurrently maintaining quality of and access to care. This article describes both the process and the product of PPAHC's efforts toward health care cost containment in Pittsburgh, specifically focusing on its utilization management component.

Community Participation↗
PubMed1987

Citizen advocacy: strategies for addressing human service needs in the community.

This article deals with strategies that have been successfully used and/or developed by West Island Citizen Advocacy for addressing community human service needs and human service delivery quality. Being independent of other human service agencies, and not being a service provider, helps the effectiveness of these strategies. Discussed are case examples of these strategies, i.e. sitting on other boards, organizing community committees or coalitions around service issues, writing briefs on service needs or issues, team and group advocacy, and public education.

Consumer Advocacy↗
PubMed1999

Addressing barriers to change: an RCT of practice-based education to improve the management of hypertension in the elderly.

BACKGROUND: In the future, primary care groups (PCGs) will have to consider how best to apply audit and education to fulfil their commitment to clinical governance and to facilitate the implementation of research findings. AIM: To establish whether an exploration of 'barriers to change' can enhance the effectiveness of an educational intervention designed to improve the management of hypertension in the elderly. METHOD: A parallel-arm, randomized, single-blind, controlled trial of practice-based educational visits in 18 practices. These practices had previously taken part in a multipractice audit of the management of hypertension in the elderly. Both groups received outreach visits in their own practice, during which they received the results of the previous audit. The nine 'intervention' practices were encouraged to explore barriers that would prevent them from implementing pertinent research findings. The control group was not encouraged to do this. The main outcome measure of the trial was determined in advance as 'the stated management of systolic hypertension in patients aged 70 to 79'. A secondary endpoint was the stated management of a specific patient scenario. The endpoints were tested by questionnaire before and after the educational intervention. RESULTS: For the primary endpoint, there was a statistically significant difference in the stated threshold for treating systolic hypertension between intervention and control groups after the visits (161.8 mmHg versus 167.2 mmHg; P = 0.007). For the secondary endpoint, there was also a statistically significant difference between the two groups, after the visits, in their willingness to treat a 70-year-old male with mild hypertension (89% of doctors would treat in the intervention group versus 57% in the control group; P = 0.047). CONCLUSION: The effectiveness of an educational intervention is significantly improved by addressing the barriers preventing practitioners from implementing the findings of research.

Aged↗
PubMed1999

The Expanded Care for Healthy Outcomes (ECHO) Project: addressing the spiritual care needs of homeless men in recovery.

As the nation's homeless population continues to rise, new practice models will need to address the specific health care needs of the homeless while providing cost-effective wellness-oriented quality care. This article describes the early development of one such model. The Expanded Care for Healthy Outcomes (ECHO) Project is an interdisciplinary curriculum/practice model that explores the vital intersection of spiritual and primary care in promoting health among homeless guests at the Pine Street Inn Nurses Clinics in Boston, Massachusetts. The authors describe the incorporation of spiritual assessment and care in clinical practice with homeless men to maximize patients' physical, psychosocial, and spiritual wellness.

Boston↗
PubMed2000

Can addressing family relationships improve outcomes in chronic disease? Report of the National Working Group on Family-Based Interventions in Chronic Disease.

The management of patients with chronic disease constitutes the largest single cost to the health care system in the United States. New approaches and methods are needed to reduce preventable complications and to enhance the health and well-being of patients with chronic disease and their families. Interventions that target the family setting in which disease management takes place have emerged as an alternative to traditional strategies that focus only on the individual patient or that consider the family only as a peripheral source of positive or negative social support. In this approach, the educational, relational, and personal needs of all family members are emphasized. Data reviewed by the National Working Group on Family-Based Interventions in Chronic Disease identified potential mechanisms by which the relational context of the family affects disease management and how characteristics of family relationships serve as risk or protective factors. In this paper we describe the major forms of family-based interventions, review the results of selected clinical trials, and present applications for clinical practice. The data suggest that approaches to the management of chronic disease should be expanded to include the broader relational context in which disease management takes place. Although it adds complexity to clinical intervention, this approach increases clinical flexibility, addresses the important players in disease management, and accounts for a significant number of risk and protective factors that affect outcome.

Adolescent↗
PubMed1999

Cell-surface area codes: mobile-element related gene switches generate precise and heritable cell-surface displays of address molecules that are used for constructing embryos.

We present an updated area code hypothesis supporting the proposal that cell surface display of seven-transmembrane olfactory receptors, protocadherins and other cell surface receptors provide codes that enable cells to find their correct partners as they sculpture embryos. The genetic mechanisms that program the expression of such displays have been largely unknown until very recently. However, increasing evidence now suggests that precise developmental control of the expression of these genes during embryogenesis is achieved in part by permanent and heritable changes in DNA. Using the developing immune system as a model, we discuss two different types of developmentally programmed genetic switches, each of which relies on recombination mechanisms related to mobile elements. We review new evidence suggesting the involvement of mobile element related switch mechanisms in the generation of protocadherin molecules, and their possible involvement in the control of expressions of olfactory receptors. As both recombinase and reverse transcriptase mechanisms play a role in the switching of the immunoglobulin genes, we searched the databases of expressed sequence tags (dbEST) for expression of related genes in other tissues. We present data revealing that transposases and reverse transcriptases are widely expressed in most tissues. We also searched these databases for expression of env (envelope) gene products, stimulated by provocative results suggesting that these molecules might function as cellular address receptors. We found that env genes are also expressed in large numbers in normal human tissues. One must assume that these three different types of mobile-element-related messenger RNA molecules (transposases, reverse transcriptases, and env proteins) are expressed for use in functions of value in the various tissues and have been preserved in the genome because of their selective advantages. We conclude that it is possible that many specific cell lineage decisions are made and remembered by means of genetic switches similar to those that control the immunoglobulin and protocadherin and, probably, the seven transmembrane/olfactory gene families. We also conclude that complex genetic programs utilizing mobile-element-related genes program these events.

Cell Membrane↗
PubMed2000

Involving families in an urban HIV preventive intervention: how community collaboration addresses barriers to participation.

This article addresses the increasing need within urban communities for effective, culturally relevant HIV prevention programs. The recruitment efforts of a family-based prevention program aimed at promoting health and preventing HIV risk exposure in urban, African American fourth and fifth grade children living in a community with high rates of HIV infection is detailed. The program, referred to as the CHAMP (Chicago HIV Prevention and Adolescent Mental Health Project) Family Program, is overseen by a collaborative partnership of community parents, school staff, and university-based researchers (Paikoff & McKay, 1995). The recruitment strategies developed as a result of this community-research collaboration are described. Preliminary results of the project's efforts to reach out to families within the targeted, inner-city community are presented.

Black or African American↗
PubMed2000

Library outreach: addressing Utah's "Digital Divide".

A "Digital Divide" in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine-- Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program.

Area Health Education Centers↗
PubMed2000

Domestic AIDS vaccine trials: addressing the potential for social harm to the subjects of human experiments.

In 1998, the FDA approved the first large-scale human trials of a candidate AIDS vaccine in our nation's history. While the legal issues raised by these trials are manifold, the academic literature has focused almost exclusively on the potential for mass tort liability and the resulting hesitancy of biotech and pharmaceutical firms to enter the field. This Comment argues that another issue of vital concern demands attention: the potential for social harm to the human subjects of AIDS vaccine trials. After providing an overview of the current epidemiology of HIV/AIDS and explaining why a safe, effective AIDS vaccine represents the best way to control the pandemic, this Comment analyzes the scientific and social obstacles to production of such a vaccine. In order to know whether a candidate AIDS vaccine is truly effective, researchers will have to test the product in HIV-negative volunteers at high risk of infection. Since these volunteers may subsequently test positive for HIV on standard blood tests, they will be vulnerable to discrimination on that basis in such areas as employment, insurance, immigration, and incarceration. Moreover, by participating in vaccine trials, volunteers will be marking themselves as people at high risk of HIV infection, another basis for disparate treatment. Researchers have suggested that federal disability discrimination law may afford protection against research-related social harms. Through close analysis of the Americans with Disabilities Act of 1990 and the Supreme Court's decision in Bragdon v. Abbott, this Comment demonstrates that optimistic reliance on federal disability law is misplaced. The unique issues raised by domestic AIDS vaccine trials must be addressed in their own right. The Comment accordingly concludes with a broad range of legislative and regulatory proposals to protect trial participants and advance the AIDS vaccine research agenda.

Animals↗