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PubMed2004

Providing a medical home: the cost of care coordination services in a community-based, general pediatric practice.

OBJECTIVE: To determine the cost of unreimbursable care coordination services for children with special health care needs (CSHCN) in 1 community-based, general pediatric practice. METHODS: A measurement tool was developed to quantify the precise activities involved in providing comprehensive, coordinated care for CSHCN. Costs of providing this care were calculated on the basis of time spent multiplied by the average salary of the office personnel performing the care coordination service. In addition, data were collected regarding the complexity level of the patient requiring the service, the type of service provided, and the outcome. RESULTS: During the 95-day study period, 774 encounters that led to care coordination activities were logged, representing service provision to 444 separate patients. When these encounters were examined on the basis of clinical complexity of the patient, the most complex patients constituted 11% of the population of CSHCN yet accounted for 25% of the encounters. In addition, care coordination activities for these clinically complex CSHCN engaged office staff 4 times as long when compared with less clinically complex CSHCN. Overall, 51% of the encounters were attributable to coordinating care for problems not considered typically medical and included activities such as processing referrals with managed care organizations, consulting with schools or other educational programs, and providing oversight for psychosocial issues. On the basis of national salary and benefits data, the annual cost of the time spent coordinating care for CSHCN in this medical home model ranged from 22,809 dollars to 33,048 dollars (representing the 25th and 75th percentiles, respectively). CONCLUSIONS: The costs of providing care coordination services to CSHCN in a medical home are appreciable but not prohibitive. Standardization of care coordination practices is essential because it makes the medical home more amenable to quality improvement interventions. Mechanisms to finance unreimbursable care coordination activities must be developed to achieve the Healthy People 2010 objective that all CSHCN have access to a medical home.

Child↗
PubMed2004

Contrasting socioeconomic profiles related to healthier lifestyles in China and the United States.

Health disparity by socioeconomic status has recently become an important public health concern. Socioeconomic status may affect health status through several pathways including lifestyle choices. The authors tested the link between socioeconomic status and lifestyle in China (in 1993) and in the United States (in 1994-1996), countries with high contrasts in development, to understand health discrepancy issues cross-nationally. Healthfulness of lifestyle was measured using the Lifestyle Index, a summary score that integrates four key lifestyle factors: diet, physical activity, smoking, and alcohol consumption. Income and education were used as indicators of socioeconomic status. In China, as socioeconomic status improved, lifestyle was less healthy (relative odds for the highest socioeconomic status group = 0.19, 95% confidence interval: 0.10, 0.35). Conversely, in the United States, higher socioeconomic status was related to a healthier lifestyle (relative odds for the highest socioeconomic status group = 3.81, 95% confidence interval: 2.94, 4.94). The contrasting relation between socioeconomic status and lifestyle depicts different phases of the lifestyle transition (changes in lifestyles accompanying economic development). The differences may in part explain why nutrition-related noncommunicable diseases are more prevalent in the developing world among people with a high socioeconomic status, whereas often the opposite is found in developed societies. Public health programs may benefit by advising each socioeconomic status group separately, while considering the country's level of development.

Adult↗
PubMed2002

Breastfeeding continues to increase into the new millennium.

OBJECTIVE: To update reported rates of breastfeeding and exclusive breastfeeding through 2001 and to compare rates in 2001 to those from 1996. METHODS: The Ross Laboratories Mothers Survey (RLMS) is a large, national survey designed to determine patterns of milk feeding during infancy. Questionnaires were mailed each month to a representative sample of mothers when their infant was 1 month of age, 2 months of age, 3 months or age, and so forth. In 1996, approximately 744 000 questionnaires were mailed, and in 2001, 1.4 million questionnaires were mailed. Mothers were asked to recall the type of milk fed to their infant in the hospital, and during each month of age. Two categories of breastfeeding were considered: breastfeeding (human milk or a combination of human milk and formula or cow's milk) and exclusive breastfeeding (only human milk). Rates of breastfeeding and exclusive breastfeeding in the hospital and at 6 months of age were evaluated. RESULTS: In 2001, the prevalence of the initiation of breastfeeding and breastfeeding to 6 months of age in the United States reached their highest levels recorded to date, 69.5% and 32.5%, respectively. Comparing rates in 2001 and 1996, increases in the initiation of breastfeeding and continued breastfeeding to 6 months of age were observed across all sociodemographic groups but were greater among groups that have been historically less likely to breastfeed: women who were black, younger (<20 years of age), no more than high school-educated, primiparous, employed at the time they received the survey, and who participated in the Supplemental Nutrition Program for Women, Infants, and Children (WIC). Breastfeeding in the hospital and at 6 months of age was most common in the Mountain and Pacific states and among women who were white or Hispanic, older, college-educated, and were not enrolled in WIC. Mothers most likely to practice exclusive breastfeeding in the hospital (46.2%) and at 6 months of age (17.2%) had a similar sociodemographic profile as mothers who breastfed their infants. CONCLUSIONS: If increases in breastfeeding continue at the current rate (approximately 2% per year), in-hospital breastfeeding in the United States should meet or exceed the Healthy People 2010 goal of 75% for the early postpartum period. However, the Healthy People 2010 goal for continued breastfeeding to 5 to 6 months of age (50%) may not be reached in every subgroup. To ensure that these goals are achieved, educational and promotional strategies for breastfeeding must be continued to support mothers who are young, less educated, and participating in WIC.

Adult↗
PubMedDate not supplied

Molecular identification of simian virus 40 infection in healthy Italian subjects by birth cohort.

Simian virus SV40, an oncogenic virus in rodents, was accidentally transmitted to humans through the Poliovirus vaccine during the years 1955 to 1963. If the vaccination program were the major source of human infection, then differences in SV40 infection rates by cohort of birth should be observed. The aim of this study was to address this issue. In 134 healthy Italian Caucasian subjects, 15 DNA samples were positive for SV40 by nested polymerase chain reaction and DNA sequencing. The prevalence of genomic infection did not differ across cohorts of birth from 1924 to 1983, however DNA sequencing revealed viral strain differences in individuals born before 1947 and after 1958. While horizontal transmission following the introduction of the polio vaccine could explain the presence of SV40 DNA in younger people, our results also suggest the possibility that other sources of the virus may also be involved in human SV40 infection.

Adult↗
PubMed2002

Impacting health through the worksite.

The achievement of the Healthy People 2010 objectives will require community involvement of health care providers. The worksite remains the best place to access the adult population for health promotion and disease prevention. In addition, it is essential that non-worksite primary care services be attuned to the effects of work on health and illness. Given the frequency and duration of exposure, the significance of a worksite health history for the primary care provider cannot be overstated. To effectively serve clients, health histories should include assessment for the presence of hazardous worksite exposures and consideration of organizational climate. Further, when considering the provision of health promotion programs in the community, offering programs at the worksites within the community can be particularly effective. There should be increased efforts by health care providers to promote lifestyle modification through client and community interventions. The worksite offers an excellent setting as well as an opportunity to collaborate with employers to facilitate health promotion programs. Recognizing the significance of the occupational environment, an increasing number of worksite intervention studies have been reported. However, continued growth in this area is still needed. Research on worksite health promotion and disease prevention intervention is still in its infancy. Nurses can make a unique contribution to research on worksite lifestyle modification programs, and in enhancing the health status of the nation.

Adult↗
PubMed1995

Human genetic susceptibility and infection with Leishmania peruviana.

Racial differences, familial clustering, and murine studies are suggestive of host genetic control of Leishmania infections. Complex segregation analysis has been carried out by use of the programs POINTER and COMDS and data from a total population survey, comprising 636 nuclear families, from an L. peruviana endemic area. The data support genetic components controlling susceptibility to clinical leishmaniasis, influencing severity of disease and resistance to disease among healthy individuals. A multifactorial model is favored over a sporadic model. Two-locus models provided the best fit to the data, the optimal model being a recessive gene (frequency .57) plus a modifier locus. Individuals infected at an early age and with recurrent lesions are genetically more susceptible than those infected with a single episode of disease at a later age. Among people with no lesions, those with a positive skin-test response are genetically less susceptible than those with a negative response. The possibility of the involvement of more than one gene together with environmental effects has implications for the design of future linkage studies.

Adolescent↗
PubMed1996

The health status of elderly people and the new direction of health services.

The projected increase of people in Japan aged 75 years and older in the years to come implies the increase of the disabled elderly. Thus, the core of societal preparation for the aging of the population is generally considered to be the expansion of services for the disabled elderly. However, gerontological studies on the health status of the elderly conducted in Japan show that the prevalence of disability is quite low and even decreasing. Relative to the services for the disabled elderly, preventive services for the healthy elderly have long been overlooked. In 1994, the Metropolitan Tokyo Government organized a task force to develop a new health education program as the preventive health service for the healthy urban elderly. A preliminary plan outlining the health education program--consisting of propagation with a booklet, on-the-job training of practitioners, and development of new curricula and teaching materials--was proposed by the authors for discussion within the task force. Although the inquiry has just begun and the plan is still nascent, it seems adequate to fit the needs for preventive health services in the near future.

Aged↗
PubMed2006

Diffusing an HIV prevention intervention for African American Women: integrating afrocentric components into the SISTA Diffusion Strategy.

Although race and gender are not indicators for HIV/AIDS, both have disproportionately impacted African American women. African American women represent 13% of the U.S. female population and 67% of the AIDS cases among women (Fitzpatrick, The U.S. HIV/AIDS Epidemic in Women and Adolescent Females, HIV Prevention Conference, Atlanta, GA, 2005). The statistics underscore the need for targeted interventions that employ culturally relevant activities to enhance self-esteem and communication skills while encouraging positive behavior change. Factors facilitating intervention effectiveness include culturally relevant components such as cultural practices, beliefs, values, norms, and ideologies (Janz et al., "Evaluation of 37 AIDS Projects," Health Education Quarterly, 23(1), 80-97, 1996). HIV prevention programs targeting African American women should incorporate an approach that includes ethnic heritage as ameans to instill pride, therebymotivating positive behavior change and empowering women. Afrocentric approaches incorporate philosophies relevant to people of African descent and may be spiritually based. Coupling culturally relevant HIV prevention interventions with a culturally relevant diffusion strategy may enhance community receptiveness. The SISTA intervention (DiClemente & Wingood, "A Randomized Controlled Trial of an HIV Sexual Risk Reduction Intervention for Young African-American Women," Journal of the American Medical Association, 274(16), 1271-1276, 1995) incorporates both culturally and gender-relevant activities to empower African American women to make healthy life choices. The article presents the strategy used to nationally diffuse SISTA, which incorporated Afrocentric components within implementation delivery. Lessons learned demonstrate the significance of integrating additional Afrocentric and gender-relevant material to an existing intervention for African American women.

Adolescent↗
PubMed1998

Health problems of late adolescence.

Late adolescents in the 18- to 24-year-old age group, which parallels the traditional college years, represent a unique subpopulation in transition between youth and adulthood. Usually considered to be a healthy group, serious injuries are not uncommon in this physically active period that is marked by new-found freedoms and participation in high-risk behaviors. Many chronic medical problems also begin during this time. A few health problems, such as eating disorders, are actually unique to this population. When the potential for lives and for productivity lost are taken into account, young people are at even greater financial risk from catastrophic medical events than are older patients; yet, people in the 18- to 24-year-old age group are the most likely to be without health insurance. The need for more effective prevention programs for late adolescents is obvious, but to be successful, the programs must consider each risk factor both individually and in the context of their high-risk behaviors.

Adolescent↗
PubMed2006

The eternal quest for optimal balance between maximizing pleasure and minimizing harm: the compensatory health beliefs model.

Particularly in the health domain, humans thrive to reach an equilibrium between maximizing pleasure and minimizing harm. We propose that a cognitive strategy people employ to reach this equilibrium is the activation of Compensatory Health Beliefs (CHBs). CHBs are beliefs that the negative effects of an unhealthy behaviour can be compensated for, or "neutralized," by engaging in another, healthy behaviour. "I can eat this piece of cake now because I will exercise this evening" is an example of such beliefs. Our theoretical framework aims at explaining why people create CHBs and how they employ CHBs to regulate their health behaviours. The model extends current health behaviour models by explicitly integrating the motivational conflict that emerges from the interplay between affective states (i.e., cravings or desires) and motivation (i.e., health goals). As predicted by the model, previous research has shown that holding CHBs hinder an individual's success at positive health behaviour change, and may explain why many people fail to adhere to behaviour change programs such as dieting or exercising. Moreover, future research using the model and implications for possible interventions are discussed.

Attitude to Health↗
PubMed2002

Second varicella infections: are they more common than previously thought?

OBJECTIVE: To describe the epidemiology and clinical characteristics of varicella reinfections reported to a surveillance project. METHODS: We investigated varicella cases reported to a surveillance project between January 1, 1995, and December 31, 1999--with more extensive investigation of cases reporting previous varicella with onset between January 1, 1998, and September 30, 1998--to provide a more detailed description of first and second varicella infections. A simple decision tree was used to assess the likelihood that reported first and second infections were varicella. RESULTS: Among varicella cases reported to the surveillance project, 4.5% of cases in 1995 and 13.3% of cases in 1999 reported previous varicella. More than 95% of first infections were physician diagnosed, epidemiologically linked to another case, or had a rash description consistent with varicella; the same was true for reported second infections. People who reported reinfections were generally healthy. There was a family history of repeat infections in 45% of people who reported reinfections. CONCLUSIONS: Clinical varicella reinfections may occur more commonly than previously thought. Additional studies of the predictive value of a positive varicella history and laboratory studies of reported reinfections are indicated to guide varicella vaccination policy.

Adolescent↗
PubMed1995

Predictors of dietary intake in a functionally dependent elderly population in the community.

OBJECTIVES: The aim of this study was to describe dietary intake and identify predictors of energy and protein intake in a group of high-risk elderly people. METHODS: All elderly persons receiving publicly financed home care services in the area of Sherbrooke, Quebec, Canada, were eligible. Subjects (n = 145) 60 to 94 years of age from three home care programs were interviewed to measure sociodemographic, health, and food-related behavior variables. Three nonconsecutive 24-hour recalls were used to describe usual dietary intake. Independent predictors of energy and protein intake were derived from multiple regression analyses. RESULTS: Very low mean energy intakes were observed in this functionally dependent population. More than 50% of the study subjects did not meet the recommended levels of daily protein intake (0.8 g/kg body weight). Significant independent determinants of intake were burden of disease, stress, poor appetite, and vision. CONCLUSIONS: Results suggest that community-living elderly people with loss of autonomy may have more nutritional problems than healthy elderly individuals. Surveillance of predictors of dietary intake may enable early detection and prevention of nutritional deficits.

Activities of Daily Living↗
PubMed2003

Developing your leadership pipeline.

Why do so many newly minted leaders fail so spectacularly? Part of the problem is that in many companies, succession planning is little more than creating a list of high-potential employees and the slots they might fill. It's a mechanical process that's too narrow and hidebound to uncover and correct skill gaps that can derail promising young executives. And it's completely divorced from organizational efforts to transform managers into leaders. Some companies, however, do succeed in building a steady, reliable pipeline of leadership talent by marrying succession planning with leadership development. Eli Lilly, Dow Chemical, Bank of America, and Sonoco Products have created long-term processes for managing the talent roster throughout their organizations--a process Conger and Fulmer call succession management. Drawing on the experiences of these best-practice organizations, the authors outline five rules for establishing a healthy succession management system: Focus on opportunities for development, identify linchpin positions, make the system transparent, measure progress regularly, and be flexible. In Eli Lilly's "action-learning" program, high-potential employees are given a strategic problem to solve so they can learn something of what it takes to be a general manager. The company--and most other best-practice organizations--also relies on Web-based succession management tools to demystify the succession process, and it makes employees themselves responsible for updating the information in their personnel files. Best-practice organizations also track various metrics that reveal whether the right people are moving into the right jobs at the right time, and they assess the strengths and weaknesses not only of individuals but of the entire group. These companies also expect to be tweaking their systems continually, making them easier to use and more responsive to the needs of the organization.

Administrative Personnel↗
PubMed1998

Education for health promotion and disease prevention: convince them, don't confuse them.

Promotion of health and prevention of disease have become some of the most emphasized issues of the 1990s. The government, health professionals, and private organizations have made the primary prevention of disease a priority. Quality education is a major intervention by which prevention is realized. However, superior quality educational offerings entail significant pre-preparation via the development of clear and realistic teaching/learning plans, faculty knowledge of educational psychology, metacognition and cognitive processing, understanding of cultural diversity, incorporation of adult learning principles, the use of varied teaching/learning strategies, and astute application of program evaluation skills. Educators, like nurses, physicians, and allied health professionals, must work with people to mutually decipher their healthcare needs and plan educational experiences that learners can merge with their own life experiences and ethnocultural perspectives. In addition, educators should use health education materials that match learners' literacy levels. Most importantly, such programs must be thoughtfully evaluated in light of the achievable goals that were outlined during preplanning stages. Without outcomes assessment as part of health promotion/disease prevention education programs, health educators are less likely to produce interventions that learners value and from which they truly benefit. Optimally, education programs about health promotion/disease prevention should generate long-term critical thinking processes that produce positive health choices, behavioral change, and healthy life styles.

Adult↗
PubMed2002

State policies and nurses with substance use disorders.

PURPOSE: To investigate the effects of two state regulatory policies on nurses with substance use disorders (SUD) on relapse rates and retention in the nursing workforce. DESIGN & METHODS: This longitudinal comparative study consisted of six data-collection points in 6 months. One sample of 100 registered nurses (RNs) and licensed practical nurses or vocational nurses (LPN/VNs) had disciplinary actions taken against their licenses by four U.S. state regulatory boards using a traditional, disciplinary approach. The alternative sample consisted of 119 RNs and LPN/VNs from three U.S. states where the regulatory board diverted nurses to programs for treatment and for determining suitability to return to practice. Data were collected via mailed surveys. FINDINGS: When compared to the sample, the alternative sample had more nurses with active licenses, fewer with criminal convictions, and more nurses employed in nursing. No difference in relapse rate was found. Fewer than 15% of nurses in either sample experienced one or more episodes of relapse during the 6-month study. Of those who did relapse, the majority used alcohol or street drugs. CONCLUSIONS: Alternative policies worked as well as disciplinary policies and were a more humane and rehabilitative approach. Alternative policy is consistent with the recommendation in Healthy People 2010 to eliminate financial barriers limiting access to treatment. Further investigation is needed to identify situations that trigger relapse.

Nurses↗
PubMed2001

[Survey on risk factors for type 2 diabetes mellitus at a higher education institution].

The increase in the population's life expectancy, the decrease in people's physical activity and the increase in calorie intake play an important role in the onset of diabetes. Therefore, this study aims at identifying risks factors for type-2 diabetes mellitus in 99 subjects from a teaching institution in a city in the interior of São Paulo State, Brazil. The results enabled the conclusion that 51.5% of the subjects were overweight; 51.5% had hereditary antecedents, 70% did not do physical exercises regularly, 68% felt stressed at work and 6% had altered pressure levels. The results showed the need for an education program within the institution aiming at awaking in the subjects the need to look for healthy life styles in order to prevent risks factors for type-2 diabetes.

Adult↗
PubMed2005

Severity of ultrasonographic liver steatosis and metabolic syndrome in Korean men and women.

AIM: To evaluate the association between the severity of liver steatosis and metabolic syndrome in apparently healthy Korean adults. METHODS: We examined 1 022 men and women, aged 30-79 years, who participated in a health screening test. A standard interview, anthropometrics, biochemical studies, and abdominal ultrasonography were conducted for each participant. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III, with a modification for the waist circumference cut-off level. The severity of liver steatosis was evaluated using liver ultrasonography, and serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (gamma-GT) levels were determined. RESULTS: Ultrasonographic liver steatosis was strongly associated with metabolic syndrome and common metabolic abnormalities. Compared with people without steatosis, people with mild, moderate, and severe steatosis had adjusted odds ratios for metabolic syndrome of 1.72 (95%CI, 1.01-2.94), 2.89 (1.75-4.76) and 3.53 (1.25-9.98) in men, and 2.86 (1.64-5.01), 3.19 (1.80-5.65) and 3.70 (0.82-16.73) in women, respectively. The serum AST level was not associated with metabolic syndrome. The serum ALT and gamma-GT levels were significantly associated with metabolic syndrome in men but not in women. CONCLUSION: The occurrence of metabolic syndrome shows a stronger association with the severity of ultrasonographic steatosis than with the serum liver enzyme levels. The degree of fatty infiltration detected on ultrasonography can be used as an indicator of liver dysfunction attributable to metabolic abnormalities.

Adult↗
PubMed2006

[Relationship between corrected QT interval and cardiovascular risk factors in young healthy adults: the Kangwha study].

OBJECTIVES: Prolongation of the heart rate-corrected QT (QTc) interval has been reported to be associated with cardiovascular morbidity and mortality. However, few studies have examined the relationship between the QTc interval and cardiovascular risk factors in young healthy people. The aim of this study was to examine the associations between the QTc interval and cardiovascular risk factors in young healthy adults. METHODS: This study was performed as part of the Kangwha study, which started in 1986, and is an on-going follow-up study on blood pressure and related cardiovascular risk factors. In follow-up examinations during 2005, cardiovascular risk factors, including anthropometrics, blood pressure, blood chemistry and carotid ultrasonography, were measured, and questionnaires on health behaviors completed by 127 men and 149 women aged 25 years. The QTc interval was measured on the resting 12-lead electrocardiogram using an automatic analysis program. RESULTS: The mean QTc interval was significantly longer in women (419+/-17ms) than in men (405+/-17ms) (p<0.001). A significant positive correlation was found between the QTc interval and waist-hip ratio (p=0.030) in men. Women showed a positive correlation between the QTc interval and systolic blood pressure (p=0.017). On a multiple regression analysis, the QTc interval was positively associated with the waist-hip ratio in men (p=0.012) and with the systolic blood pressure (p=0.020) in women. CONCLUSIONS: In young healthy Korean adults, the QTc interval was independently associated with the waist-hip ratio in men and with the systolic blood pressure in women.

Adult↗