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PubMedDate not supplied

Assessment of the integration of the ecological approach in health promotion programs.

PURPOSE: This article proposes a model of the ecological approach in health promotion programs. Based on system theory, the model identifies intervention settings and targets as two independent dimensions for assessing the integration of this approach in programs. Additional objectives are to present and pretest an analytical procedure that allows the assessment of integration of the ecological approach in programs. DESIGN: This was a descriptive study of the integration of the ecological approach in a sample of health promotion programs. SUBJECTS: Subjects were 44 health promotion programs drawn from the population of Canadian federally funded programs. MEASURES: Descriptions of programs were obtained by telephone interviews. A coding scheme was applied to the data to identify intervention settings and targets for each program. Using this information, a summative score of the integration of the ecological approach was estimated for each program. RESULTS: Single-setting programs were the dominant pattern in the sample. Individuals whose health was of concern were very frequently the direct targets of the programs. However, organizational and interpersonal environments were also often directly targeted. Single-setting or single-intervention strategy programs outnumbered ecological programs. CONCLUSION: The proposed model and analytical procedure is a useful framework for the assessment of integration of the ecological approach in health promotion programs. The pilot test having been conducted on a convenience sample, future work should replicate the study in a representative sample of programs.

Canada↗
PubMed1998

Health Care Fraud and Abuse Data Collection Program: reporting of final adverse actions--extension of comment period--OIG, HHS. Notice of proposed rulemaking; extension of comment period.

On October 30, 1998, we published a notice of proposed rulemaking designed to set forth the policy and procedures for implementing the new Healthcare Integrity and Protection Data Banks (HIPDB), in accordance with the statutory requirements of section 1128E of the Social Security Act, as added by section 221(a) of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (63 FR 58341). We are extending the comment period at the request of several organizations.

Data Collection↗
PubMed2026

Re-emerging Marburg virus disease in Africa: spillover ecology, geographic expansion, and surveillance vulnerabilities.

Marburg virus disease (MVD) is re-emerging across Africa as a high-consequence zoonosis shaped by expanding ecological suitability, repeated spillover, and uneven surveillance capacity. This review synthesizes current evidence on the ecological, epidemiological, and operational determinants of contemporary Marburg virus (MARV) emergence. We conceptualize MVD as an ecological-emergence system produced by interactions among reservoir-host biology, environmental change, human exposure, health-system readiness, and mobility, rather than as a series of isolated outbreaks. Recent detections in multiple African regions indicate wider enzootic circulation than previously recognized and support repeated, reservoir-associated introductions from distributed ecological foci. Spillover risk is heightened where mining, land-use change, agricultural encroachment, settlement growth, climate-sensitive habitat disruption, and population movement increase contact with Egyptian rousette bats (Rousettus aegyptiacus) and contaminated roost environments. Following primary spillover, diagnostic delays, fragmented surveillance, limited laboratory decentralization, healthcare-associated transmission, and mobility-linked exposure can enable outbreak amplification and delayed recognition. Serological findings further suggest possible "shadow epidemiology," with unrecognized or mild MARV infections occurring outside confirmed outbreak chains. Critical preparedness gaps persist in ecological risk mapping, longitudinal reservoir surveillance, decentralized molecular diagnostics, genomic sequencing, data integration, and cross-border early warning. Future preparedness should move beyond reactive containment toward integrated One Health approach combining predictive ecological surveillance, rapid community-level detection, real-time genomics, infection prevention, risk communication, and regional coordination to identify spillover early and prevent human transmission.

Animals↗
PubMed1988

[Handicaps and maladjustment: evaluation of social policies].

This article examines various methods of assessing social policies with regard to the integration of handicapped or maladjusted children and adults in France. It begins with an account of the existing system of policies and services for handicapped or maladjusted children and adults in France today. By following the progress of an educationally retarded child (with minor mental handicap or retardation plus behavioural problems), noting the various instructions with which the child is involved, the reader will come to realise the limited nature of the facts available concerning the effectiveness of social integration schemes for the handicapped and maladjusted. The paper then examines the statistical data issued by the ministries of health and education as well as from separate institutions. These data indicate a lack of awareness of the various passages from childhood to adulthood, a bridge between institutions coinciding with the passage into adult life. Educational statistics are completely independent of other statistics on adult services. Measurements focus on institutional activity and often ignore the effects on the individual of the various measures taken. In 1975, France passed legislation concerning integration but little has been done to evaluate the effects of this law. Based on observations in one department of France, the author has found unequal development of the policy for educational integration on the one hand and vocational rehabilitation on the other. Such inequalities are producing increasing difficulties. Integration of physically handicapped children into an ordinary school environment has met with some success. However educational maladjustment, as manifested by children with minor mental handicap or retardation and those with behavioral problems, remains largely beyond the scope of legislation on educational integration. Increasingly, educationally maladjusted children are sent so special schools. Since job opportunities for the handicapped and maladjusted are in short supply, employment inequalities exist. As a result transitional measures or other programmes designed to occupy time have increased whereas employment in ordinary work settings has declined. More often than not, women are employed in "Centres d'Aide par le Travail" (Employment centres for the handicapped). Access to ordinary jobs tends to be mainly available to men whereas specialised employment is mainly for women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

A hand-held decision-aid system designed for rural health workers.

A great part of the world's population is cared for by rural health workers who are also collecting data for epidemiological studies. These workers have a low level of medical training and are working in a poor technical environment. At the request of an international humanitarian and medical organization (Médecins Sans Frontières), we have developed an integrated (hardware and software) system, TROPICAID, based on a hand-held computer and designed to increase rural health workers' efficiency. The software is easy to use and enables users to get information from an internal data base on 60 drugs. The decision-making module analyzes the patient's parameters (460 different symptoms are recognized) and indicates possible diagnoses (the system knows 210) and relevant treatments. In addition, the system facilitates the collection of medical data for elementary statistical analysis. The computer, which is lightweight (1.5 kg) and compact, runs on battery power for up to a week in normal use. The program which is written in Pascal and data are stored in high-capacity EPROMs. An early trial in Chad with Médecins sans Frontières has shown the value of such a project as well as a few weaknesses to be overcome.

Chad↗
PubMed2002

Genetic toxicology: web resources.

Genetic toxicology is the scientific discipline dealing with the effects of chemical, physical and biological agents on the heredity of living organisms. The Internet offers a wide range of online digital resources for the field of Genetic Toxicology. The history of genetic toxicology and electronic data collections are reviewed. Web-based resources at US National Library of Medicine (NLM), including MEDLINE, PUBMED, Gateway, Entrez, and TOXNET, are discussed. Search strategies and Medical Subject Headings (MeSH) are reviewed in the context of genetic toxicology. The TOXNET group of databases are discussed with emphasis on those databases with genetic toxicology content including GENE-TOX, TOXLINE, Hazardous Substances Data Bank, Integrated Risk Information System, and Chemical Carcinogenesis Research Information System. Location of chemical information including chemical structure and linkage to health and regulatory information using CHEMIDPLUS at NLM and other databases is reviewed. Various government agencies have active genetic toxicology research programs or use genetic toxicology data to assist fulfilling the agency's mission. Online resources at the US Food and Drug Administration (FDA), the US Environmental Protection Agency (EPA), the National Institutes of Environmental Health Sciences, and the National Toxicology Program (NTP) are outlined. Much of the genetic toxicology for pharmaceuticals, industrial chemicals and pesticides that is performed in the world is regulatory-driven. Regulatory web resources are presented for the laws mandating testing, guidelines on study design, Good Laboratory Practice (GLP) regulations, and requirements for electronic data collection and reporting. The Internet provides a range of other supporting resources to the field of genetic toxicology. The web links for key professional societies and journals in genetic toxicology are listed. Distance education, educational media resources, and job placement services are also available online in the field of genetic toxicology. As molecular biology and computational tools improve, new areas within genetic toxicology such as structural activity relationship analysis, mutational spectra databases and toxicogenomics, now have resources online as well.

Animals↗
PubMed1982

Integration of theory, practitioner standards, literature findings, and baseline data: a case study in planning breast self-examination education.

Delineation of the planning process necessary for designing sound education programs aimed at changes in health behavior continues to be a primary concern of health educators. Careful planning will ultimately maximize the application of existing evidence and identify areas in need of further research and evaluation. This paper discusses the preliminary and refinement planning phases involved in the design of an educational program for a three-year breast self-examination demonstration/evaluation project. The initial phase involved review of empirical data of previous studies, and application of behavioral science theory and standards of professional practice. The refinement phase involved the application of results from a community diagnostic baseline survey of the target population. Factors found to correlate with BSE practice were integrated into the educational strategies: group sessions in classes and informal workshops, a breast exam clinic, and mass media activities.

Breast↗
PubMedDate not supplied

The National Reporting Program for Mental Health Statistics: history and findings.

The National Reporting Program for Mental Health Statistics had its origins in the decennial U.S. census, with enumeration of the "insane and idiotic" in 1840. A series of special censuses of the insane and feebleminded in public and private hospitals and other institutions began in 1904, and annual censuses of patients in mental institutions were conducted from 1926 to 1946. The National Institute of Mental Health of the Public Health Service took over responsibility for the annual census of patients in mental institutions in 1947. Coverage and content remained the same until the mid-1960s, when only State and county mental hospitals were included in the census. Because the annual census could not provide the data needed, separate programs were begun for inpatient and outpatient service. These were integrated into the National Reporting Program in 1966. Trend data for the last 40 years describe how the specialty mental health sector has developed. Non-Federal general hospitals with separate psychiatric services increased dramatically, from 81 in 1940 to 1,531 in 1982, as did community mental health centers, from 125 in 1965 to 691 in 1980. There was generally less emphasis on inpatient care and more on outpatient care. Full-time equivalent staff in specialty mental health facilities increased from about 325,000 in 1970 to about 432,000 in 1982. Expenditures by facilities also increased dramatically.

Community Mental Health Centers↗
PubMed1999

Performing cost-effectiveness analysis by integrating randomized trial data with a comprehensive decision model: application to treatment of acute ischemic stroke.

A recent national panel on cost-effectiveness in health and medicine has recommended that cost-effectiveness analysis (CEA) of randomized controlled trials (RCTs) should reflect the effect of treatments on long-term outcomes. Because the follow-up period of RCTs tends to be relatively short, long-term implications of treatments must be assessed using other sources. We used a comprehensive simulation model of the natural history of stroke to estimate long-term outcomes after a hypothetical RCT of an acute stroke treatment. The RCT generates estimates of short-term quality-adjusted survival and cost and also the pattern of disability at the conclusion of follow-up. The simulation model incorporates the effect of disability on long-term outcomes, thus supporting a comprehensive CEA. Treatments that produce relatively modest improvements in the pattern of outcomes after ischemic stroke are likely to be cost-effective. This conclusion was robust to modifying the assumptions underlying the analysis. More effective treatments in the acute phase immediately following stroke would generate significant public health benefits, even if these treatments have a high price and result in relatively small reductions in disability. Simulation-based modeling can provide the critical link between a treatment's short-term effects and its long-term implications and can thus support comprehensive CEA.

Acute Disease↗
PubMed1988

Rigor in health-related research: toward an expanded conceptualization.

When the research process is viewed not merely as a set of methods for data collection and analysis but, instead, as an integrated series of arbitrary choices made by the researcher, it quickly becomes apparent that the prevailing conceptualization of rigor is much too narrow; indeed, the way rigor is currently conceptualized may well be responsible for the many errors that are commonly made in the research process. An expanded conceptualization of rigor is presented, and its implications for research into some critical health issues are discussed in some detail.

Data Collection↗
PubMed1996

Information systems for integrated healthcare delivery.

Even without passage of Federal healthcare reform legislation, the healthcare market is responding to cost-control pressures by becoming more integrated and business-driven. As mergers and collaborations increase, automated system infrastructures must be developed to support the information needs of newly formed integrated healthcare delivery systems. Strategic plans must include provisions for creating new information systems or expanding existing systems so they can support seamless integration and access to patient data among varying providers.

Community Networks↗
PubMed1999

Electronic medical record systems at academic health centers: advantages and implementation issues.

The growth of managed care has fueled expectations for a more coordinated delivery of clinical services and a reduction of unnecessary utilization. Among the most important issues that constrain these expectations is the transfer of medical information. Electronic medical record (EMR) systems appear to offer substantive advantages over paper records for both containing costs and improving the quality of care. However, incorporation of EMR systems into practice settings has languished. Among the barriers to implementation are software problems of codification and entry of data, security issues, a dearth of integrated delivery systems, reluctant providers, and prohibitive costs. The training programs of academic health centers (AHCs) are optimal environments for testing and implementing EMR systems. AHCs have the expertise to resolve remaining software issues, the components necessary for integrated delivery, a culture for innovation in clinical practice, and a generation of future providers that can be acclimated to the requisites for computerized records. The authors critically review these and other issues of implementing EMR systems at AHCs and propose four necessary steps for financing their implementation.

Academic Medical Centers↗
PubMedDate not supplied

Wellness motivation theory: an exploration of theoretical relevance.

Data were collected from 14 older, rural African American men and women to explore how individual motivation affects the initiation and maintenance of health-related behavior. The research consisted of an inductive exploration designed to examine the validity and cultural relevance of an existing theoretical framework for wellness motivation in health behavior change. Through the technique of constant comparative analysis, the basic social process of empowering potential was substantiated as a process of individual growth and goal-directed behavior that facilitated the initiation and maintenance of positive health patterns. The process of empowering potential consisted of three stages: appraising readiness, changing, and integrating change. Two categories provided a cultural context for the process: health value orientation and network affiliation. The data validated and expanded a developing theoretical framework for wellness motivation in health behavior change.

Adaptation, Psychological↗
PubMed2001

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults.

UNLABELLED: A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.

Adolescent↗
PubMed1996

Health care reform in the American states: administrative capacity building.

As the nation moves to reform Medicare and the health care industry becomes more competitive which will dramatically change the means by which health care is organized and financed, state governments ought to be establishing administrative capacity to administer new systems. This article describes past experiences of states in similar efforts and uses the legislation written in 13 states to analyze in greater detail current state health reform activities. Policies that create new central authorities have the greatest likelihood of building the appropriate administrative infrastructures. Provisions related to establishing data bases, creating regional authorities or advisory committees, establishing uniform claims, and facilitating integrated systems of care are common to several proposals. Previous state experiences with health planning and citizen involvement are evident in the schemes being proposed and enacted.

Health Care Reform↗
PubMed2006

Integrating education into primary care quality and cost improvement at an academic medical center.

INTRODUCTION: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical clinical guidelines for common medical conditions; measure and provide feedback on physicians' performance; and facilitate systemic changes to support appropriate care. Various methods are used to improve care, including evidence reviews, formal education, informal clinical "opinion leaders," feedback, reminders, and procedure changes. Twenty-four common medical conditions have been addressed through this process. More than 30 measures of clinical performance have been developed and reported. METHODS: This case study describes a systematic, multifaceted program to improve the quality and cost-effectiveness of primary care. RESULTS: Illustrative results for clinical performance are presented for 2 measures of chronic care, 2 measures of preventive care, and 2 measures of acute care. All 6 measures show general improvement in performance across years, with performance near or above the National Committee for Quality Assurance's 90th percentile for Health Plan Employer Data and Information Set measures. DISCUSSION: A systematic approach involving all relevant components of a health system integrates the synthesis of information, education about the information and how to implement it, and addressing operational barriers. Benefits include a curriculum that is shared across faculty, residents, and medical students and more uniform quality of care that faculty model for physicians-in-training.

Academic Medical Centers↗
PubMed2000

Networking and expert-system analysis: next frontier in biomonitoring.

The extensive use of biomarkers in environment biomonitoring programmes has raised the problem of data management and intercomparison. A research project (Pollution Effect Network, PEN) is proposed here, consisting of the realisation of an on-line warehouse for biomarker data (http://www.muf.unipmn.it/pen). The web site will contain repository sections and expert system procedures able to integrate information from different biomarkers and provide ranking of the organism health status in terms of synthetic stress syndrome indexes. Researchers accessing the site will be able to submit and process their own data. This will allow common criteria in the evaluation of the biological effects of pollutants, and an intercomparison of biomonitoring data among different geographic areas and sentinel species.

Animals↗