[Epidemiologic surveillance in health programs].
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Communicable Disease Control↗
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Character development in adolescents.
This study explored the effects of a program consisting of communication and counseling skills, assertiveness training and moral dilemmas on the character development, i.e., moral reasoning, ego development, and assertiveness of high school students. It was hypothesized that exposure to the experimental treatment would enhance the character development of high school students. Fifty-four high school seniors enrolled in three psychology classes were assigned randomly to two treatment groups and one control group. Assessment instruments were the Defining Issues Test, to measure moral reasoning, the Washington University Sentence Completion Test, to measure ego development, and the Rathus Assertiveness Schedule, to measure assertiveness. A repeated measures analysis of variance was used to determine significant differences between control and treatment posttest means with respect to the dependent variables--moral reasoning, ego development, and assertiveness. The results demonstrated that the character development of the students in the experimental treatment group was affected significantly over time by the program.
Achievement↗
[Improvement of communication behavior of laryngectomized and voice-rehabilitated patients by a psychological training program].
An important goal of laryngectomee rehabilitation is achieving the best possible result in voice restoration. In addition to good voice quality, efficient intelligibility in daily conversation requires specific communication skills, which are very often neglected in speech therapy. In this study 51 male laryngectomees were randomized to an intervention group or an attention control group. After hospital discharge the intervention group participated in a psychological training program aimed at improving the communication behavior of the laryngectomees. This training was part of a comprehensive rehabilitation program (lasting over six months) and consisted of four modules: Improvement of communication over the disability; Discrimination of factors affecting intelligibility; Development of behavioral strategies for improving intelligibility in daily conversation; Transferring the strategies to daily live. The effectiveness of training was evaluated by a questionnaire which covered three important aspects of communication behavior. As a result of the intervention the patients influenced more effectively their own communication behavior and also influenced more adequately the behavior of typical communication partners. Present finding with the psychological training program demonstrated that the communication behavior of laryngectomees can be significantly improved.
Adaptation, Psychological↗
Challenges for communicable disease surveillance and control in southern Iraq, April-June 2003.
The recent war in Iraq presents significant challenges for the surveillance and control of communicable diseases. In early April 2003, the World Health Organization (WHO) sent a team of public health experts to Kuwait and a base was established in the southern Iraqi governorate of Basrah on May 3. We present the lessons learned from the communicable disease surveillance and control program implemented in the Basrah governorate in Iraq (population of 1.9 million) in April and May 2003, and we report communicable disease surveillance data through June 2003. Following the war, communicable disease control programs were disrupted, access to safe water was reduced, and public health facilities were looted. Rapid health assessments were carried out in health centers and hospitals to identify priorities for action. A Health Sector Coordination Group was organized with local and international health partners, and an early warning surveillance system for communicable disease was set up. In the first week of May 2003, physicians in hospitals in Basrah suspected cholera cases and WHO formed a cholera control committee. As of June 29, 2003, Iraqi hospital laboratories have confirmed 94 cases of cholera from 7 of the 8 districts of the Basrah governorate. To prevent the transmission of major communicable diseases, restoring basic public health and water/sanitation services is currently a top priority in Iraq. Lack of security continues to be a barrier for effective public health surveillance and response in Iraq.
Communicable Disease Control↗
Personal communication networks and the effects of an entertainment-education radio soap opera in Tanzania.
The personal networks of listeners and nonlisteners to an entertainment-education radio soap opera in Tanzania are examined to determine the effects of interpersonal discussion of the soap opera's educational themes of family planning and HIV prevention. Listeners are more likely to discuss these two educational issues in their personal communication networks and are also more likely to have other listeners to the radio program in their personal communication networks. Respondents demonstrate a relatively high degree of homophily with their network partners and are more likely to discuss matters arising from the radio program with their network partners who are of similar tribal membership, religious affiliation, and gender, and those who are equally or more highly educated than themselves.
Communication↗
The role of public health surveillance: information for effective action in public health.
Public health surveillance can provide the quantitative information needed for setting priorities and establishing rational health policy. Although there are many examples of the effective use of such information, the full potential for surveillance has not yet been realized. To a large degree, failure to achieve this potential has resulted from limited perspectives regarding the role and conduct of surveillance. Both practitioners (those who conduct surveillance) and users (those who apply surveillance data in a real-world setting) have fallen victim to such myopia. Public health surveillance must be advocated as an essential part of the global health agenda if we are to achieve international goals for improving health status. As we improve our appreciation of the variety of uses for public health surveillance data, we need to understand more fully the determinants of the decision-making process. Effective dissemination of information and effective communication are as important as data collection and analysis. No longer do we have--or should we have--the luxury of collecting information for its own sake. The information collected must have a demonstrated utility. Developing and training personnel to have expertise in public health surveillance will necessarily incur opportunity costs. Bridging gaps in data methodology and coverage will force us to weigh alternatives and to compromise. We hope that the International Symposium on Public Health Surveillance will accomplish several goals. First, we wish to foster international understanding of the definition, role, and importance of surveillance in reducing morbidity and mortality, in improving quality of life, and in setting effective health priorities. Second, we hope that this symposium will serve as a springboard for identifying issues and topics that can be addressed in greater depth at future international meetings. Finally, we see the symposium as an essential step in developing a firm commitment on the part of countries, donor agencies, and multilateral organizations to develop the essential capacity for public health surveillance throughout the world. Each country should have the capacity to measure and monitor changes in health status, risk factors, and health-service access and utilization among its people. All countries should have the means to detect emerging health problems and implement measures for their control, to evaluate the impact of health policies and programs, and to communicate health information in a meaningful fashion to policymakers and the public. If we are successful in these endeavors, the long-term effects on the public's health will be well worth the struggle required to achieve them.(ABSTRACT TRUNCATED AT 400 WORDS)
Global Health↗
Assessing communications effectiveness in meeting corporate goals of public health organizations.
Much evaluation of health communications in public health is considered from a program perspective of smoking cessation, weight reduction, education on sexually transmitted diseases, etc. These studies have advanced the knowledge base of communications theory and evaluation and have contributed to program effectiveness. In program-based evaluation the communications process is structured as part of the program itself. This article extends program-based communications evaluation to view communications from the perspective of the consumer and how effectively public health departments respond to consumer expectations. It develops a conceptual model for evaluating elements of communications such as its importance in defining mission and goals within the community, managing strategic constituencies, and enlisting individuals and groups as customers and co-producers of health. It gives a broader perspective on how communications in public heath organizations are managed and a basis for assessing whether they are being managed effectively.
Communication↗
Benefits communication: its impact on employee benefits satisfaction under flexible programs.
Using field data from a private organization in upstate New York, a large statistically significant portion of benefits satisfaction was explained by benefits communication, employee benefits choice and change patterns, and demographics. Users of the organization's benefits communication materials and employees reporting fewer unmet benefits needs are more satisfied.
Adult↗
Hospital CEOs' priorities and perceptions regarding industry issues and the Virginia Hospital Association's activities.
Based on a survey of Virginia hospital CEOs, it was revealed that four industry issues are causing a high degree of concern, namely Medicare/Medicaid reimbursement policies, personnel shortages, indigent care, and increased operating expenses. Each of these issues will be discussed regarding the VHA's activities to devise possible solutions. Regarding Medicare, the VHA has worked closely with the American Hospital Association in their federal advocacy efforts encouraging members to write, call, and visit their Congressional representatives to persuade them to pass legislation increasing the Medicare budget. Regarding Medicaid, which is administered by each state and in Virginia involves a 50/50 sharing of the funding between the federal and state governments, the VHA has challenged what it believes to be an illegal hospital reimbursement system through the federal judicial system. While the process is continuing, the VHA is encouraged by the U.S. Supreme Court's decision (July 1990) affirming hospitals' and all other health care providers' right, to pursue via the judicial process their allegation that a state is violating federal law by setting inadequate and inequitable Medicaid reimbursement rates to hospitals. In order to address the personnel shortages issue, the VHA has actively addressed recruitment and retention challenges by establishing a Health Manpower Resource Center and hiring a full-time director. This office targets high school students, second-career adults, and current health care professionals through communication and education programs. The area of indigent care represents one of the VHA's most notable achievements to date. This entails the recent Virginia legislation creating the Indigent Care Trust Fund. This fund's initial amount is some $15 million and represents an approximate 60/40 contribution ratio involving both the State of Virginia and hospitals in Virginia. A formula has been developed for each hospital in Virginia to assess how sensitive they are to indigent care patients, which includes patients who are either in households whose annual income is below the federal poverty level and/or patients who do not have health care insurance. Those Virginia hospitals who are less sensitive to indigent care will contribute to this fund, while those who have more exposure to indigent care patients will be reimbursed from it. Legislation will be proposed to the state legislature to broaden the contributory base to the Indigent Care Trust Fund by requiring employers who do not currently offer health care insurance to their employees to also contribute to the fund. Reimbursements from the fund to Virginia hospitals are scheduled to begin in FY 1991.(ABSTRACT TRUNCATED AT 400 WORDS)
Attitude of Health Personnel↗
Concepts about infant health, growth, and weaning: a comparison between nutritional scientists and Madurese mothers.
Nutrition education is a critical component of programs designed to improve nutritional status, yet it often fails because of differences in the concepts underlying the educational message and those motivating mothers' behavior. To illustrate this discrepancy in the context of infant feeding we compare the views of nutritional scientists' and mothers in Madura, Indonesia on (a) health and disease and (b) the relationship of foods to the concepts of state-of-health, infancy and growth. The relationship of these concepts to mothers' practices and nutritional scientists' recommendations are also explored. Views of the nutritional scientist were drawn from the published literature and those for the Madurese mothers' from ethnographic and survey data gathered between February 1983 and June 1984. While mothers and nutritional scientists both seek to give a diet appropriate for a stage of infancy, their definitions of key concepts differed. Nutritional scientists recommend feeding infants high quality clean foods in amounts sufficient for maintenance, activity and growth. Underlying these recommendations are the concepts of disease as a deviation from the norm, food as a source of pathogens as well as nutrients, infancy as a period of physiological growth, and poor growth as an indicator of disease. All infants have the same type of nutrient requirements. Madurese mothers perceive health and its components as a process of balance. Balance is partly attained either by feeding rice soon after birth or by withholding rice until after one year of age. This concept results in two distinct but coexisting types of requirement and weaning patterns for infants. The important development during an infant's first year of life is 'growth' from a vulnerable state in the 'neonatal' period (40 days) to a state of independence and reason (akal) in late infancy (greater than 7 months). To foster 'growth' in rice-fed infants, mothers force-feed increasing amounts of quality foods. Once akal is achieved, mothers no longer feed quality foods or increase amounts of food, and the infant, not the mother, initiates feeding. These comparisons suggest how nutritional scientists can help improve the process of communication in nutrition programs. First they can describe and analyze the mother's as well as their own conceptual framework to arrive at approaches and messages that blend together points of views. Second, by studying the consequence on infants of mother's behavior, nutritional scientists may gain further insight into the biological processes leading to good nutrition and refine messages and interventions accordingly.
Attitude to Health↗
Staff survey of organizational structure and process for a Public Health Department.
A survey of 227 North York Public Health Department (NYPHD) staff provided their perspective on the organizational structure. They perceived that (a) the departmental and divisional organizational structures are effective for program delivery, (b) the Central Resources structure and divisional and departmental reporting structures are moderately effective for program delivery, (c) the decentralized office structure is an advantage for service delivery but less so for administration and intra-division and inter-division communication, (d) the mandatory program structure involves low to moderate interdisciplinary teamwork and moderately impacts service delivery, (e) intra-division and management-staff communication are fair but inter-division and office communication are between poor and fair, (f) education, research, and service are moderately integrated, and (g) the divisional and departmental work atmospheres are a little positive. Management perceived greater participation in program planning, more frequent communication with other divisions, a number of education and research opportunities from various divisions/units, and more management recognition than front line staff did.
Attitude of Health Personnel↗
Inaccurate communications in telephone calls to an antimicrobial stewardship program.
BACKGROUND: Antimicrobial stewardship programs (ASPs) decrease unnecessary antimicrobial use, decrease antimicrobial resistance, and improve patient outcomes. The effectiveness of a prior approval system--that is, the requirement that approval be obtained from ASP practitioners before certain antimicrobials can be used--depends on the accuracy of the patient data communicated from the primary service. OBJECTIVES: To determine the incidence of inaccurate communication of patient data during ASP interactions, describe examples of inaccurate communications, and identify risk factors for inaccurate communication. DESIGN: We used a retrospective cohort design. We evaluated the communicated patient data for clinically important inaccuracies, using the patients' medical records as the gold standard. SETTING: A tertiary care medical center that has a prior approval system for restricted antimicrobials. PATIENTS: Inpatients discussed in telephone ASP interactions. INTERVENTION: Observational study. RESULTS: Of telephone calls requesting prior approval from ASP practitioners, 39% (95% confidence interval [CI], 31%-48%) contained an inaccuracy in at least 1 type of patient data (eg, current antimicrobial therapy); the incidence varied widely between data types. Examples of inaccuracies are given to demonstrate their clinical relevance. In multivariable analysis, inaccurate communications were more common for telephone calls from surgical services (versus calls from nonsurgical services: odds ratio, 2.1 [95% CI, 1.1-3.9]) and for calls received by Infectious Diseases fellows (versus pharmacists: odds ratio, 2.0 [95% CI, 1.1-3.8]). CONCLUSIONS: A high proportion of ASP calls requesting prior approval included patient data inaccuracies, which have the potential to affect the prescribing of antimicrobials. Although risk factors were identified, these communication errors were common across the different types of ASP interactions. Inaccurate communications may compromise the utility of ASPs that use a prior approval system for optimizing antimicrobial use.
Academic Medical Centers↗
The Philippine population program: a stocktaking.
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Communication↗
Spousal communication and family planning behavior in Navrongo: a longitudinal assessment.
The poor performance of most family planning programs in the 1980s, especially in sub-Saharan Africa, generated concern among researchers and led to a quest for explanations. In most countries, the alienation of men from participation in these programs was subsequently identified as one of the major causes, a finding that led researchers to redirect their attention to couples instead of individuals as the focus of such programs. Lack of spousal communication about family planning was identified as one reason for the low level of contraceptive use among women. Subsequent research has persistently demonstrated a positive relationship between spousal communication and contraceptive use. Most prior studies on this topic have been based on cross-sectional data, so that whether the identified relationships are causal remains unclear. Does communication, in fact, predict contraceptive use, or does the use of contraceptives generate communication among couples? This study addresses the question of causality by using longitudinal data from the Navrongo Health Research Centre panel survey. Results from both cross-sectional and longitudinal analysis demonstrate that spousal communication does, indeed, predict contraceptive behavior, even when other factors are controlled.
Adolescent↗
[Programs and politics on growth deficit (consequences of a line of research carried out in Chile)].
This communication offers suggestions for programs and policies in relation to stunting within the infant population. The proposal is based on current social strategies and the results of research carried out on Chilean school children. These results indicate that height deficit is concentrated in sectors of the population belonging to low socio-economic levels, and the risk factors are related to the small stature of their parents with a record of undernutrition, small size at birth and low per capita income. This deficit begins early, occurring mainly before the child's second birthday and as a consequence is reflected in below average performance at school of those children living in areas of social vulnerability. Suggestions offered take into account the orientation that should be considered for social policies, the selection of beneficiaries, program contents and management and problems that need to be overcome. Among these, the following issues are highlighted:--That the social welfare programs designed to combat stunting in the infant population should have, as a priority objective, the aim of benefiting sectors of the population most at need. It is vital to include in these programs: adequate pre-natal care of women with a high risk profile of giving birth to a child with intrauterine growth retardation; promotion of child growth; food supplementation and/or fortification, and improvement of physical fitness.--The government should play a leading role in the promotion and management of these programs, in the regulation of private sector involvement, as well as promoting local community participation.--Warnings are given about the inadequacies of present government social welfare policies related to infant nutrition, and the lack of research carried out into the effectiveness of current programs. In relation to future aims, we would like to see more emphasis put into the integration of international and regional intervention programs aimed at combating infant undernutrition. This would include sharing resources and collecting information related to the problem. Finally, all these actions should be aligned and focused on the principal aim; allowing children to reach their full growth potential.
Body Height↗
Personalised risk communication for informed decision making about entering screening programs.
BACKGROUND: There is a trend towards greater patient involvement in health care decisions. Adequate discussion of the risks and benefits associated with different choices is often required if involvement is to be genuine and effective. Achieving adequate involvement of consumers and informed decision making are now seen as important goals for any screening programme. Individualised risk estimates have been shown to be effective methods of risk communication in general, but the effectiveness of different strategies has not previously been examined. OBJECTIVES: To assess the effects of different types of individualised risk communication for consumers making decisions about participating in screening. SEARCH STRATEGY: We searched the Cochrane Consumers and Communication Review Group specialised register (searched March 2001), MEDLINE (1985 to 2001), EMBASE (1985 to 2001), CancerLit (1985 to 2001), CINAHL (1985 to 2001), ClinPSYC (1989 to 2001), and the Science Citation Index Expanded (searched March 2002). Follow-up searches involved hand searching Preventive Medicine, citation searches on seven authors, and searching reference lists of articles. SELECTION CRITERIA: Randomised controlled trials addressing the decision by consumers of whether or not to undergo screening, incorporating an intervention with a 'personalised risk communication element' and reporting cognitive, affective, or behavioural outcomes. A 'personalised risk communication element' is based on the individual's own risk factors for a condition (such as age or family history). It may be calculated from an individual's risk factors using formulae derived from epidemiological data, and presented as an absolute risk or as a risk score, or it may be categorised into, for example, high, medium or low risk groups. It may be less detailed still, involving a listing, for example, of a consumer's risk factors as a focus for discussion and intervention. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Data about the nature and setting of the intervention, and the relevant outcome data were extracted, along with items relating to methodological quality. MAIN RESULTS: Thirteen studies were included. Personalised risk communication (whether written, spoken or visually presented) was associated with increased uptake of screening tests (odds ratio (OR) 1.5 (95% confidence interval (CI) 1.11 to 2.03). There was no evidence from these studies that this increase in uptake of tests was related to informed decision making by consumers. More detailed personalised risk communication was associated with a smaller increase in uptake of tests. That is, for personalised risk communication which used and presented numerical calculations of risk, the OR for test uptake was 1.22 (95% CI 0.56 to 2.68). For risk estimates or calculations which were categorised into high, medium or low strata of risk, the OR was 1.42 (95% CI 1.07 to 1.88). For risk communication that simply listed risk personal risk factors the OR was 1.7 (95% CI 1.17 to 2.48). Most of the included studies addressed mammography programmes. These studies showed slightly smaller effects than the overall dataset, again with numerical calculated risk estimates being associated with lower ORs for uptake of tests (OR 1.13; 95% CI 0.98 to 1.29) than the other categories of (less detailed) personalised risk communication. The four studies examining risk communication in high risk individuals showed larger odds ratios for uptake of tests than the other studies. The OR for numerical calculated risk estimates was 1.48 (95% CI 1.06 to 2.07), compared to 4.66 (95% CI 2.24 to 9.69) for categorised risk estimates and 2.64 (95% CI 1.42 to 4.9) for listed personal risk factors. There were insufficient data from the included studies to report odds ratios on other key outcomes such as: intention to take tests, anxiety, satisfaction with decisions, decisional conflict, knowledge and risk perception. REVIEWER'S CONCLUSIONS: Personalised risk communication (as currently implemented in the included studies) is associated with increased uptake of screening programmes, but this may not be interpretable as evidence of informed decision making by consumers.
Communication↗
Integration of new genetic diseases into statewide newborn screening: New England experience.
Using a data set of newborn screening specimens tested by the New England Newborn Screening Program (NENSP) between January 1999 and February 2003, we analyzed the number of infants with positive newborn screening results and determined how many positive screening results were due to a recent multiplex expansion of services in some of the states. We found that for the subset of the 4-year cohort for which there was a 233% increase in the number of disorders screened (from 9 to 30 disorders), there was a 31% increase in the number of affected infants identified by the screen. We project that if all states in the program expanded their services and if the incidence of disorders is similar across states, there would be an observed 45% increase in the number of infants detected by the screen and a 43% increase in the number of infants for whom the screening algorithm would require some contact with the infants' health care provider. Furthermore, of those requiring contact, we project a 300% increase in the number of screened-positive infants who would be referred to tertiary care centers for a diagnostic evaluation. Increased contact with the medical community from additions to newborn screening as demonstrated in this report emphasizes the need for an approach in which the newborn screening program assures coordinated communications between birth units, laboratory, primary health care providers, and specialists.
Child Health Services↗
Visualizing 3D data obtained from microscopy on the Internet.
The Internet is a powerful communication medium increasingly exploited by business and science alike, especially in structural biology and bioinformatics. The traditional presentation of static two-dimensional images of real-world objects on the limited medium of paper can now be shown interactively in three dimensions. Many facets of this new capability have already been developed, particularly in the form of VRML (virtual reality modeling language), but there is a need to extend this capability for visualizing scientific data. Here we introduce a real-time isosurfacing node for VRML, based on the marching cube approach, allowing interactive isosurfacing. A second node does three-dimensional (3D) texture-based volume-rendering for a variety of representations. The use of computers in the microscopic and structural biosciences is extensive, and many scientific file formats exist. To overcome the problem of accessing such data from VRML and other tools, we implemented extensions to SGI's IFL (image format library). IFL is a file format abstraction layer defining communication between a program and a data file. These technologies are developed in support of the BioImage project, aiming to establish a database prototype for multidimensional microscopic data with the ability to view the data within a 3D interactive environment.
Animals↗