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PubMed2006

2006 AHA environmental assessment.

The AHAs Environmental Assessment identifies emerging trends facing health care providers, consumers and stakeholders. Health care leaders can use it to understand their environment and analyze the effects these trends will have on their organizations.

Biomedical Technology↗
PubMedDate not supplied

[Control of postoperative vaginal sonographic findings following Shirodkar cerclage].

Up to now postoperative control of the uterine cervix following cerclage was performed by bimanual palpation. Since clinical use of transvaginal sonography it is possible to get objective results about preoperative morphology of the cervix (exact cervical length, dilatation of the cervical canal and opening of internal and external os). Besides postoperative vaginal sonography following cerclage can ascertain lengthening and stabilization of the incompetent cervix and localize the ligature's position. 75 pregnant women between 15th and 30th week of gestation were examined using a 5-MHz vaginal sector scanner probe following Shirodkar cerclage to gain information about the residual cervical length and the distance from the surface of the ectocervix to the ligature's position within the anterior and posterior lip of the cervix. The mean postoperative cervical length was 3.75 cm (1.5 cm-6.5 cm). Compared to the preoperative average length of 3.0 cm (0.5 cm-5.0 cm) the cerclage resulted in an increase of about 25%. The average distance from the surface of the ectocervix to the ligature at anterior lip of the cervix was 1.85 cm, ranging from 0.9 cm to 2.6 cm. The mean value at the posterior lip was 1.56 cm, ranging from 0.8 cm to 2.0 cm. This study showed that the actual positions of ligatures after cerclage operations varied very much. Unsatisfying position can be an explanation why some preterm deliveries can not be prevented. Therefore it is recommended to control the position of the cerclage ligation postoperatively using transvaginal sonography.

Cervix Uteri↗
PubMed1990

Deprivation and health in Scotland.

A measure of deprivation has been devised using data from the 1981 Census about area characteristics which may be considered to reflect material deprivation, and a score is calculated for each postcode sector in Scotland. The routine data sources provide information for a range of health measures which are shown to be strongly linked to levels of deprivation, with specific causes--respiratory conditions, cancer of the lung and cancer of the cervix--exhibiting very considerable differentials in respect of both mortality and cancer morbidity. Nevertheless not all causes exhibit this positive association. This area-based measure provides a valuable tool for the analysis of health data in relation to socio-economic circumstances which overcomes many of the limitations which arise in the use of the more traditional measure of social class. Like social class however it depends on data from the census which are available only at ten-yearly intervals. Other existing data sources are suggested which could possibly provide relevant information on area characteristics and populations for inter-censal years.

Female↗
PubMedDate not supplied

The 1990 objectives for the nation for injury prevention: a progress review.

Unintentional injuries are the principal cause of preventable early death. Beyond terms of human suffering and death, injuries place enormous burdens on this country's economic and health care resources. Demographic, sociological, environmental, and behavioral factors that influence our society contribute to the complexity and scope of the injury problem. Progress in injury prevention will be achieved only through the combined efforts of individuals, organizations, and government at every level of our society. The Federal Government is an important contributor to this process through its role of leading, catalyzing, and providing strategic support. Within the Department of Health and Human Services, numerous agencies have major injury prevention components with a broad range of responsibilities, including the direct delivery of services, establishment of safety standards, sponsorship of education and information efforts, building of the capacity of other sectors, basic and applied research, and surveillance. The Centers for Disease Control, as the lead agency, assists State and local health departments in their injury prevention efforts and coordinates activities undertaken jointly by Federal agencies, State and local governments, and private-sector organizations. To meet the 1990 Objectives for the Nation with respect to injury prevention, both the public health and private-sector providers must recognize the injury problem of the 1980s. Without the support and involvement of the public health and provider communities and of the private sector, injuries and their costs will continue at their present alarming rates. The opportunity is great for promoting health, preventing injuries, and reducing associated costs to society. Making the best of this opportunity is our challenge during this decade.

Accident Prevention↗
PubMed1994

Health insurance and preventive care sources of children at public immunization clinics.

BACKGROUND: Recent proposals to reform immunization financing aim to help more children receive vaccines at their sources of primary care. Under the current system, referrals of children from the private sector may strain public immunization clinics, but scant information exists on what proportions of public clinic patients actually have insurance or primary care sources. OBJECTIVE: To describe the health insurance, usual sources of health care, and referral patterns of children at low-cost public immunization clinics. DESIGN: Cross-sectional study based on face-to-face, structured interviews. SETTING: Public immunization clinics at three sites in Contra Costa County. PARTICIPANTS: Five hundred thirty-eight parents of children awaiting immunizations. RESULTS: Thirty-four percent of families at these public immunization clinics had Medicaid alone, whereas 24% had private insurance. Of those with private insurance, almost one third had at least partial coverage for vaccines. Sixty-two percent of families had sources of preventive care other than the immunization clinic, and most would have preferred to receive their vaccines at these sources. Most in this group named cost as the main barrier to immunizations at primary care sources; but one third of this group, including almost all the families insured by health maintenance organizations, named the wait for appointments at their usual source of care as the main barrier to receiving vaccines there. Two thirds of Medicaid patients and at least one third of privately insured patients were either uninformed or mistaken about whether their insurance covered vaccines. CONCLUSIONS: Financing reform may improve immunization delivery and reduce the load on public clinics. However, legislation to improve immunization financing will not achieve optimal results unless parent education is improved and organizational barriers are also removed.

California↗
PubMed1996

Error rates in Australian chemical pathology laboratories.

OBJECTIVE: To measure transcription and analytical errors made by Australian chemical pathology laboratories. DESIGN: Retrospective data collection covering the period 1 November 1993 to 1 April 1994. SETTING AND PARTICIPANTS: Fourteen pathology laboratories in five Australian States (seven in the public sector, and seven in the private sector). MAIN OUTCOME MEASURES: Error rates in transcribing information from request forms to computer record systems, and laboratory performance on chemical analysis. RESULTS: Pathology laboratories had a transcription-error rate of up to 39% and an error rate of up to 26% for analytical results. The worst-performing laboratory had errors (of patient identification or results of analysis) in 46% of requests. The three best-performing laboratories achieved 85% error-free reporting, with one achieving 95%. CONCLUSIONS: Error rates in Australian pathology laboratories vary widely, but may be as high as 46% for all specimens in some laboratories. The types of errors reported were under the control of the laboratory, and would affect the accuracy of reported pathology test results, with potential adverse outcomes for patient care and inefficient use of health-care resources. There is a need to establish broader quality assurance programs and performance requirements to reduce these types of error.

Australia↗
PubMedDate not supplied

[Antiplatelet agents and cardiovascular prevention].

The main contributions of meta-analysis methodology to antiplatelet therapy in the field of cardiovascular prevention are presented with regard to the different sectors of the health system: help with therapeutic information, help in the planning of clinical trials for the pharmaceutical industry and help in decision-making for Health Authorities. The results of meta-analysis of available data concerning aspirin in cardio-vascular prevention are discussed, in an attempt to define optimal daily dose and duration of aspirin treatment.

Aspirin↗
PubMed1997

[Educational components of school health promotion programs].

To implement an education initiative on school health in the Region, PAHO and other agencies will disseminate knowledge and experiences to schools in various countries throughout the Americas, organize meetings and workshops for the purpose of strengthening institutional capacity to identify the needs of local health education systems, and put into practice strategies to promote health and strengthen schools' involvement in this area. To determine a country's ability to set up and evaluate school health programs, the rapid assessment and analysis methodology will be used. This methodology, which arose in response to the need of governments to make decisions, formulate policies, and design programs on the basis of knowledge of the individual and collective behavior of their beneficiaries, is a useful tool for decision making and facilitates coordination mechanisms between the health and education sectors. In addition, it contributes quantitative and qualitative information for program review and analysis in an average of two months. This information is obtained through the compilation of data from secondary sources, interviews with key informants, and discussions with focal groups made up of formal and informal community leaders.

Adolescent↗
PubMed2004

The use of electronic books in midwifery education: the student perspective.

The objectives of this paper are: (i) to illustrate the use of e-books by health studies students at a college of higher education; (ii) to provide a demonstration of how e-books may be facilitated by library and information services staff working across the health and academic sectors; (iii) to comment upon the experiences of health studies students, in using e-books. A focus group of 10 student midwives was used to gain insight into how e-books may be used in an academic context for health professionals. The findings of the student midwives' focus group are reported and discussed. In this instance, the student midwives were encouraged to use e-books as part of a structured information skills programme. The paper concentrates on how the e-books were used within this context and addresses the potential benefits and disadvantages from a student perspective. The results provide evidence of a largely positive experience of using e-books as an electronic information resource. The focus group reveals many benefits and advantages in the facilitation and use of e-books, as well as addressing areas for development. It is concluded that e-books have a place in health library and information resources, but further development of e-books and e-book collections is required and subsequent investigation into their most effective use.

Books↗
PubMed2003

Building support for health information technologies.

Despite the increasing role of information technology in health care, its use still lags behind that occurring in other sectors. Factors contributing to this include the complex health care environment and conflicting political agendas. Building political support for information technology in health care depends on understanding the importance of stakeholders and the environment in which they operate. It is important to involve stakeholders early in the process of implementing new information technology in order to identify needs, barriers, and non-starters. Understanding the historical experience of the community and its past attempts at using information technology is also important. Quality of care issues, nursing shortages, cost control concerns, health insurance costs and coverage rates, institutional solvency, and overwhelming paperwork are current problems in the healthcare environment that can hinder willingness to invest in information technology. Ironically, information technology can also help remedy these problems. Impact on workflow, privacy of personal health information, and system reliability, interoperability, and the ease of updating the system can all have political ramifications with regard to acceptance and implementation of information technology.

Medical Informatics↗
PubMed1992

Somatic sensory responses in the rostral sector of the posterior group (POm) and in the ventral posterior medial nucleus (VPM) of the rat thalamus.

The rodent barrel field cortex integrates somatosensory information from two separate thalamic nuclei, the ventral posterior medial nucleus (VPM) and the rostral sector of the posterior complex (POm). This paper compares the sensory responses of POm and VPM cells in urethane-anesthetized rats as a first step in determining how cortex integrates multiple sensory pathways. A complete representation of the contralateral body surface was identified in POm. Trigeminal receptive fields (RFs) of POm and VPM cells were mapped by computer-controlled displacement of individual whiskers; responses were quantified by using peristimulus time histograms. Average RF size was similar in POm (5.1 whiskers) and VPM (4.4 whiskers), but evoked responses in the two nuclei differed significantly according to all other measures. VPM cells were maximally responsive to one single whisker--the "center RF." Stimulating this whisker evoked, on average, a response of 1.4 spikes/stimulus at a latency of 7 ms; surrounding whiskers evoked responses of less than 1 spike/stimulus at latencies of greater than 8 ms. In contrast, POm cells were nearly equally responsive to several whiskers. Quantitative criteria allowed us to designate a single whisker as the "center RF" and stimulating this whisker evoked, on average, a response of 0.5 spikes/stimulus at a latency of 19 ms. VPM cells, but not POm cells, were able to "follow" repeated whisker deflection at greater than 5 Hz. We conclude that, when a single whisker is deflected, VPM activates the related cortical barrel-column at short latency--before the onset of activity in POm. The timing of activation could allow POm cells to modulate the spread of activity between cortical columns.

Animals↗
PubMed2006

Wealth, mother's education and physical access as determinants of retail sector net use in rural Kenya.

BACKGROUND: Insecticide-treated bed nets (ITN) provide real hope for the reduction of the malaria burden across Africa. Understanding factors that determine access to ITN is crucial to debates surrounding the optimal delivery systems. The influence of homestead wealth on use of nets purchased from the retail sector is well documented, however, the competing influence of mother's education and physical access to net providers is less well understood. METHODS: Between December 2004 and January 2005, a random sample of 72 rural communities was selected across four Kenyan districts. Demographic, assets, education and net use data were collected at homestead, mother and child (aged < 5 years) levels. An assets-based wealth index was developed using principal components analysis, travel time to net sources was modelled using geographic information systems, and factors influencing the use of retail sector nets explored using a multivariable logistic regression model. RESULTS: Homestead heads and guardians of 3,755 children < 5 years of age were interviewed. Approximately 15% (562) of children slept under a net the night before the interview; 58% (327) of the nets used were purchased from the retail sector. Homestead wealth (adjusted OR = 10.17, 95% CI = 5.45-18.98), travel time to nearest market centres (adjusted OR = 0.51, 95% CI = 0.37-0.72) and mother's education (adjusted OR = 2.92, 95% CI = 1.93-4.41) were significantly associated with use of retail sector nets by children aged less than 5 years. CONCLUSION: Approaches to promoting access to nets through the retail sector disadvantage poor and remote communities where mothers are less well educated.

Bedding and Linens↗
PubMed1991

Tandem mass spectrometry of peptides using hybrid and four-sector instruments: a comparative study.

Product-ion spectra produced by high- and low-energy collisionally activated dissociation (CAD) of [M + H]+ ions of a series of peptides (Mr 550-2500) have been compared on four-sector and hybrid tandem mass spectrometers, respectively. The fast atom bombardment product-ion spectra obtained for the smallest peptide analyzed (methionine-enkephalin) were remarkably similar, but substantial differences in fragmentation were observed for the heavier analytes. For peptides with Mr greater than 1000, more complete sequence information was obtained from high-energy CAD on the four-sector instrument. Nevertheless, low-energy CAD on the hybrid mass spectrometer was able to produce partial sequence information even for the largest of the peptides compared. Limits of analysis, defined as the least quantities of analyte for which product-ion spectra of essentially uncompromised quality could be obtained, were similar (ca. 15 pmol) for small peptides, but lower limits were achieved for larger peptides (Mr greater than 1000) with the four-sector instrument. High-energy CAD spectra were found to be highly reproducible, with qualitatively similar spectra obtained over a wide range of operating conditions. In contrast, it was necessary to carefully control collision gas pressures and collision energies in order to obtain good reproducible data for low-energy CAD. Experimental procedures for obtaining reproducible spectra with good sensitivity for peptides on the hybrid instrument are presented.

Adrenocorticotropic Hormone↗