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PubMed1999

A review of the evaluation literature on health professions training and enrichment programs for minority/disadvantaged students.

This paper includes the authors' review of the outcome evaluation articles of federal and non-federal training programs to prepare minority/disadvantaged students for entry into health programs as managers and practitioners. It provides information from the senior author's 1987-1993 Health Careers Opportunity Program grant for comparison purposes. The paper makes an argument for the standardization of outcome variables so that cross-program comparisons may be made. Until now, the variables reported in the literature have been very disparate. This paper suggests which kind of training program may have the most chance for success. Finally, it provides information rarely found in the evaluation literature: success rates for different ethnic groups and costs for running such programs. These data are provided for Health Care Administration faculty who could use planning information for similar grant applications.

Costs and Cost Analysis↗

PubMed2000

Federal immunization policy and funding: a history of responding to crises.

BACKGROUND: This article outlines the history of federal immunization policy and funding, with a focus on discretionary federal funding under Section 317 of the Public Health Service Act, paying particular attention to the role of Congress in shaping the program in the past 2 decades. This review of funding trends and initiatives indicates that when both a presidential administration and key congressional actors viewed immunization as a priority and made sufficient funds available to support the public health delivery system and its infrastructure, coverage levels would continue to rise and disease levels continue to decline. From the beginning, immunization financing was explicitly structured as a federal-state-private-sector partnership. Section 317 program's statute has not changed much in 35 years, despite significant changes to the health care delivery system, other federal immunization activities, and rates of immunization coverage. Although the creation and implementation of the Vaccines for Children (VFC) program in the mid-1990s resulted in some congressional deliberations over immunization policies, no explicit restructuring of the 317 program occurred as a result. The Section 317 program retains its traditional authority and mission to address urgent needs, sustain public delivery systems, and provide funds for purchase of vaccines. The question remains whether the resources to sustain progress in immunization can be secured during times with no crisis, to ensure constant "readiness" in immunization (as in defense), or whether another epidemic must occur before the federal government is willing to commit optimal resources.

Centers for Disease Control and Prevention, U.S.↗

PubMed2006

Business strategies for conservation on private lands: Koa forestry as a case study.

Innovative financial instruments are being created to reward conservation on private, working lands. Major design challenges remain, however, to make investments in biodiversity and ecosystem services economically attractive and commonplace. From a business perspective, three key financial barriers for advancing conservation land uses must frequently be addressed: high up-front costs, long time periods with no revenue, and high project risk due to long time horizons and uncertainty. We explored ways of overcoming these barriers on grazing lands in Hawaii by realizing a suite of timber and conservation revenue streams associated with their (partial) reforestation. We calculated the financial implications of alternative strategies, focusing on Acacia koa ("koa") forestry because of its high conservation and economic potential. Koa's timber value alone creates a viable investment (mean net present value = $453/acre), but its long time horizon and poor initial cash flow pose formidable challenges for landowners. At present, subsidy payments from a government conservation program targeting benefits for biodiversity, water quality, and soil erosion have the greatest potential to move landowners beyond the tipping point in favor of investments in koa forestry, particularly when combined with future timber harvest (mean net present value = $1,661/acre). Creating financial mechanisms to capture diverse ecosystem service values through time will broaden opportunities for conservation land uses. Governments, nongovernmental organizations, and private investors have roles to play in catalyzing this transition by developing new revenue streams that can reach a broad spectrum of landowners.

Acacia↗

PubMed2002

The employment service and vacancy durations.

In the literature, there are few examples of studies analyzing the impact of labor market programs on vacancies. This article presents the results of a study of the impact of personnel increase at Swedish employment offices on vacancy durations. The evaluation method in the study is quasi-experimental. The main results of the study are as follows: (a) The increase of employment office staff members reduced their vacancy durations by approximately 2 days, and the probability that a vacancy is cancelled from the register is 1.17 times higher for the program offices; and (b) this effect is too small for the increase of staff members to represent a socially efficient use of resources and for a positive outcome in a public finance context.

Cost-Benefit Analysis↗

PubMed2002

Rearrest rates after incarceration for DWI: a comparative study in a southwestern US county.

OBJECTIVES: This study was undertaken to assess a 28-day detention and treatment program's effect, in a multiethnic county with high rates of alcohol-related arrests and crashes, on first-time offenders sentenced for driving while impaired (DWI). METHODS: We used comparison of baseline characteristics, survival curves of subsequent arrest, and Cox proportional hazards regression to examine probability of rearrest of those sentenced and those not sentenced to the program. RESULTS: Probability of not being rearrested was significantly higher for the treatment group after adjustment for covariates. At 5 years, probability of not being rearrested for the treatment vs the nontreatment group was 76.6% vs 59.9%. CONCLUSIONS: Results suggest that this county's program has significantly affected rearrest rates for Native Americans, Hispanics, and non-Hispanic Whites.

Accidents, Traffic↗

PubMed2004

Integration of child health information systems: current state and local health department efforts.

Public health departments at the state and local levels are pursuing integration strategies to consolidate child health information systems to improve child health. Eighteen health departments were interviewed in this exploratory research study to gather information to describe their current activities related to integrating child health information systems. Results illustrate the common systems being brought together and the technical process for doing so, financing mechanisms, range of anticipated information-users and their method of access to the integrated system, and common internal and external challenges and strengths that the health departments face. The evidence suggests a trend towards more efficient and thoughtful use of the multiplicity of information systems within public health departments as programs consolidate and share data and expand electronic communication with their external partners in the health care delivery system to improve children's health.

Child↗

PubMed2005

Effects of a national health education program on the medication knowledge of the public in Taiwan.

BACKGROUND: The inappropriate use of medication and inadequate medication knowledge among the general population has long been a concern in Taiwan. One reason for the deficiencies might be the lack of an active role of pharmacists in educating the public. To rectify the situation, in 2002, the Bureau of Pharmaceutical Affairs, Department of Health of Taiwan, began to sponsor a national effort, titled Community Education Program on Medication Use, to involve the expertise of pharmacists in public education. OBJECTIVE: To evaluate the effects of this education program by analyzing the changes in knowledge of drug therapy among the participating public. METHODS: This was a single-group pre- and post-comparison study. Between September 2003 and January 2004, a total of 955 community residents enrolled in the pharmacist-facilitated education program offered at 31 community universities. The medication knowledge of the participants was evaluated before and after the program. Demographic variables that might affect the education outcomes of the program were also examined. RESULTS: Medication knowledge at baseline was positively correlated with education level and negatively correlated with age. Females were more aware of drug-related information than were males. The participants showed a significant improvement in medication knowledge (p < 0.001) at the end of the program. The baseline knowledge score was the most important determinant of the improvement of the posttest score. CONCLUSIONS: A national education program facilitated by pharmacists can improve the medication knowledge of the participants. Pharmacists should be encouraged to play a proactive role in large-scale health education programs.

Adolescent↗

PubMed2005

Healthy marriage programs: learning what works.

Evidence of public and private interest in programs designed to strengthen the institution of marriage and reduce the number of children growing up without both their parents is growing. Robin Dion addresses the question of whether such programs can be effective, especially among disadvantaged populations. She begins by describing a variety of marriage education programs. Although new to the social welfare umbrella, such programs have existed for several decades. Social scientists have evaluated a number of these programs and found them effective in improving relationship satisfaction and communication among romantically involved couples. All the programs tested so far, however, have served primarily white, middle-class, well-educated couples who were engaged or already married. Because these programs were neither designed for nor tested with disadvantaged populations, Dion observes, there is some question whether they can respond to the unique needs and circumstances of low-income couples, many of whom have multiple stressors and life challenges that can make stable relationships and marriages especially difficult. New research suggests that low-income families often face specific relationship issues that are rarely addressed in the standard programs, such as lingering effects of prior sexual abuse, lower levels of trust and commitment, and lack of exposure to positive role models for marriage. Dion describes the recent efforts of several groups to adapt research-supported marriage education programs or create entirely new curriculums so they are more responsive to and respectful of the needs of low-income families. Finally, Dion describes ongoing efforts by the Administration for Children and Families to evaluate rigorously the effectiveness of several healthy marriage initiative models being implemented on a large scale across the country. These evaluations will determine whether such programs can work with less advantaged and more culturally diverse families, including whether the impacts on couples' relationships will translate into positive effects on the well-being of their children.

Adult↗

PubMed2005

HIV-1 drug resistance in Thailand: before and after National Access to Antiretroviral Program.

BACKGROUND: The Ministry of Public Health (Thailand), MoPH, has had a program called National Access to Antiretroviral Program for People who have AIDS (PHA) or "NAPHA", to offer free antiretroviral drugs (ARV), which are locally produced in Thailand, to any HIV-1 infected patients with CD4<200 since 2002. This program may increase usage of ARV therapy and the emergence of HIV-1 drug resistance. OBJECTIVES: To monitor HIV-1 ARV drug resistant codon mutation in Thailand before and after the "NAPHA" program. MATERIALS AND METHODS: EDTA blood samples were collected from 542 HIV-1 infected subjects, who received ARV therapy in 1999 and 2001-2003, and perinatal chemoprophylaxis in 1998 and 2000. HIV-1 pol nucleotide sequences were analyzed. RESULTS: The percentage of drug resistant detection from the ARV therapy group in 1999 and 2001-2003 were 12.14 (34/280), 10.23 (9/88), 86.96 (20/23) and 57.55 (61/106), respectively. Of 332 NRTI drug resistant codon mutation, 226 (68.07%) were thymidine analogue mutations (TAMs). The percentage of TAMs detection in 1999 and 2001-2003 were 7.14 (20/280), 9.09 (8/88), 56.52 (13/23) and 43.34 (46/106), respectively. Of 105 NNRTI drug resistant codon mutation, 95 (90.48%) were related to nevirapine drug resistance. CONCLUSION: Thailand may need more appropriate monitoring of drug resistance in the free ARV therapy program to protect the future usage of drugs by minimizing the emergence of drug resistance.

Anti-Retroviral Agents↗

PubMed2001

Evaluation of Responding in Peaceful and Positive Ways (RIPP): a school-based prevention program for reducing violence among urban adolescents.

Evaluated Responding in Peaceful and Positive Ways (RIPP)--a 6th-grade universal violence prevention program. Classes of 6th graders at 3 urban middle schools serving predominantly African American youth were randomized to intervention (N = 321) and control groups (N = 305). Intervention effects were found on a knowledge test but not on other mediating variables. RIPP participants had fewer disciplinary violations for violent offenses and in-school suspensions at posttest compared with the control group. The reduction in suspensions was maintained at 12-month follow-up for boys but not for girls. RIPP participants also reported more frequent use of peer mediation and reductions in fight-related injuries at posttest. Intervention effects on several measures approached significance at 6-month and 12-month follow-up. The program's impact on violent behavior was more evident among those with high pretest levels of problem behavior.

Adolescent↗

PubMed1995

Creating greater efficiency in ambulatory surgery.

Ambulatory surgery emerged as a new modality in health care 25 years ago, and it has continued to grow substantially since that time. Several thousand facilities and programs have been established, developed, and expanded, while hundreds of millions of dollars were expended and committed to react to industry demands. Ambulatory surgery growth between 1970 and 1980 (Figure 1) was primarily fueled by patient, physician, and cost considerations. Surgical facilities and programs were initially faced with establishing credibility and legitimacy by demonstrating safety and quality in the outpatient setting. Thus began the competition for the ambulatory surgery patient in the United States. Ambulatory surgery became synonymous with efficiency in that there was a reduction in overnight stays, lowering the cost for the ambulatory surgery patient and providing hospital beds for those who required them. In addition, ambulatory surgery centers' fees were initially considerably less than hospital ambulatory surgery fees. Between 1980 and 1990 (Figure 2), the principal influences in ambulatory surgery expanded from surgeons and patients to include insurance companies and government reimbursement programs, including Medicare and Medicaid. A substantial growth in technology occurred, the investment community discovered ambulatory surgery, and an increase in reimbursement was a result of those marketplace dynamics. From 1990 (Figure 3) to the present, principal influences expanded from surgeons, patients, insurance, and government, to include managed care, creative alliances, affiliations, and employers. The health care industry is now dominated by cost control, competition, exclusionary contracts, changing referral patterns, fragmentation, self-referral legislation, continuing governmental regulations, consumerism, accountability and measurability, over-capacity, capital limitations, and technological advances. Health care clinicians and analysts comfortably project that, by the year 2000, 75% of all surgery will be performed on an ambulatory basis./4+ key/(ABSTRACT TRUNCATED AT 400 WORDS)

Ambulatory Surgical Procedures↗

PubMed2002

Hematopoietic stem cell transplantation: the Vancouver experience.

Hematopoietic stem cell transplantation has been available as a therapeutic modality for selected adult patients in Vancouver, British Columbia since 1981. We report on the history, progress, and future prospects of the Leukemia/Bone Marrow Transplantation Program of British Columbia. The basic mechanisms and indications for hematopoietic stem cell transplantation are outlined. Limitations of this procedure are also examined, particularly that of associated toxicities such as graft-versus-host-disease.

British Columbia↗

PubMed2003

Developing a scientific basis for radiation risk estimates: goal of the DOE Low Dose Research Program.

The U.S. Department of Energy's Low Dose Radiation Research Program is a 10 y activity currently funded at $21 million per year. It focuses on biological responses to low doses (<0.1 Gy) of low-LET ionizing radiation. The overall goal of this program is to provide a sound scientific basis for the radiation protection standards. The program supports basic research that combines modern genomic, molecular, and cellular techniques with recent advances in scientific instrumentation. These combinations make it possible to detect responses and test paradigms associated with the mechanisms of low dose radiation action not previously measurable or testable. Research to date is briefly reviewed and suggests the need for some major paradigm shifts. Exposure of the extracellular matrix can modify both the pattern of gene expression and the phenotype of the cells which result in cell transformation without direct mutation. Low dose radiation exposure results in a range of dose-response relationships for changes in the number, types, and patterns of gene expression. Such studies suggest an increased role for gene expression relative to single mutations for radiation induced cancer. Low dose research using microbeams demonstrated that cells do not require a direct "hit" to result in significant biological alterations. These "bystander effects" demonstrate that "non-hit" cells respond with changes in gene expression, DNA repair, chromosome aberrations, mutations, and cell killing. Research to link genomic instability with cancer is also being conducted and will be discussed. Detection of radiosensitivity genes as markers of genetic susceptibility in individuals and populations can be used in epidemiological studies to determine how molecular changes may impact risk. It is not possible to determine how this research will influence current radiation standards. However, the Low Dose Research Program will help ensure that radiation standards are set using the best scientific data available, and that they are adequate and appropriate for the protection of workers and the public.

DNA↗

PubMedDate not supplied

Healthcare pay: belts tighten--but who feels the squeeze?

A CEO of a renowned acute care facility echoes what many in the healthcare industry are experiencing: "At no time in my memory are we changing so much so fast ... with so little time in which to make changes." The once mighty fortress of the healthcare industry has been invaded by a Trojan horse: managed care. Consequently, managed care has become the primary impetus for industry change. Managed care penetration has increased dramatically over the past few years, and all indications point to its continued growth throughout the US. In 1995, 71% of employees covered under an employer-sponsored health plan received their care through a managed care arrangement (health maintenance organization, preferred provider organization, point of service plan) and only 29% were covered under a traditional indemnity plan. In contrast, 52% of employees had indemnity plans in 1992. Managed care is growing in the public sector as well. Government-sponsored programs such as Medicare and Medicaid increasingly rely on managed care to help control costs and utilization. Though Medicare managed care enrollment today represents only about 10% of the Medicare population, enrollment has more than doubled between 1990 and 1995. Almost every state has some form of Medicaid managed care program in place. Fifteen states have received waivers to mandate that recipients receive care through managed care arrangements, and an additional ten states await federal approval to do the same. Between the years 1993-95, the number of Medicaid beneficiaries enrolled in managed care plans increased 140% to a national enrollment of close to 12 million. In addition to factors in the healthcare field such as uncompensated care, increased outpatient services, excess bed capacity, and restrictions in government reimbursement, the shift to managed care has forced hospitals to find new ways to operate within the healthcare delivery system. In particular, because hospitals' human resource costs are a substantial portion of their budgets, compensation policies are an important component of managing the cost of day-to-day operations. The 1996 Coopers & Lybrand Compensation in the Healthcare Industry Survey summarizes the responses from 207 healthcare organizations, primarily hospitals, in terms of their efforts to survive this constantly changing environment. Respondents included acute care and specialty hospitals, community-based hospitals, academic medical centers, public, and private organizations. The survey addresses operational issues, compensation incentives, special pay, and other compensation-related programs. This article analyzes the results of the Coopers & Lybrand survey.

Cost Control↗

PubMed2003

STD program activity in state policy processes, 1995 and 2000.

BACKGROUND: Generating state policy support for sexually transmitted disease (STD) prevention is crucial; however, little is known about policy activity by STD programs. GOALS: The goals of the study were to identify state-level policy behaviors by state STD programs and to examine the association between policy behavior and selected state characteristics. STUDY DESIGN: Information was gathered through a survey of STD directors in 2001. Policy activities were recalled for 1995 and 2000 and compared with several state characteristics. RESULTS: A majority of state STD programs reported at least one policy behavior in the state policy process for 1995 and for 2000. An increase was observed with the provision of state legislative testimony, participation in STD coalitions, and dissemination of information to policy-makers by STD programs. CONCLUSION: Reported policy activity may be evidence of an emerging environment enabling state STD directors to engage in public policy activity. An opportunity exists to improve state and local support for STD prevention.

Government Programs↗

PubMed2002

Exemplars of successful Alzheimer's demonstration projects.

The Alzheimer's Demonstration program was established in 1991 to develop models of home and community-based care for persons with Alzheimer's disease and their families. After more than ten years of program experience and evaluation, the Alzheimer's Demonstration program has generated significant information about how to work successfully with families coping with Alzheimer's disease. In particular, the Demonstration program has been very successful in developing innovative program models and approaches to serving traditionally underserved populations such as ethnic minorities, low income, and rural families. Of particular interest is the significant number of successful project components that are replicable in a variety of community settings. This article provides detailed programmatic and replication information for successful Alzheimer's Demonstration program models: Mobile Day Care Rural Geriatric Dementia Evaluation, El Portal services for Latino, Client Advocates, and AL-CARE services for clients who live alone.

Adaptation, Psychological↗

PubMed2006

Special Populations Networks--how this innovative community-based initiative affected minority and underserved research programs.

The Special Populations Networks (SPN) Program was created to address both community needs for cancer information and NCI's desire to obtain community-based answers to research questions and promote training opportunities for racial/ethnic minority and underserved researchers in populations with an unequal burden of cancer. The SPN program included 3 components: 1) infrastructure and capacity building combined with cancer awareness, 2) community-based research, and 3) community-centered training. The 18 SPN grantees conducted more than 1000 cancer awareness activities. More than 2000 community lay health workers were trained. Communities formalized more than 300 partnerships with Memoranda of Understanding (MOU). More than 255 pilot research project applications were submitted by junior researchers and over 135 were funded. Approximately 90% of the applications were submitted by minority junior researchers; of which more than 100 were funded. More than 290 scientific publications thus far have resulted from the work of the SPNs. In the first 3 years of the program, the SPNs also secured an additional $20 million in outside funding. The SPN program effected a paradigm shift for minority research programs by combining community-based cancer awareness, research, and training into a single program. By engaging research leaders of minority and underserved populations to aid their own, train their own, and develop research to help their own, the SPN program activated the power of their commitment to their own. That commitment was reflected in the trust and participation offered by their communities. Cancer 2006. (c) 2006 American Cancer Society.

Community Networks↗

PubMed2006

Asthma risk factor assessment: what are the needs of inner-city families?

BACKGROUND: A complex array of risk factors contributes to sustained high levels of asthma morbidity in inner-city children. OBJECTIVE: To describe risk factors for asthma morbidity in a national sample of inner-city children with persistent asthma. METHODS: This study examined baseline questionnaire results from 1,772 children ages 5 to 11 years old with moderate to severe persistent asthma who enrolled in the Centers for Disease Control and Prevention-funded Inner-City Asthma Intervention between April 2001 and March 2004. Risk for asthma morbidity was assessed in 9 domains using the Child Asthma Risk Assessment Tool. The domains included environmental exposures, parental stress, medication adherence, pessimistic asthma beliefs, smoke exposure, aeroallergen exposure, child psychological well-being, responsibility for medication administration, and medical care. RESULTS: A total of 51% of families demonstrated high risk of asthma morbidity in 3 or more domains. High risk of asthma morbidity was suggested based on household environmental exposures (47.7%), high parental stress (38.5%), poor medication adherence (38.3%), pessimistic asthma beliefs (31.8%), environmental tobacco smoke (24.4%), sensitization to aeroallergens in the home (24.8%), child behavioral or emotional concerns (22.9%), child assigned responsibility for medication administration (21.2%), and poor medical care (20.7%). Allergy testing was completed for 40% of the participating children. Of these children, 61% were exposed to aeroallergens in their home to which they were sensitized. CONCLUSIONS: In this national sample of inner-city children, multiple risk factors for asthma morbidity were identified. Asthma programs that provide multilevel support and intervention are needed to reduce the burden of asthma on inner-city families.

Air Pollution, Indoor↗