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At least 1,171 records · Page 65Linked to original sources
PubMed1998

The changing paradigm of sexually transmitted disease control in the era of managed health care.

Several trends in sexually transmitted diseases (STDs) have laid the foundation for a new paradigm for STD treatment and prevention that encompasses a community-wide, population-oriented approach. Public health STD programs, in partnership with a wide variety of community collaborators, will need to carry out the essential functions of public health-assessment, policy development, and assurance-by developing resources for community organizing and planning, enhanced information systems, and comprehensive training programs for professional staff and community partners. Community providers (particularly practicing clinicians and community and hospital clinics) will need to deliver primary prevention (community health promotion and clinical preventive services) and secondary prevention (screening and treatment) services while categorical STD clinics focus on providing care for high-risk, high-frequency STD transmitters who serve as the reservoir for much of a community's bacterial STDs. Managed care organizations and public health STD programs will need to formalize collaborative arrangements and capitalize on the strengths of each organization in order to have a population-level impact on STD transmission.

Communicable Disease Control↗
PubMed2000

Tuberculosis among foreign-born persons in the United States, 1993-1998.

CONTEXT: Immigration is a major force sustaining the incidence of tuberculosis (TB) in the United States. OBJECTIVE: To describe trends and characteristics of foreign-born persons with TB and the implications for TB program planning and policy development. DESIGN, SETTING, AND SUBJECTS: Descriptive analysis of US TB surveillance data from case reports submitted from 1993 to 1998. MAIN OUTCOME MEASURE: Demographic and clinical characteristics of foreign-born persons with TB. RESULTS: The number of TB cases among foreign-born persons increased 2.6%, from 7402 in 1993 to 7591 in 1998, and the proportion of US cases that were foreign-born increased from 29.8% to 41.6%. During 1993-1998, the TB case rate was 32.9 per 100000 population in foreign-born persons compared with 5.8 per 100000 in US-born persons. Six states reported 73.4% of foreign-born cases (California, New York, Texas, Florida, New Jersey, and Illinois). Approximately two thirds of these cases were originally from Mexico, the Philippines, Vietnam, India, China, Haiti, and South Korea. Among those for whom date of US entry was known, 51.5% arrived 5 years or less prior to the diagnosis of TB. Most were male and aged 25 to 44 years. During 1993-1996, the proportion receiving some portion of treatment under directly observed therapy increased from 27.3% to 59.1% and approximately 70% completed therapy in 12 months. The rate of primary resistance to isoniazid was 11.6% and to both isoniazid and rifampin was 1.7%. Conclusions As the United States moves toward the goal of TB elimination, success will depend increasingly on reducing the impact of TB in foreign-born persons. Continued efforts to tailor local TB control strategies to the foreign-born community and commitment to the global TB battle are essential.

Adolescent↗
PubMed2005

HIPAA and patient care: the role for professional judgment.

Federal health privacy regulations, commonly known as the Health Insurance Portability and Accountability Act (HIPAA) regulations, came into effect in April 2003. Many clinicians and institutions have relied on consultants and risk managers to tell them how to implement these regulations. Much of the controversy and confusion over the HIPAA regulations concern so-called incidental disclosures. Some interpretations of the privacy regulations would limit essential communication and compromise good patient care. This article analyzes misconceptions regarding what the regulations say about incidental disclosures and discusses the reasons for such misunderstandings. Many misconceptions arise from gaps in the regulations. These gaps are appropriately filled by professional judgment informed by ethical guidelines. The communication should be necessary and effective for good patient care, and the risks of a breach of confidentiality should be proportional to the likely benefit for the patient's care. The alternative for communication should be impractical. We offer specific recommendations to help physicians think through what incidental disclosures in patient care are ethically permissible and what safeguards ought to be taken. Physicians should work with risk managers and practice administrators to develop policies that promote good communication in patient care, while taking appropriate steps to protect patient privacy.

Confidentiality↗
PubMed1990

Book availability as a performance measure of a library: an analysis of the effectiveness of a health sciences library.

User satisfaction as a measure of library effectiveness has been studied by using Kantor's branching technique. Cleveland Health Sciences Library, Cleveland, Ohio, was used as the center of this study. The study measured independently the user bibliographic information performance, collection development policy performance, acquisition policy performance, user catalog performance, circulation performance, library operation/functioning performance, and the user search performance. Each of these categories represented one or more of the factors of library performance that could account for the possibility of users' failure. The sample size consisted of 1000 requests for book titles. The book availability rates were 59.60% without the help of the librarian and 63.50% with the help of the librarian. The results indicate that a dynamic study of library policies at regular intervals by using the Kantor's method, which is easily reproducible, can maximize library resources for the most effective fulfillment of user demand.

Consumer Behavior↗
PubMed1993

Utilization of mammography. Social and behavioral trends.

Key policy developments in the utilization of mammographic screening for the early detection of breast cancer in the U.S. since 1973 are reviewed. Recent data from the 1990 and 1992 Mammography Attitudes and Usage Studies on attitudes toward mammography and screening behaviors among U.S. women aged 40 and older are summarized. Physician screening behavior is discussed using data from the National Cancer Institute and the American Cancer Society. The author concludes that additional efforts are needed to change screening behaviors among women and physicians and summarizes key issues for future research.

Adult↗
PubMed1999

Statistics and environmental policy: case studies from long-term environmental monitoring data.

Environmental objectives are statements of policy which are intended to be assessed using information from a monitoring program. An environmental monitoring program has to be adequate in its quality and quantity of data so that the environmental objectives can be assessed. Also, the resulting data should be able to contribute information towards decisions to modify policy at a later time if desirable. However, monitoring programs can fail to return satisfactory information for policymakers because future statistical needs have not been anticipated, potential confounding factors were not considered, or sampling protocols did not specify suitable randomization. A key intermediate role exists for the use of statistical inference in providing a logical framework for using monitoring data to test hypotheses about fulfillment of environmental objectives. The undertaking of a statistical inferential approach to monitoring design can result in data which are more general in their interpretation and, thus, more useful as input to policy development and review. Some case studies from the Victorian EPA monitoring programs will be presented to illustrate these points.

Environmental Monitoring↗
PubMed2006

Disease risk analysis: a tool for primate conservation planning and decision making.

Concern about emerging and re-emerging diseases plays an increasing role in conservation and management of both captive and free-ranging nonhuman primates (NHPs). Managers and policy makers must formulate conservation plans in an arena plagued by uncertainty, complexity, emotion, and politics. The risk analysis paradigm provides a framework that brings together scientists and policy experts to make better decisions for both people and animals. Risk analysis is a multidisciplinary, science-based process that provides an organized and logical approach for incorporating scientific information into policy development in the real world. By blending four specific goal-oriented stages-hazard identification, risk assessment, risk management, and risk communication-one can logically assess the probability that an adverse event, such as the introduction of an emerging disease into a naïve population, will occur. The following is a review of this process as it pertains to NHP conservation and risks associated with infectious diseases.

Animals↗
PubMed2004

Sedentism, seasonality, and economic status: A multivariate analysis of maternal dietary and health statuses between pastoral and agricultural Ariaal and Rendille communities in northern Kenya.

This paper examines longitudinal data to assess the effects of the recent transition from pastoralism to sedentary agriculture for Ariaal and Rendille mothers in northern Kenya. Dietary, morbidity, and anthropometric data resulting from bimonthly repeated surveys of the pastoral community of Lewogoso and the sedentary agricultural community of Songa, covering the period from September 1994-July 1995, were used to test two hypotheses: 1) that sedentism is associated with changes in diet, seasonality, morbidity, and socioeconomic differentiation, and 2) that these changes affect maternal body composition. The first hypothesis is partly supported, with starch replacing milk in the sedentary diet. Repeated-measures multivariate analysis of variance revealed no seasonal effects for diet in the agricultural sample, while starch consumption was significantly affected by seasonality for the pastoral sample. The agricultural community also featured economic dietary disparities favoring wealthier mothers, while no such effect was found in the pastoral community. However, no seasonal or economic effects were found for morbidity patterns in either sample. The second hypothesis is also partially supported, as a generalized estimating equations analysis revealed differences in the way diet and economic strata influence maternal anthropometric values. Economic status was significantly associated with maternal arm-fat area in Lewogoso. Milk was a significant factor associated with maternal weight and arm-muscle area in Songa. These findings are discussed in light of development policy implications.

Adipose Tissue↗
PubMed2026

Prevalence of pharmacogenomically implicated prescriptions in multi-ethnic populations in Singapore.

AIM: To assess the potential impact of implementing pre-emptive pharmacogenomic (PGx) testing in Singapore, focusing on prevalence and genetic actionability of PGx prescriptions. METHODS: Electronic Health Records from 2014 to 2021 were obtained from the National University Hospital (NUH), a tertiary medical centre serving approximately 6% of Singapore's population, which were filtered for pharmacogenomically implicated medicines (CPIC Level A or A/B), defined as PGx medications. Coupling this with published data of whole-genome sequencing of 9051 Singaporeans, we estimated the proportion of patients whose prescriptions might have been modified based on pre-emptive PGx at population level. RESULTS: From 2014 to 2021, a total of 1 157 359 unique patients were seen at NUH, with 38.1% to 43.0% of patients with prescriptions receiving at least one PGx medication annually, exhibiting minimal variance over year of prescription, sex or race/ethnicity. The most frequently prescribed PGx medications were omeprazole, statins and tramadol, while the most implicated pharmacogenes were CYP2C19, CYP2D6 and SLCO1B1. The age-dependent increase in PGx medication exposure varied significantly by sex, with males prescribed these medications earlier in life than females. Similarly, Indians and Malays were more likely to be prescribed these medicines at a younger age than Chinese. Based on frequency of PGx variants in Singaporeans, we estimate that 18.4% of patients could have their prescriptions modified from pre-emptive PGx testing. DISCUSSION: Pharmacogenomically implicated medication prescriptions are common in Singapore and are particularly prevalent in elderly populations. Strategic investments in infrastructure and policy development will be pivotal to the successful integration of pre-emptive PGx into clinical practice.

Asian genomes↗
PubMedDate not supplied

Cost analysis of pneumonia treatment in the Philippines.

The objectives of this study were to describe the cost distribution of pneumonia treatment in tertiary hospitals in the National Capital Region (NCR) and to identify variations in costs in order to provide basic information to the Philippine Health Insurance Corporation (PHIC) for quality assurance and policy development. This study focuses on 3861 reimbursement claims, which come from 22 government and 38 private tertiary hospitals. Wide variations of cost existed among the hospitals and among the inpatients. Medicine was the leading expenditure in total costs (38%), second was examinations (27%), third was beds (22%) and the last was doctors fees (13%). The same ranking ocurred for reimbursement by PHIC. The private hospitals were more expensive than the government hospitals, but also more efficient in the length of hospitalization. The member patients spent more and were reimbursed more for clinical practice than the dependent patients. However, there was no difference in the length of hospitalization between member and dependent patients. There was no difference in the length of hospitalization and expenditure between Government Service Insurance System (GSIS) in 1997 and Social Security System (SSS) patients. Clinical guidelines should be effectively implemented and PHIC should contribute more to reduce existing variations, improve cost-effectiveness and the quality of clinical practices.

Analysis of Variance↗
PubMedDate not supplied

Quality of life in quadriplegic adults: a focus group study.

This article describes a study whose purpose was to provide additional information about the components of quality of life for quadriplegic individuals. A focus group technique was used to determine subjects' opinions about what constitutes an acceptable quality of life. Three focus groups with a total of 14 subjects met to discuss the topic. Transcripts of the interviews were analyzed to determine themes and to identify components of quality of life for these individuals. Findings indicate that the factors influencing quality of life for quadriplegics include inner strength/survival, finances, relationships, job/productivity, health, level of activity, assertiveness, and independence/dependence. These findings will provide health professionals and policymakers with information about what factors quadriplegics consider important to maintaining an acceptable quality of life. This knowledge is necessary for public policy development, resource allocation, and interventions that will enhance the quality of life for people affected by quadriplegia.

Activities of Daily Living↗
PubMed2006

Leading a horse to water: an action perspective on mental health policy.

Following publication of several landmark policy documents beginning in 1999, there are unprecedented opportunities for reforming mental health care to meet the needs of persons with mental illness. In this article, the authors suggest that transforming mental health requires dramatic changes in theory as well as in policy and practice, offering action theory as a corrective for a clinical psychology that has yet to view people as active agents shaping their own lives. A participatory approach to policy development and adoption of an action-oriented model of clinical practice provide examples of the shift, which results from treating people to enhancing their access to opportunities and offering them the in vivo supports they need to pursue meaningful lives even while disabled.

Adult↗
PubMed2006

Critical role of the March of Dimes in the expansion of newborn screening.

Expansion of newborn screening (NBS) has been driven primarily by a combination of advances in technology and medical treatment, and the sustained advocacy efforts of consumers and voluntary health organizations. The longstanding leadership of the March of Dimes has been credited by many as a critical factor in the expansion and improvement of state NBS programs. From the historic vantage point of four decades of March of Dimes involvement with newborn screening, this report reviews the unique origin of the first newborn screening test, and identifies from this point of origin several of the elements which still define the evolution of advocacy for NBS today. It also documents activities at the federal level and in seven states that have lead to expanded screening for newborns. Advances in NBS technology and medical treatment have informed policy development. Mobilization of volunteers and focused advocacy activities have brought about expansion of screening opportunities for newborns across the United States. But more work is needed. Continued application of the effective strategies identified in this report will help assure that all families have the best possible chance of assuring that their newborns do not have to suffer the complications of conditions that we know can be treated effectively.

Financing, Government↗
PubMed1988

Differences in the performances of baccalaureate, associate degree, and diploma nurses: a meta-analysis.

The findings of 139 studies of nurses educated in one of three basic nursing education programs (associate degree, diploma, and baccalaureate degree) were synthesized using meta-analysis. The results indicated significant differences between professional (BSN) and technical (AD and diploma) nurses on measures of nurse performance. Measures resulting in larger effects for professional nurses included communication skills, knowledge, problem-solving, and professional role. No differences resulted from studies of nurses from the two technical programs, AD and diploma. Further analyses indicated that the effects could not be solely attributed to substantive and methodological features of the studies. However, the hospital setting where a study was conducted and years of nursing experience decreased the size of the effect. The results of the meta-analysis have implications for policy development about educational preparation and for service expectations of professional and technical nurses.

Clinical Competence↗
PubMed2002

Developing a sustainable energy strategy for a water utility. Part II: A review of potential technologies and approaches.

Environmental legislation is increasing the amounts of bought-in electricity required for sewage treatment, and generating larger volumes of sewage sludge to be treated and disposed of. Concurrently, concerns over global warming and food safety from sewage sludge recycling on agricultural land is augmenting the costs of conventional sewage and sludge treatment technologies and practices. This paper reviews some emerging technologies and practices that may assist in mitigating these problems in the future. In addition, a number of potential renewable energy technologies available to water companies are reviewed. Results suggest that through the take-up of new technologies, current and future water quality standards could be delivered in a more sustainable way. However, this series of papers also highlights that institutional and political conflicts may have inadvertently failed to recognise the wider effects of improving water quality and lessened the financial support necessary for their widespread take-up. It is also suggested that through the use of a Strategic Environmental Assessment (SEA) approach, stakeholders could gain a better understanding of the broader environmental effects of achieving certain water quality standards and develop policy and long-term investment strategies accordingly. However, to fulfill the information requirements of an SEA, an appropriate appraisal tool that considers many of these factors in unison is required, and a possible technique is suggested.

Conservation of Natural Resources↗
PubMed1986

Legal and regulatory aspects of genetically engineered animals.

The commercialization of genetically engineered food animals will pose a number of legal and regulatory questions. These may be grouped into questions of process and questions of products. The process of animal genetic engineering with artificially constructed vectors will probably be regulated in much the same manner as other veterinary procedures. There may be some discussion, however, as to whether animal drug or animal biologic regulations are more applicable. The products of animal genetic engineering, i.e., transgenic food animals and food products made from them, also raise important questions about product safety and identity. These include whether and how genetically engineered food animals will be subject to federal inspection for wholesomeness, whether artificial vectors, foreign genes, or gene products will adulterate recipient animal tissues, and how food products made from such animals will be labeled. Prior federal experience with the inspection of interspecific hybrids of cattle and buffalo provides a useful basis for further policy developments in the inspection and labeling of genetically engineered food animals. In particular, the inspection of cattle/buffalo hybrids has established a phenotypic (based on appearance) criterion for deciding how novel food animals should be inspected. As the genetic engineering of food animals on a production basis draws nearer, it may be necessary to supplement the phenotypic criterion with genetic (based on pedigree) criteria to assure that the essential characteristics of animals slaughtered under current food statutes are maintained.

Animal Husbandry↗
PubMed1989

Self-help efforts in a squatter community: implications for addressing contemporary homelessness.

This analysis addresses the nature of contemporary homelessness in the United States, the historical foundations of the shelter system, and survival strategies utilized by homeless persons in meeting their physical, social, and psychological needs. A framework that examines the degree of publicness/privateness and permanency/temporariness of spaces utilized by homeless persons is applied to a case study of a self-help squatter community living on an empty lot in New York City. By looking at the members of the group, their relationship to their neighbors and the local community, and their approaches in dealing with their needs, an assessment is made of this labor-intensive, self-help effort for providing shelter. Implications of self-help approaches are related to policy development and further research.

Activities of Daily Living↗