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PubMed1984

Factors associated with the use of child restraint devices.

A thorough behavioral diagnosis of why parents do and do not use car safety seats is important for designing an effective, comprehensive approach to the significant public health problem of childhood motor vehicle occupant deaths and injuries. With a clear understanding of the demographic, knowledge, attitudinal and social support factors related to car seat use, it will be possible to develop or refine program methods and persuasive communication strategies which will have the greatest potential for effectiveness. Project KISS (Kids in Safety Seats) of the Maryland Department of Health and Mental Hygiene surveyed parents of young children in Maryland to identify factors which differentiate child restraint device users from nonusers. A statewide telephone survey was conducted using random digit dialing, a method of computerized sampling for telephone interviewing. The survey instrument incorporated demographic variables and used Fishbein and Ajzen's model of behavioral intention to develop an attitude scale and identify social referents important to parental safety seat use. Of the factors associated with reported use of car seats, the attitudinal variables were extremely significant. Using these variables as well as spouse approval, socio-demographic characteristics, and other preventive health behaviors of parents, resulted in the correct classification of 75.5% of cases and 26.7% of the variance in reported car seat use. Practitioners can use this analysis to design and target effective educational efforts to those individuals who are least likely to use car seats properly and consistently.

Adult↗
PubMed2006

Emerging role of epidemiologic literacy.

BACKGROUND: The ability to understand and apply epidemiology methods is a growing part of pharmacy practice, pharmacy accreditation standards, and evidence-based practice. OBJECTIVE: To examine the trends in epidemiology-related terminology used in the literature over the past 20 years. METHODS: The frequency of the use of epidemiology-related terminology in 3 representative pharmacy journals, 2 representative medical journals, and 1 public health journal from January through December 1984, 1994, and 2004 was recorded. The 3 pharmacy journals were the American Journal of Health-System Pharmacy (formerly American Journal of Hospital Pharmacy), The Annals of Pharmacotherapy (formerly Drug Intelligence and Clinical Pharmacy), and Pharmacotherapy. The 2 medical journals were the New England Journal of Medicine and The Journal of the American Medical Association (JAMA), and the public health journal was the American Journal of Public Health. The number of times an epidemiology-related term was used was summed for each year and each journal. RESULTS: For all the journals examined in this study combined, the proportion of epidemiologic terms used in the literature has increased over the past 20 years. In 1984, of the total articles published in the 6 journals, 7.02% contained epidemiologic terms increasing to 12.27% and 15.46% in 1994 and 2004, respectively. The most dramatic differences in the 20-year comparisons were noted for Pharmacotherapy (0 to 17.75%) and JAMA (7.32 to 26.72%). CONCLUSIONS: The increase in the use of epidemiology-related terms has implications for both curricular planning in schools and colleges of pharmacy, as well as for continuing education programs and effective interprofessional communication.

Epidemiology↗
PubMedDate not supplied

The challenge of mandatory evacuation: providing for and deciding for.

Insufficient attention has been given to the ethical and legal questions surrounding mandatory evacuation in disasters and emergencies. We argue that mandatory evacuation orders entail a governmental duty both to provide for people and to decide for people: Government must trigger the provision of critical resources as well as vigorous and persistent efforts to persuade reluctant citizens to leave. Public health professionals, with their experience in weighing costs and risks in the face of uncertainty and balancing individual liberties with the need to protect the common welfare, offer a unique perspective that should be brought to bear in emergencies and disasters.

Civil Rights↗
PubMed2000

An elementary school-based health clinic: can it reduce medicaid costs?

OBJECTIVE: School-based health services have evolved from primarily controlling communicable disease to comprehensive programs with direct services, education, and improvement of the school environment. School-based health clinics (SBHCs), currently 1157 in number, are used to reach children for preventive and other routine care. Although several studies have examined the costs and effects of such programs, few, if any, have examined their potential to save Medicaid program outlays. The objective of this study was to assess the effect of the Whitefoord Elementary School-Based Health Clinic (WESBHC), located in Atlanta, Georgia, on health care costs paid by Georgia Medicaid over the 1994-1996 period. This clinic has been in operation since late 1994. DESIGN: The analysis uses 1994-1996 claims data for Medicaid-enrolled children 4 through 12 years old served by the WESBHC and similar children in a comparison school district without such a clinic. Descriptive and multivariate analyses are used to discern the differences in the changes in Medicaid expenses per child-year enrolled for these 2 groups of children. Both those who only used the WESBHC sporadically and those for whom it was their medical home were identified for analysis. RESULTS: The descriptive analysis shows that although there were no significant differences in the Medicaid expenses for the WESBHC and comparison children in 1994, before the operation of the WESBHC, by 1995, the WESBHC children had significantly lower emergency department expenses. In addition, they had higher Early Periodic Screening Diagnosis and Treatment preventive care expenses. By 1996, the WESBHC children had significantly lower inpatient, nonemergency department transportation, drug, and emergency department Medi- caid expenses. Multivariate analysis confirmed the effect of the WESBHC on lowering emergency department expenses. CONCLUSIONS: The results strongly suggest that the operation of a SBHC can have effects on the child's use of services and health care expenses. Given that these clinics serve all those who come for care and many of these are low-income children, these savings are likely to accrue to the Medicaid program of the state. As states continue to implement Medicaid-managed care for their child populations, they will need to consider the ability of SBHCs to participate in and receive Medicaid revenues through health maintenance organization networks.

Child↗
PubMed1997

A slippery slope: economists and social insurance in the United States.

Since the 1980s welfare state protections have been blamed for a host of economic problems. In the United States, conservatives have always disliked Social Security but could not effectively attack this popular program until the 1980s, when they devised a new tactic--warning young people that they would never get their "money's worth" from Social Security, which is on the brink of "bankruptcy." The political climate, dominated by a drive to cut back "big government," also became favorable for attempts to destabilize Social Security politically. Thus, negative images of Social Security have been forced onto the public agenda, and economists who consider themselves "liberal" have uncritically accepted this new set of political "givens." It is an example of how they address "crises" as separable issues tied to no particular social context.

Aged↗
PubMed1988

Leadership in action: students learn with resource persons.

The faculty maintain close contact with the resource persons and are aware of their interaction with students on a weekly basis. Faculty and resource persons exchange observations, assessments, suggestions and problems they have either anticipated or experienced. The resource persons report that as students gain from the experiences, so do they. In particular, resource persons state interactions with students have stimulated them to increase their own clinical inquiry. A head nurse, functioning as a resource person, recently told the members of the Nursing Curriculum Committee she wished she had had such a course seven years ago when she was a senior in the program (S. Collier, personal communication, October 1987). She further elaborated that the learning opportunities she sees students experiencing today would have been invaluable to her and her peers as they began their professional nursing careers. We, the authors, believe individual learning opportunities with nurse leaders as resource persons is a unique, invaluable experience for nursing leadership students. These interactions provide a variety of learning opportunities sufficient for undergraduate students to develop beginning leadership skills, while also narrowing the education-practice gap. These experiences enhance the students' orientation to "real-world" nursing leadership and management. Students recognize the uniqueness of this teaching-learning strategy and value the time spent with resource persons. They frequently report never dreaming "that such problems have to be dealt with." They agree that learning with resource persons provides an essential ingredient for reinforcing the theoretical concepts of nursing leadership and putting classroom lectures into action.

Curriculum↗
PubMed1989

The development of a master's degree program based on perceived future practice needs.

The need for an accessible master's degree program was determined through informal communication between practicing nurses and nursing educators. The purpose of the descriptive study was to project a master's degree program based on perceived future nursing practice needs. Forty-seven nurse administrators and staff nurses responded to a mailed survey (61.8%). The respondents were asked to make predictions regarding the probability of occurrence of 18 previously Delphi-generated events by the year 2000. Respondents also provided judgments regarding the degree of agreement/disagreement that various content items would be critical to survival in practice and best learned in a master's degree program. Most respondents agreed that general education content items were both critical to survival and best learned by master's education. Less strong agreement that nursing content items were critical to survival and best learned in a master's degree program was an unexpected finding. A multidisciplinary master's program for all health-care professionals was proposed.

Adult↗
PubMed1998

A geographic information system applied to a malaria field study in western Kenya.

This paper describes use of the global positioning system (GPS) in differential mode (DGPS) to obtain highly accurate longitudes, latitudes, and altitudes of 1,169 houses, 15 schools, 40 churches, four health care centers, 48 major mosquito breeding sites, 10 borehole wells, seven shopping areas, major roads, streams, the shore of Lake Victoria, and other geographic features of interest associated with a longitudinal study of malaria in 15 villages in western Kenya. The area mapped encompassed approximately 70 km2 and included 42.0 km of roads, 54.3 km of streams, and 15.0 km of lake shore. Location data were entered into a geographic information system for map production and linkage with various databases for spatial analyses. Spatial analyses using parasitologic and entomologic data are presented as examples. Background information on DGPS is presented along with estimates of effort and expense to produce the map information.

Altitude↗
PubMed2001

"Folate before pregnancy": the impact on women and health professionals of a population-based health promotion campaign in South Australia.

OBJECTIVES: To evaluate a South Australian campaign to promote and implement knowledge that taking adequate folate/folic acid in the periconceptional period can reduce the risk of having a baby with a neural tube defect. DESIGN AND SETTING: The campaign, conducted in October 1994--August 1995, targeted women of reproductive age and health professionals. Evaluation was by computer-assisted telephone interviews undertaken by random dialling throughout the State before and after the campaign, and by self-administered questionnaires to health professionals and women in the postnatal period. PARTICIPANTS: Women of reproductive age and four groups of health professionals. MAIN OUTCOME MEASURES: Knowledge about folate, folate-rich foods and the periconceptional period; participation of health professionals in advising women about folate; use of periconceptional folic acid supplements; sales of folic acid tablets; and prevalence of neural tube defects. RESULTS: Significant increases in knowledge about folate followed the campaign. Health professionals and women in the postnatal period had higher initial levels of knowledge about folate, which also increased significantly. The proportions of women taking periconceptional folic acid supplements, and of health professionals advising women planning a pregnancy about folate, also increased significantly, and folic acid tablet sales doubled. Total prevalence of neural tube defects declined between 1966 and 1999 from a baseline of 2.0 per 1,000 births to 1.1 per 1,000 births (Poisson regression, P= 0.03; average decline of 1.0% per year). CONCLUSIONS: A short educational campaign with a limited budget ($40,000) can promote folate successfully, but alternative strategies such as food fortification are likely to be needed to achieve adequate periconceptional folate intake for a very high proportion of women.

Adolescent↗
PubMed1985

Ethical and legal issues related to the use of computer programs in clinical medicine.

As computer programs are used with increasing frequency in the clinical setting, ethicists, lawyers, computer scientists, clinicians, and patients must confront a group of problems: In what situations is it appropriate to use a medical computer program? Who should use these programs and how should they be used? What is the legal status of a computer program that provides medical advice? Can a proper balance be achieved between confidentiality of patient information and shared access to records by health care personnel? How can regulatory agencies, physicians, and patients determine if a program is safe for human use? Will programs be able to communicate with users well enough to prevent clinically harmful misunderstandings? Because few if any definitive answers are yet available, these questions remain the subject of much discussion.

Computers↗
PubMed1996

The effect of pharmaceutical benefits managers: is it being evaluated?

Over the last decade, the number of pharmaceutical benefits managers has increased, and their influence has expanded rapidly. These managers now provide prescription drug coverage to more than 100 million Americans. The effect of pharmaceutical benefits managers on health care delivery remains unclear. We review the development of these organizations, their current role in the delivery of pharmaceutical therapies to patients, and their relationship with pharmaceutical manufacturers. We discuss potential advantages and disadvantages of pharmaceutical benefits manager practices and suggest ways in which these organizations can be made more accountable to the employer groups that hire them.

Administrative Personnel↗