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PubMed2006

[Establishing ophthalmology in the research framework programs of the European Union].

The framework programmes (FP) of the European Commission have substantially contributed to the funding of research within the European countries. The contribution of the funding provided by the EU relative to the funding available on the national level has steadily increased. European ophthalmology and vision research has benefited from this support provided by the EU. This review introduces the European funding policies and the European Research Area (ERA) and provides a list of all projects in ophthalmology and vision research that have been funded within FP1 to FP6. As an example for new instruments within FP6, Integrated Projects, the EVI-GENORET project is introduced. Finally an outlook for FP7 is provided.

Biomedical Research↗
PubMed2000

Cost-effectiveness of mental health services for persons with a dual diagnosis: a literature review and the CCMHCP. The Cost-Effectiveness of Community Mental Health Care for Single and Dually Diagnosed Project.

People suffering from comorbid mental illness and substance abuse disorders (the dually diagnosed) are thought to constitute large portions of clients treated as outpatients by public-sector community-based mental health providers. These providers dispense units of ambulatory mental health services and treatments incrementally to maintain clients in the community and out of psychiatric hospitals. Community maintenance is one step, albeit critical, toward quitting drugs and eventual abstinence. Thus, there is a need for information that compares the effectiveness and cost of such services on dually diagnosed clients to identify appropriate low-cost high-yield treatment and service options and packages. This article provides a review of the literature on the effectiveness of ambulatory mental health services and recent emergent reports of cost-effectiveness of programs for the dually diagnosed, paying special attention to the gray areas and gaps. This article also describes a new project; an inexpensive add-on to an existing community mental health center. The project will be examining over 4 years of data to compare influence and cost of different ambulatory mental health services and treatments delivered to a matched pair group of clients with dual disorders and those with only mental illness. The intention of this project is not only to address gray areas and gaps in the literature, but also to inform a more rational deployment of mental health services.

Community Mental Health Services↗
PubMedDate not supplied

Barriers and solutions in implementing occupational health and safety services at a large nuclear weapons facility.

The Hanford Nuclear Reservation is one of the U.S. Department of Energy's largest nuclear weapons sites. The enormous changes experienced by Hanford over the last several years, as its mission has shifted from weapons production to cleanup, has profoundly affected its occupational health and safety services. Innovative programs and new initiatives hold promise for a safer workplace for the thousands of workers at Hanford and other DOE sites. However, occupational health and safety professionals continue to face multiple organizational, economic, and cultural challenges. A major problem identified during this review was the lack of coordination of onsite services. Because each health and safety program operates independently (albeit with the guidance of the Richland field operations office), many services are duplicative and the health and safety system is fragmented. The fragmentation is compounded by the lack of centralized data repositories for demographic and exposure data. Innovative measures such as a questionnaire-driven Employee Job Task Analysis linked to medical examinations has allowed the site to move from the inefficient and potentially dangerous administrative medical monitoring assignment to defensible risk-based assignments and could serve as a framework for improving centralized data management and service delivery.

Contract Services↗
PubMed2003

Promoting repeat mammography use: insights from a systematic needs assessment.

This article describes the process and outcome of a needs assessment conducted to guide the development of interventions to increase repeat mammography use among participants in a federally funded cancer screening program. Health behavior theory and data from a phone survey are used to uncover key barriers to repeat mammography use and to identify fruitful intervention approaches for modifying them. Estimates of (a) compliance with mammography guidelines, (b) readiness to adopt regular mammography use, (c) the most common reasons for not being rescreened, and (d) population attributable risks associated with various predictors of repeat mammography use are presented and, with guidance from the transtheoretical model of behavior change, used to make inferences about the type of intervention strategies most appropriate for promoting repeat mammography use in this population.

Aged↗
PubMed2005

A federal perspective on EAPs and emergency preparedness.

Federal Employee Assistance Programs (EAPs) have a long history of intervention in emergency situations, and their role has expanded since September 11, 2001. There is considerable evidence on the importance of organizational factors such as social support in protecting disaster victims from the psychological effects of trauma. The authors recommend that EAPs become integrally involved in organizations' emergency planning processes, so that such supports can be built into all aspects of plans. EA professionals should function as organizational consultants, not simply as helpers who will eventually care for those affected. Two federally based case studies provide examples of EA professionals who have successfully used such an approach in their respective organizations.

Disaster Planning↗
PubMed1998

Factors influencing the use of adult day care by individuals with Alzheimer's disease: a multivariate examination of the California Alzheimer's Disease Diagnostic and Treatment Center Program.

Longitudinal data from the California State Alzheimer's Disease Diagnostic and Treatment Center Program (ADDTC) are analyzed to determine what factors, including ADDTC staff recommendations for service use, influence utilization of adult day care services by individuals with Alzheimer's disease. The records of 737 clients are examined from 1988 to 1992 to determine predictors of client service utilization (including client predisposing, enabling, and need characteristics; caregiver characteristics; and community characteristics). Results of logistic regression analyses indicate that ADDTC staff recommendations and previous use of adult day care services are significantly related to use of adult day care services. Other client predisposing, enabling, and need characteristics; caregiver characteristics; and community characteristics were not significantly related to service use.

Adult↗
PubMedDate not supplied

Safety, permanency, and in-home services: applying administrative data.

This article describes the construction and use of safety and permanency indicators, two aspects of a full set of indicators that also includes child well-being and family functioning. The indicators were constructed from Philadelphia's Family and Child Tracking System and were used to examine the city's Services to Children in their Own Home (SCOH) program. Cohort datasets were constructed through the use of extract files, and two independent data file construction algorithms were employed to calibrate the accuracy of the data construction process. The primary unit of analysis was the "family" spell in SCOH services. Contextual variables included family structure, race, and service intensity. The indicators associated with SCOH spells included reports of maltreatment after service, founded maltreatment after service, and out-of-home placement after service. Event history techniques were used to conduct the data analysis. Baseline indicator data for Philadelphia are presented, and future uses for such data are discussed.

Child↗
PubMed1982

Requirements applicable to projects for family planning services: Public Health Service. Proposed rule.

The Secretary of Health and Human services proposes to amend the regulations governing the program for family planning services funded under Title X of the Public Health Service Act in order to implement a recent amendment of that Act. The statutory amendment requires family planning projects to encourage family participation in the provision of services by the projects, to the extent practical. The Secretary proposes to implement this amendment by requiring projects to notify the parents of unemancipated minors seeking family planning services when prescription drugs or devices are provided. In addition, where state law requires family planning providers to provide Title X services to unemancipated minors only with notification to or the consent of their parents, projects would be required to comply with that law.

Adolescent↗
PubMed2000

Immunization pockets of need: science and practice.

Despite high overall immunization coverage levels among U.S. preschool children, areas of underimmunization, called pockets of need, remain. These areas, which pose both a personal health and a public health risk, are typically poor, crowded, urban areas in which barriers to immunization are difficult to overcome and health care resources are limited. The purpose of this report is to review barriers to immunization of preschool children living in pockets of need and to discuss current issues in the identification of and implementation of interventions within these areas. The Centers for Disease Control and Prevention administers a federal grants program that funds state and metropolitan immunization programs. This program promotes a three-pronged approach for addressing pockets of need: (1) identification of target areas, (2) selection and implementation of programmatic strategies to improve immunization coverage, and (3) evaluation of progress or impact. At each step, scientific evidence can guide programmatic efforts. While there is evidence that state and metropolitan immunization programs are currently making efforts to address pockets of need, much work remains to be done to improve immunization coverage levels in pockets of need. Public health agencies must take on a broadened role of accountability, new partnerships must be forged, and it may be necessary to strengthen the oversight authority of public health. These tasks will require a concentration and redirection of resources to support the development of an immunization delivery infrastructure capable of ensuring the timely delivery of immunizations to the most vulnerable of America's children.

Centers for Disease Control and Prevention, U.S.↗
PubMed2001

Knock-knock: a population-based survey of risk behavior, health care access, and Chlamydia trachomatis infection among low-income women in the San Francisco Bay area.

To estimate the prevalence of urogenital chlamydial infection among young, low-income women in northern California and to describe correlates of infection, a population-based door-to-door household cluster survey was conducted from 1996 through 1998. The participants included 1439 women 18-29 years of age, with a mean age of 24 years, most of whom were African American (43%) or Latina (23%) and had a median income of $500-$999 per month. Most (94%) had received health care in the past year, and approximately 50% was covered by state insurance programs. Although more than half (62%) had had a recent pelvic examination, only 42% had recently used a condom with a new partner. The prevalence of urogenital chlamydial infection was 3.2% (95% confidence interval, 2.2%-4.2%). Women with chlamydia were more likely to be younger (18-21 years of age) and nonwhite and to have lower socioeconomic status. These data demonstrated an approximately 2-3-fold greater burden of infection than routine surveillance data have suggested.

Adolescent↗
PubMed2006

Lessons for Medicare Part D in the hemodialysis community.

BACKGROUND: Medicare beneficiaries without prescription drug coverage consistently fill fewer prescriptions than beneficiaries with some form of drug coverage due to cost. ESRD patients, who are disproportionately poor and typically use multiple oral medications, would likely benefit substantially from any form of prescription drug coverage. Because most hemodialysis patients are Medicare-eligible, they as well as their providers would be expected to be well informed of changes in Medicare prescription drug coverage. By examining the level of understanding and use of the temporary Medicare Prescription Drug Discount Card Program in the hemodialysis population, we can gain a better understanding of the potential long-term utilization for Medicare Part D. METHODS: We surveyed English-speaking adult hemodialysis patients with Medicare coverage from two urban hemodialysis centers affiliated with the University of California San Francisco (UCSF) during July and August 2005 (n = 70). We also surveyed University- and community-based nephrologists and non-physician dialysis health care professionals over the same time frame (n = 70). RESULTS: Fifty-nine percent of patients received prescription drug coverage through Medi-Cal, 20% through another insurance program, and 21% had no prescription drug coverage. Forty percent of patients with no prescription drug coverage reported "sometimes" or "rarely" being able to obtain medications vs. 22% of patients with some form of drug coverage. None of the patients surveyed actually had a Medicare-approved prescription drug card, and of those who intended to apply, only 10% reported knowing how to do so. Only 11% health care professionals knew the eligibility requirements of the drug discount cards. CONCLUSION: Despite a significant need, hemodialysis patients and providers were poorly educated about the Medicare Prescription Drug Discount Cards. This has broad implications for the dissemination of information about Medicare Part D.

Adult↗
PubMed2003

Integrated program enhancements increased utilization of Farmers' Market Nutrition Program.

Three New York State agencies undertook a state-wide initiative in 2001 to enhance the effectiveness of the Special Supplemental Program for Women, Infants, and Children (WIC) Farmers' Market Nutrition Program (FMNP) for both families and farmers. The program enhancements included four components intended to influence market and consumer behavior: hiring a state-wide Cornell Cooperative Extension staff member to initiate and coordinate FMNP promotion efforts; increased collaboration among state-level agencies; local-level community capacity-building; and dissemination of newly developed nutrition education resources. Because components were overlapping and potentially synergistic, the total effect was considered. To test the hypothesis that the enhancements increased Program utilization as measured by redemption rates, a time-series, quasi-experimental design was employed in which observed 2001 redemption was tested for departure from earlier trends. Linear regression showed FMNP coupon redemption rates from 1996 through 2000 decreased 2.36% annually (P = 0.002). This trend was interrupted in 2001 when actual redemption exceeded predicted redemption by >2.2% (P < 0.055). Alternate explanations for this shift were deemed improbable. These findings show that FMNP goals were advanced through a coordinated, collaborative initiative with activities at state and local levels, resulting in increased utilization of FMNP benefits by WIC participants and increased income to local farmers.

Agriculture↗
PubMed2001

[National colorectal carcinoma screening program deserves further study; a report from the Dutch Health Council].

Each year there are about 8400 new colorectal carcinoma (CRC) cases in the Netherlands. Despite improved treatment possibilities the mortality rate has not shown a decline. A reduction in the mortality rate can be achieved by screening for CRC by means of faecal occult-blood testing. Endoscopic screening (flexible sigmoidoscopy or colonoscopy) could reduce not only the mortality but also the incidence of CRC, but this has yet to be conclusively demonstrated. The introduction of a national screening programme deserves serious consideration, although various questions need to be answered before a final decision can be taken. These concern the optimal screening strategy, the expected degree of participation, the follow-up under persons in whom polyps are found, the demand on human resources and other resources, and the cost-effectiveness.

Colonoscopy↗
PubMedDate not supplied

Risk factors for chronic non-communicable diseases: a follow-up model.

Chronic non-communicable diseases are caused by interaction between numerous environmental and socio-economic factors and biological response of the human body. They are gaining importance due to the fact that they largely depend on common risk factors, of which more than 70% can be prevented. In 1996, an integrated health prevention program for chronic non-communicable disease based on the Aims of the World Health Organization "Health for all in the 21st century" was designed in the Republic of Serbia. This program concerns the whole population and measures for its implementation. For its successful realization it is necessary to define standard procedures: uniform terminology, diagnostics, therapy and rehabilitation, its risk factors. The aim of this study was to establish data from basic medical documentation of the primary health care and propose a more efficient and effective evidence, as well as to establish a program for surveillance, prevention and control of mass non-communicable diseases within the existing medical documentation. The data were gathered from medical records of the general practice and occupational health services. A special questionnaire was designed to register data from medical records. Medical records of general practice and occupational health service in Kikinda have been analyzed. The existing medical documentation is insufficient regarding data necessary for evidence, surveillance and analysis of risk factors for chronic non-communicable diseases. A follow-up model for surveillance and evidence of risk factors in basic medical documentation, which should be incorporated in routine statistical reports, would actively include medical professionals--doctors and medical staff in prevention and detection of risk factors.

Chronic Disease↗
PubMed2006

The Inner-City Asthma Intervention tool kit: best practices and lessons learned.

BACKGROUND: Asthma is a major public health problem of increasing concern in the United States. Low-income populations, minorities, and children living in inner cities experience disproportionately higher morbidity and mortality due to asthma. In 1991, the National Institute of Allergy and Infectious Disease at the National Institutes of Health funded the National Cooperative Inner-City Asthma Study (NCICAS), the foundation for the Centers for Disease Control and Prevention (CDC)-funded Inner-City Asthma Intervention (ICAI) on which the tool kit discussed in this article is based. OBJECTIVE: To summarize the purpose and content of a tool kit for health care organizations that wish to enhance their asthma management efforts and to improve the quality of life of children with asthma and their families. METHODS: The ICAI was tailored to the individual child and family through a combination of group and individual activities (core) and follow-up. Information contained in the tool kit is based on project reports, tracking and data collection reports, program oversight activity, and general subject matter knowledge. RESULTS: Although the NCICAS proved successful, moving from a research design to the real world of implementation was difficult. The tool kit draws on the experience of implementation and provides strategies, options, and considerations for health care organizations to use in tailoring project activities. CONCLUSION: The ICAI demonstrated that committed health care organizations, with trained and experienced individuals, could help empower children and families to manage childhood asthma. The tool kit was designed to share the best practices and lessons learned from the ICAI implementation of the NCICAS protocol at the community level.

Asthma↗
PubMed2002

The Environmental Protection Agency's National SunWise School Program: sun protection education in US schools (1999-2000).

BACKGROUND: Melanoma, the most fatal form of skin cancer, is rising at a rate faster than that of all preventable cancers except lung cancer in the United States. Childhood exposure to ultraviolet (UV) light increases the risk for skin cancer as an adult; thus starting positive sun protection habits early may be key to reducing incidence. METHODS: We evaluated the US Environmental Protection Agency's SunWise School Program, a national, environmental education program for sun safety of children in primary and secondary schools (kindergarten through eighth grade). The program was evaluated with surveys administered to participating students. An identical 18-question, self-administered survey was completed by students (median age, 10 years) in the classroom before and immediately after the SunWise educational program. RESULTS: Surveys were completed by students in 40 schools before (pretests; n = 1894) and after the program was presented (post-tests; n = 1815). Significant improvement was noted for the 3 knowledge variables: appropriate type of sunscreen to be used for outdoor play, highest UV Index number, and need for hats and shirts outside. Intentions to play in the shade increased from 73% to 78% (P <.001), with more modest changes in intentions to use sunscreen. Attitudes regarding healthiness of a tan also decreased significantly. CONCLUSIONS: Brief, standardized sun protection education can be efficiently interwoven into school health education and result in improvements in knowledge and positive intentions for sun protection.

Chi-Square Distribution↗
PubMed1998

Augmentation of Pap smear screening of high risk aboriginal women. Use of a computerised process tool within the Broome Aboriginal Medical Service.

OBJECTIVE: The Broome Regional Aboriginal Medical Service (BRAMS) in Broome, Western Australia, conducted a 4 month program to augment the Pap smear screening of Aboriginal women. The emphasis was on those with a past history of abnormal smears, aged greater than 40 years, living in remote communities and very (more than 5 years) overdue. METHOD: Continuation of existing opportunistic recall processes supplemented by three components: the development of an Aboriginal Health Worker (AHW) run Pap smear clinic; the provision of Aboriginal outstation screening; and active recruitment of targeted women (by AHW staff) using worklists. All components used Healthplanner, a computerised process tool to facilitate targeting and recall. MAIN OUTCOME MEASURES: The number of Pap smears taken from the target groups before and after intervention and the proportion screened from the women eligible in each target group at the start of the program. RESULTS: There was statistically significant increase in the coverage of Aboriginal women overall, those over the age of 40 years, and those from remote communities when compared with the same period the previous years. In 4 months, 21-30% of Aboriginal women eligible for Pap smears in these high risk categories including those with past abnormal smears were screened. Over-screening of women did not occur as only 4% of smears taken were from women screened less than 12 months previously. Smears taken by AHW staff were of high quality. CONCLUSION: Use of a computerised process tool in a remote setting can facilitate selective recruitment of high risk women overdue for Pap smears.

Adult↗
PubMed2001

Evaluating the accuracy of the benefit transfer method: a rural water supply application in the USA.

Due to declining federal, state, and local government budgets, there is an increasing need to analyze the benefits of government funded programs to determine where increasingly limited funds would best be spent. The benefits transfer technique is analyzed for the development of a rural water supply system and guidelines for successful benefits transfer are presented. Benefit transfer appears to provide reasonably accurate estimates of natural resource benefits if a broad based benefit model is used. The benefits-transfer-based estimates are accurate as long as a model based on data from a wide variety of conditions is used or the model is based on data from a very similar region. The wide-based data modeling approach has the greatest practical application. These findings are based upon contingent valuation data obtained from four sites in the western USA.

Conservation of Natural Resources↗