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PubMed2002

Resources for development of training in public health and health managment in Eastern Europe: the Kaunas experience.

The aim of this paper is to review the resources and steps required for development and evaluation of training in public health and management of public health as experienced in Kaunas University of Medicine, Lithuania. The transition from Departments of Social Medicine and Hygiene to a Faculty of Public Health of international standards requires a process of adaptation and development of human resources more than physical facilities. After restoration of independence in 1990, rapid development of training in public health was started in Lithuania. Great support was provided by the international projects Baltic Rim Partnership for Public Health (BRIMHEALTH) and European Union Trans-European Mobility Scheme for University Students (TEMPUS). Undergraduate and postgraduate training programs were successfully implemented in the Faculty of Public Health, Kaunas University of Medicine. Lithuanian experience could serve as an example of success and pitfalls in training a critical mass of professionals who should act as powerful advocates for health, promoting analysis, continuity and success of public health interventions, and health care reforms in countries in transition.

Curriculum↗
PubMed2006

Improving knowledge about disability transitions by adding retrospective information to panel surveys. Population health metrics.

BACKGROUND: Panel data are often used to estimate key measures of public health, such as years lived with and without disability. Panel surveys commonly measure disability at intervals of one or two years, and occasionally more than two. It is likely that these intervals often include unreported changes in functional status. Unreported changes may bias estimates of disability transition probabilities, which are commonly used to estimate years lived with and without disability. Most surveys do not ask participants about periods with and without disability in the time since they last responded to the survey. We examined a way to improve the usefulness of panel surveys and our understanding of disability processes, by eliciting retrospective disability information. METHODS: Data were from the United States' National Long Term Care Survey. At each wave, this survey asks disabled respondents how long they have been disabled. We tested whether estimates of probabilities predicting changes in disability status can be improved by making use of this retrospective disability information. Methods included embedded Markov Chain analysis, microsimulation, and the Hausman specification test. RESULTS: Estimates based on data that include retrospective information are significantly different from those that use only the more limited information that is contemporaneous to the surveys. They are also more efficient. At age 65, all estimated probabilities for becoming disabled were higher when retrospective information was used, and all probabilities for remaining disabled were lower. Microsimulation revealed that using retrospective information increased the number of functional status transitions. For example, for women the mean number of transitions from nondisabled to disabled or dead was 52.7% greater when retrospective information was added to the analysis. CONCLUSION: Our results suggest that the value of future panel studies for estimating transitions in disability could be notably enhanced by adding a small number of questions asking respondents for details about their disabilities--and lack of disabilities--in the period since a preceding survey wave. Information provided by such questions could substantially improve both the measurement of disability histories and estimates of disability processes.

Journal Article↗
PubMed1996

Determinants of health of North-American adolescents: evolving definitions, recent findings, and proposed research agenda.

The recent literature on the determinants of adolescent health is reviewed. Four definitions of adolescent health are presented: successful transition to adulthood, successful coping, lack of mortality and morbidity, and healthy behaviors and risk avoidance. The review of determinants of health is presented within a framework focused upon adolescent characteristics, aspects of adolescents' immediate environments, and adolescents' ongoing activities and aspirations. An expanded framework which considers societal and structural factors and adolescent health is considered and a proposed research agenda presented.

Adaptation, Psychological↗
PubMed2005

Recognizing health risks in childhood cancer survivors.

PURPOSE: To provide information about the special health needs of childhood cancer survivors through a discussion of Wilms' tumor, a common childhood renal tumor, and case studies of two survivors of Wilms' tumor, who encountered significant health problems as adults. This information may be generalized to many cancer survivors. DATA SOURCES: Actual case studies as well as extensive review of the current literature on childhood cancer survivorship. CONCLUSIONS: Adult healthcare practitioners may help to decrease morbidity of childhood cancer survivors in adulthood when they are knowledgeable about the risks of this population. Resources are readily available, both in the medical literature and on the Internet. IMPLICATIONS FOR PRACTICE: With well-established success in the treatment of childhood cancer, there are many young and middle-aged adult survivors of the disease. However, as many as two-thirds of survivors may have chronic long-term effects of treatment. Most survivors eventually discontinue follow-up with their pediatric oncologists and receive primary health care from adult providers, many of whom are unaware of survivors' health risks. Awareness of primary care providers regarding the special health needs of childhood cancer survivors is critical to decrease morbidity and improve quality of life. The ever-increasing number of childhood cancer survivors is creating a public health issue as they transition into adulthood.

Adult↗
PubMed2026

Predictors of transition readiness in adolescents with neurogenic lower urinary tract dysfunction.

PURPOSE: Adolescents with Neurogenic Lower Urinary Tract Dysfunction (NLUTD) face significant challenges in their quality of life and readiness to transition to adult healthcare services. This study examines the impact of various demographic and clinical factors on transition readiness. METHODS: We performed a retrospective review of prospectively collected data from 75 adolescents with NLUTD managed at a specialized tertiary referral pediatric facility. We employed multivariate linear regression analysis to explore the relationship between transition readiness scores collected from the Good2Go questionnaire, including the total transition readiness score and its sub-domains (self-advocacy, knowledge, self-care, and social support), and predictors such as age, sex, reconstructive surgery status, and clean intermittent catheter (CIC) usage. RESULTS: The mean age of participants was 16.74 years (SD 2.44). Reconstructive surgery had been performed in 32 % of patients, and 77.3 % were on CIC. Multivariate regression analysis indicated that age significantly predicted transition readiness across several domains. Each additional year of age was associated with a 4.40-point increase in the total transition readiness score, a 3.66-point increase in knowledge, a 4.26-point increase in self-advocacy and a 5.41-point increase in self-care. Conversely, CIC significantly negatively impacted the social support domain, with scores decreasing by 9.69 points. Reconstructive surgery was significantly associated with lower self-care scores, with an average decrease of 12.12 points among those who had undergone surgery. CONCLUSION: Age significantly improves transition readiness in adolescents with NLUTD, reflecting cognitive and developmental growth. However, the negative effects of CIC on social support and reconstructive surgery on self-care underscore the need for personalized interventions to optimize health outcomes during the transition to adult care.

Humans↗
PubMed2006

Health sector reform and sexual and reproductive health services in Mongolia.

Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.

Abortion, Induced↗
PubMedDate not supplied

The transition to Web-based education: enhancing access to graduate education for women's health providers.

Nurse-midwives and women's health nurse practitioners have a long history as positive change agents in health care as well as education. This article chronicles the transition of a traditional face-to-face nurse-midwife and women's health nurse practitioner graduate curriculum to a Web-based format with campus seminars and clinical laboratories. This change was made to increase access to these graduate programs. A total of 20 courses, including both graduate core and specialty courses, was converted to the Web-based format over a 3-year period. Practical considerations for implementing a similar program, including faculty development and support, student orientation and ongoing support, development of a learning community, and time management, are discussed. The importance of listening to student feedback and partnering with them as the program continues to develop is emphasized as a key element of program evaluation and improvement.

Academic Medical Centers↗
PubMed2006

Ill health and retirement in Britain: a panel data-based analysis.

We examine the effect of ill health on retirement decisions in Britain, using the British Household Panel Survey (1991-1998). As self-reported health status is likely to be endogenous to the retirement decision, we instrument self-reported health by a constructed 'health stock' measure using a set of health indicator variables and personal characteristics, as suggested by Bound et al. (Bound, J., Schoenbaum, M., Stinebrickner, T.M., Waidmann, M., 1999. The dynamic effects of health on the labor force transitions of older workers. Labour Economics 6, 179-202). Using a range of econometric techniques, we show that adverse shocks to individual health stocks predict individual retirement behaviour among workers aged from 50 until state pension age. We compare responses of economic activity to constructed health measures with that arising using direct indicators of functional limitations and specific health problems. We also examine the dynamics of health shocks and whether adverse and positive health shocks have symmetric effects on transitions in and out of economic activity.

Aged↗
PubMed2004

Evolutionary, historical and political economic perspectives on health and disease.

The origin and rise of social inequalities that are a feature of the post-Neolithic society play a major role in the pattern of disease in prehistoric and contemporary populations. We use the concept of epidemiological transition to understand changing ecological relationships between humans, pathogens and other disease insults. With the Paleolithic period as a baseline, we begin with ecological and social relationships that minimized the impact of infectious disease. Paleolithic populations would have retained many of the pathogens that they shared with their primate ancestors and would have been exposed to zoonoses that they picked up as they adapted to a foraging existence. The sparse mobile populations would have precluded the existence of endemic infectious disease. About 10,000 years ago, the shift to an agricultural subsistence economy created the first epidemiological transition, marked by the emergence of infections, a pattern that has continued to the present. Beginning about a century ago, some populations have undergone a second epidemiological transition in which public health measures, improved nutrition and medicine resulted in declines in infectious disease and a rise in non-infectious, chronic and degenerative diseases. Human populations are entering the third epidemiological transition in which there is a reemergence of infectious diseases previously thought to be under control, and the emergence of novel diseases. Many of the emerging and reemerging pathogens are antibiotic resistant and some are multi-antibiotic resistant. Inequality continues to widen within and between societies, accelerating the spread of emerging and reemerging diseases.

Chronic Disease↗
PubMed2004

Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health.

BACKGROUND: No nationally representative longitudinal data have been analyzed to evaluate the incidence of obesity in the transition between adolescence and adulthood. OBJECTIVE: The objective was to examine dynamic patterns of change in obesity among white, black, Hispanic, and Asian US teens as they transitioned to young adulthood. DESIGN: We used nationally representative, longitudinally measured height and weight data collected from US adolescents enrolled in wave II (1996; ages 13-20 y) and wave III (2001; 19-26 y) of the National Longitudinal Study of Adolescent Health (n = 9795). Obesity incidence was defined on the basis of International Obesity Task Force (IOTF) cutoffs (wave II), which link childhood body mass index (BMI) centiles to adult cutoffs (BMI > or = 30; wave III), for comparability between adolescence and adulthood. In addition, the more commonly used cutoff of BMI > or = 95th percentile for age- and sex-specific cutoffs from the 2000 Centers for Disease Control and Prevention growth charts for adolescents (wave II) were compared with adult cutoffs (BMI > or = 30; wave III). RESULTS: On the basis of the IOTF cutoffs, obesity incidence over the 5-y study period was 12.7%; 9.4% of the population remained obese and 1.6% shifted from obese to nonobese. Obesity incidence was especially high in non-Hispanic black (18.4%) females relative to white females. The prevalence of obesity increased from 10.9% in wave II to 22.1% in wave III, and extreme obesity was 4.3% at wave III on the basis of a BMI > or = 40. CONCLUSIONS: During a 5-y transitional period between adolescence and young adulthood, the proportion of adolescents becoming and remaining obese into adulthood was very high. This upward trend is likely to continue. Effective preventive and treatment efforts are critically needed.

Adolescent↗
PubMed1996

Ambulatory systems for managed care.

Providence Health System is successfully making the transition from an acute care-based holding company of health care business to a diversified, operating, managed care company with the mission of improving the health status of the populations it serves, and being at financial risk for doing so. Information systems have been a leading change agent in this transition, not only from the standpoint of consolidating and standardizing practices within Providence Health System, but also by facilitating the exchange and integration of information within the health care community. ProvNet has made available the tools to accomplish this information integration in the physician's office and to extend it not only to Providence, but to other health systems as well.

Ambulatory Care Information Systems↗
PubMed2003

Health selection: the role of inter- and intra-generational mobility on social inequalities in health.

This paper investigates the effect of health selection and its contribution to the social class gradient in health. Both inter- and intra-generational mobility were examined. Longitudinal data on health and social class at three life stages (16, 23, 33 years) are from the 1958 British birth cohort. Individuals with poor health were more likely to move down and less likely to move up the social scale, especially at the inter-generational transition. The effect of health selection on the social gradient was variable, of modest size and cannot be regarded as a major explanation for inequalities in health in early adulthood.

Adolescent↗
PubMed2002

A study to assess patient satisfaction of transitioning from Medicaid to managed care by sickle cell patients in Hampton Roads, Virginia.

Transition issues faced by the sickle cell patient who has a significant chronic illness or disability are many and often life threatening. The problems that are faced in transitioning from Medicaid to managed care are many that could hinder the process and patient satisfaction. Such problems during the transition periods could stem from interrupted health care services; improperly coordinated services; inappropriate intervention; and inappropriate or unfounded psychologically diagnosed cases (Blum, 1993). It is not known which health care programs are cost-effective and which are not. Nor is it known which health care program best meets the needs of patients with chronic illnesses or varying levels of severity; and it is not known if health status actually improves as a result of transitioning from one program to another. What factors then impact the satisfaction levels in transitioning from Medicaid to managed care for sickle cell patients in Hampton Roads, Virginia? This study looked at patient satisfaction with the transition from Medicaid to managed care as related to the cost of care, quality of care, and access to care.

Adolescent↗
PubMed2002

Estimation of covariate-dependent Markov transition probabilities from nested case-control data.

Multi-state models are used to describe situations where individuals may move among a finite number of states defined by specific conditions of health, including death. The transition intensities of the models are described by proportional hazards models, and it is reviewed how estimation of the regression parameters and the baseline transition intensities may be performed when only nested case-control data are available for all or some of the transitions. The regression parameter estimates and the estimates of baseline transition intensities are combined to give estimates of the integrated transition intensities for specified covariate histories, and from these estimates covariate-dependent Markov transition probabilities are derived.

Analysis of Variance↗
PubMed2004

Stop shuffling paper. Case study: document management offers efficiency, access.

Document image management (DIM) technology for patient charts can organize tasks, automate redundant chores, improve access to data and decrease error. DIM allows multiple users to share patient information and has audit and security features. The technology offers a strategic benefit for practices preparing for health care's ongoing transition from paper-based systems to electronic ones.

Documentation↗
PubMed2005

Integrated nutrition science: from theory to practice in South Africa.

OBJECTIVE: To describe an integrated, holistic conceptual framework and research paradigm for a better understanding of the nutrition transition in middle- and low-income countries. MOTIVATION: Current inability effectively to prevent the increasing burden related to changes in food consumption patterns and other health behaviours of populations in transition motivates a new approach for nutrition research and practice. In this proposed approach, broader and integrated dimensions of science and practice may be applied for a better understanding of this complex phenomenon. RESULT: Examples from our own studies are given and quoted to illustrate how results from transdisciplinary studies were used to design an integrated, holistic programme to improve quality of life of people infected with HIV. CONCLUSION: Based on these experiences it is argued that the more holistic and integrated approach should and could lead to more effective and sustainable interventions to prevent the adverse health consequences of the nutrition transition. At the same time such an approach will contribute to efforts to conserve the environment and also human, living and natural resources.

Developing Countries↗