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PubMed2006

Exploiting the potential of vector control for disease prevention.

Although vector control has proven highly effective in preventing disease transmission, it is not being used to its full potential, thereby depriving disadvantaged populations of the benefits of well tried and tested methods. Following the discovery of synthetic residual insecticides in the 1940s, large-scale programmes succeeded in bringing many of the important vector-borne diseases under control. By the late 1960s, most vector-borne diseases--with the exception of malaria in Africa--were no longer considered to be of primary public health importance. The result was that control programmes lapsed, resources dwindled, and specialists in vector control disappeared from public health units. Within two decades, many important vector-borne diseases had re-emerged or spread to new areas. The time has come to restore vector control to its key role in the prevention of disease transmission, albeit with an increased emphasis on multiple measures, whether pesticide-based or involving environmental modification, and with a strengthened managerial and operational capacity. Integrated vector management provides a sound conceptual framework for deployment of cost-effective and sustainable methods of vector control. This approach allows for full consideration of the complex determinants of disease transmission, including local disease ecology, the role of human activity in increasing risks of disease transmission, and the socioeconomic conditions of affected communities.

Animals↗
PubMed2004

Clinical research in the United States at a crossroads: proposal for a novel public-private partnership to establish a national clinical research enterprise.

The clinical research infrastructure of the United States is currently at a critical crossroads. To leverage the enormous biomedical research gains made in the past century efficiently, a drastic need exists to reengineer this system into a coordinated, safe, and more efficient and effective enterprise. To accomplish this task, clinical research must be transformed from its current state as a cottage industry to an enterprise-wide health care pipeline whose function is to bring the novel research from both government and private entities to the US public. We propose the establishment of a unique public-private partnership termed the National Clinical Research Enterprise (NCRE). Its agenda should consist of informed public participation, supportive information technologies, a skilled workforce, and adequate funding in clinical research. Devoting only 0.25% of the budgets from all health care stakeholders to support the NCRE would permit adequate funding to build the infrastructure required to address these problems in an enterprise fashion. All participants in the US health care delivery system must come together to focus on system-wide improvements that will benefit the public.

Academic Medical Centers↗
PubMed1997

Family strengths, motivation, and resources as predictors of health promotion behavior in single-parent and two-parent families.

The extent to which selected aspects of family health potential (strengths, motivation, and resources) predicted health work (health-related problem-solving and goal attainment behaviors) was examined in a Canadian sample of 138 female-headed single-parent families and two-parent families. The mother and one child (age 10-14) each completed mailed self-report instruments to assess the independent variables of family cohesion, family pride, mother's non-traditional sex role orientation, general self-efficacy, internal health locus of control, network support, community support, and family income, as well as the dependent variable, health work. With the effects of mothers' education held constant, the independent variables predicted 22 to 27% of the variance in health work in the total sample and each family type. Family cohesion was the most consistent predictor of health work, accounting for 8 to 13% of the variance. The findings challenge existing problem-oriented views of single-parent families by focusing on their potential to engage in health promotion behavior.

Adolescent↗
PubMed2003

Videoconferenced grand rounds: needs assessment for community specialists.

INTRODUCTION: Grand rounds are a traditional means of continuing education for specialist physicians. The purpose of this study was to determine the need for and feasibility of interactive videoconferenced grand rounds between an academic health center and community specialists practicing in the three provinces served by the health center. METHODS: Using questionnaires, we studied two populations: the academic center's clinical department and division heads and community specialists in three provinces. RESULTS: We received 27 of 34 (79%) questionnaires from department heads. Nine reported that they already videoconferenced their rounds, 12 expressed a willingness to do so, and 4 responded that they may be interested. Fourteen departments responded that they were willing to include community specialists in planning and presenting. Using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree), respondents rated the statement "Regional specialists would benefit from videoconferenced grand rounds" as 4.2. The return rate from community specialists was 333 of 876 (38%), of which 274 indicated that they would attend videoconferenced rounds, 42 said "maybe," and 9 said "no." Using the same 5-point scale, respondents rated both the following statements as 3.8: "Videoconferenced grand rounds would benefit me" and "These rounds would help me keep in touch with my colleagues." One hundred and two (31%) indicated that they would help plan rounds from the academic center. DISCUSSION: This study demonstrated the willingness on the part of one academic center to videoconference grand rounds to community specialists and interest from community specialists in participating. It raises logistical and educational issues, including scheduling and how to effectively include community physicians in needs assessment and planning. As requirements for specialists to participate in accredited learning activities become more rigorous, videoconferencing grand rounds may be one way to increase access to important learning activities.

Academic Medical Centers↗
PubMed2006

Creating alliances to improve cancer prevention and detection among urban medically underserved minority groups. The East Harlem Partnership for Cancer Awareness.

The East Harlem Partnership for Cancer Awareness (EHPCA) was formed in 1999 to reduce disparities in cancer screening and prevention among medically underserved minorities residing in a large urban community (East Harlem, New York City) by increasing awareness of cancer risk, prevention, and treatment, and promoting greater participation in breast, cervical, colorectal, and prostate cancer screening and early detection. The Partnership augments a 20-year collaboration between an academic medical center, a public hospital, and 2 community health centers. Needs assessments were conducted to inform program development. Cancer education, outreach, and screening programs were developed based on the PRECEED-PROCEED model for health education and health promotion programming. Needs assessments revealed that although the majority of the population (86%) was insured and had a source of primary care, cancer screening guidelines for breast, cervical, prostate, and colorectal cancers were not being followed. Outreach strategies, targeted curricula, educational sessions, and screening programs have been developed and implemented to improve knowledge levels and increase screening participation. The EHPCA is a model of a successful partnership among the public and private sectors to reduce disparities in cancer screening and prevention in a diverse, medically underserved, urban minority community. Future efforts to reduce cancer screening disparities in this population will include patient navigation and improved access to standard-of-care screening such as colonoscopy. Cancer 2006. (c) 2006 American Cancer Society.

Black or African American↗
PubMed2006

Building Native Hawaiian capacity in cancer research and programming. A legacy of 'Imi Hale.

In 2000, cancer health indicators for Native Hawaiians were worse than those of other ethnic groups in Hawai'i, and Native Hawaiians were under-represented in research endeavors. To build capacity to reduce cancer health disparities, 'Imi Hale applied principles of community-based participatory research (CBPR) and empowerment theory. Strategies included: 1) engaging Native Hawaiians in defining cancer priorities; 2) developing culturally appropriate processes and products; 3) supplementing primary and secondary cancer prevention activities; 4) offering skills training and technical assistance; and 5) providing an infrastructure to support culturally appropriate research. Between 2000 and 2005, 'Imi Hale involved more than 8000 Native Hawaiians in education, training, and primary and secondary prevention activities; developed 24 culturally tailored educational products (brochures, curricula, and self-help kits); secured $1.1 million in additional program and research funds; trained 98 indigenous researchers, 79 of whom worked on research projects; and engaged more than 3000 other Native Hawaiians as research participants and advisors. Evidence of empowerment was seen in increased individual competence, enhanced community capacity and participation, reduced barriers, and improved supports to address cancer in Hawaiian communities. Operationalizing CBPR and empowerment requires a commitment to involving as many people as possible, addressing community priorities, following cultural protocol, developing and transferring skills, and supporting an infrastructure to reduce barriers and build supports to sustain change. This approach is time consuming, but necessary for building competence and capacity, especially in indigenous and minority communities. Cancer 2006. (c) 2006 American Cancer Society.

Biomedical Research↗
PubMed1997

Managed care physician organizations: next generation of healthcare reform.

This article focuses on the evolution of physician-sponsored organizations in the managed care continuum. Given the amount of influence that physicians have on the overall level of healthcare expenditures within the U.S. economy, physician commitment to the managed care process is critical to truly drive the next round of managed care initiatives. The capital markers have recognized this and have contributed significant amounts of capital to fuel the development of for-profit models called physician practice management companies.

Capital Financing↗
PubMed2006

Development and testing of the social capital scale for families of children with special health care needs.

The purpose of this study was to develop and psychometrically test the Social Capital Scale for families of children with special health care needs. Researchers have suggested a link between social capital and health, however, psychometrically tested measures of social capital are not described in the literature. The Social Capital Scale (SCS) demonstrated internal consistency, stability over time, and construct validity (as evaluated through factor analysis, correlation with existing measures, and hypothesis testing). Five subscales provide insight into family strengths and areas for improvement related to their investment in relationships that support health. Use of the SCS will contribute to the establishment of consensus and precision in communication about social capital's utility and measurement in the population of families of children with special health care needs.

Adult↗
PubMed2005

Management of chronic myeloid leukemia in France: a multicentered cross-sectional study on 538 patients.

PURPOSE: Little is known about the actual management and treatment of chronic myeloid leukemia (CML) in clinical practice, although there have been many recent changes, such as the introduction of imatinib. PATIENTS AND METHODS: A two-phase cross-sectional observational study with retrospective data collection was conducted in France. In the first phase information regarding health services treating patients with CML was collected. In the second phase, centers caring for 10 or more patients were asked to provide data regarding patients diagnosed with CML that had had a consultation or been hospitalized in the last 3 months. RESULTS: All French departments of hematology (n=218) were contacted by phone. The median number of patients followed per center is 6 (range 0--200). The median number of new patients seen during the last 12 months was 2 (range 0--60). In the second phase 538 patients were included, the sex ratio being 1.14 and median age 55. At the time of diagnosis, 96.8% (n=519) were in chronic phase, 2.2% (n=12) in accelerated phase and 0.9% (n=5) in blastic phase. Eighty-two percent (n=443) of the patients have been treated by interferon (IFN). Sixteen point 3% (n=87) of the patients received a bone marrow transplantation (BMT). Forty-six percent (n=236) of the patients were treated with imatinib. CONCLUSIONS: This is the first study providing detailed descriptive data concerning the use of medications and procedures in a large population of patients from the medical centers involved in treating CML patients in France. Further observational studies are needed to assess the impact of different treatment strategies and economic impact of CML care in France.

Adult↗