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A community-driven action plan to eliminate breast and cervical cancer disparity: successes and limitations.

BACKGROUND: The objective of Alabama Racial and Ethnic Approaches to Community Health 2010 is to implement and evaluate a community action plan (CAP) developed by a diverse coalition to reduce breast and cervical cancer screening disparities between African American and White women. METHODS: The CAP entailed (1) establishing a core working group (CWG) in each county, (2) training CWG members to promote screenings, and (3) providing coalition members with technical assistance to write mini-grants. RESULTS: Overall, 241 CWG members were trained. They have conducted 2800 cancer screening surveys. A total of 8 coalition members received mini-grants. CONCLUSION: Community capacity building can lead to a sense of ownership and empowerment.

Adult↗

Organizational readiness for telemedicine: implications for success and failure.

The use of telemedicine brings about change in health-care organizations and opens up new possibilities for service delivery. The organizational environment is often crucial in determining whether or not telemedicine applications will be successful. To examine the concept of 'organizational readiness for telemedicine' as a factor to explain why telemedicine initiatives succeed or fail, the results were used of interviews with key informants, conducted in two studies: the Alliance for Building Capacity project and the National Initiative for Telehealth guidelines project. The data indicate that organizational readiness for telemedicine is a multifaceted concept that is related to planning and the workplace environment. A greater understanding of the factors within organizational readiness could help to avoid costly implementation errors. 'Readiness' needs to be systematically assessed and is important for long-term success.

Health Facility Administration↗

The organizational environment and evidence-based nursing.

The Province-Wide Nursing Project (PWNP) was designed to remove some of the structural barriers that can impede the ability of nurses in selected health care settings to assess, implement and evaluate best nursing practice. Literature on capacity building and research utilization suggests that the organization is the most important factor in promoting best nursing practice. Therefore, managers and nursing leaders need to encourage the creation of optimum work environments. A survey undertaken by the PWNP Research Centre team assessed the extent to which the 23 agencies in the 4 Participating Complexes provided supportive environments for evidence-based practice. The Characteristics of Agencies in Participating Complexes: Demographics and Resources questionnaire investigated the resources available to help nurses improve their standards of practice in agencies participating in the project. Larger agencies, especially those associated with academic centres, had considerably more resources than agencies in smaller towns. Participation in the Province-Wide Nursing Project enabled agencies to develop strategies to improve the use of evidence in nursing practice.

Education, Nursing, Continuing↗

Home and community-based care: recent accomplishments and new challenges.

This article traces the development of home and community-based care to its current place in the worlds of health and social policy. An argument is developed to the effect that such services have by now gained both heightened policy legitimacy and organizational capacity. Building on these contentions, the article goes on to suggest that such services should continue to gain a more prominent place within long-term care policy, and that long-term care issue deserve a more central place within social insurance policy more generally. The article concludes by suggesting that demonstrations of policy efficacy such as those that are taking place in home and community services might help to at least modestly offset the frontal assault which is currently taking place across the range of American social policy.

Aged↗

Medicaid case-mix nursing home reimbursement in three states.

Case-mix nursing facility payment raises issues of access, quality, equity, and cost. Case-mix should better match payment to costs, improve access, and provide incentives to increased staffing and quality of care; but it may also increase costs. This paper reports analysis of Medicaid cost-report data from three case-mix states. Case-mix did not discourage capacity building and was more equitable for providers. Medicaid access declined in one state but increased in another. There were shifts toward greater skilled care in two states, with evidence of greater focus of resources on patient care. Case-mix showed no evidence of cost-constraint and some signs of increased costs. Whether such mixed outcomes are viable in the current era remains to be seen.

Diagnosis-Related Groups↗

Statewide system change in positive behavior support.

In the past few decades, the field of positive behavior support has emerged from its origins in applied behavior analysis. However, the difference between an appropriate literature base and statewide implementation by a state MR/DD agency cannot be overstated. The development process and model for statewide system change in positive behavior support being implemented by the South Carolina Department of Disabilities and Special Needs in collaboration with the Center for Disability Resources at the University of South Carolina are described. Key areas discussed include the impetus for change, the development process, plan components, and implementation of methods for change in capacity building, training, state regulations, MR/RD Waiver changes, and case-specific technical assistance.

Adolescent↗

Can Community Health Center funding enhance health services for Native American tribes and organizations?

This paper reports on the applicability of the Public Health Service Act (42 USC, 254b) Section 330 Community Health Center program to Arizona Native American tribes and organizations. Data review and analysis consisted of a review of two federal government documents concerning the funding of Community Health Center applications and a review of questionnaire responses received from the Arizona Native American health care community. Findings indicate a general lack of knowledge among the Arizona Native American health care community about the program as well as a need for capacity building among Arizona Native American tribes and organizations. As currently designed, the program has built-in barriers that prevent Native American tribes and organizations from applying for funding. Changes must be made to the existing program and local-level seminars must be offered to make this program and funding more readily available to Arizona Native American tribes and organizations.

Administrative Personnel↗

Assessing the accuracy and efficiency of an electronic platform for managing childhood illnesses in rural China: A cluster randomized controlled trial.

OBJECTIVES: The Integrated Management of Childhood Illness (IMCI) faces challenges in capacity building and quality control. This trial aims to assess an electronic IMCI (eIMCI) platform in improving the effectiveness and efficiency in disease classification and management by community health workers (CHWs). DESIGN: Cluster randomized controlled trial. SETTING: Rural western China. PARTICIPANTS: 24 CHWs and 72 ill children aged 2 months to 5 years (3 children per CHW). CHWs were randomly assigned to intervention or control groups. INTERVENTIONS: The intervention CHWs received online training and performed disease management using the eIMCI platform featuring integrated training modules and decision-support tools. The control group received traditional face-to-face training and used paper-based IMCI protocols. MAIN OUTCOME MEASURES: Proportion of children correctly diagnosed or classified by CHWs, as determined by a pediatric specialist. Relative risk (RR) between groups was estimated using Poisson Generalized Linear Mixed Models incorporating a random intercept for CHW to account for clustering of children within individual CHWs and adjusting for key covariates at both the CHW and child levels. RESULTS: The intervention group (13 CHWs, 39 children) had a higher rate of correct classification (64.1%) compared to the control group (11 CHWs, 33 children) (39.4%, P&#x2009;=&#x2009;.056). Multivariable regression analysis confirmed this (RR&#x2009;=&#x2009;2.1, 95% CI: 1.5-3.1; P&#x2009;<&#x2009;.001). No significant difference was found in correct treatment rates (38.5% vs. 27.3%, P&#x2009;=&#x2009;.316). Online training reduced time and costs by approximately 80%, though with a slight decrease in post-training evaluation scores. CONCLUSIONS: The eIMCI platform shows potential in enhancing IMCI implementation and significantly reducing the training burden in resource-limited settings. Trial registration: Chinese Clinical Trial Registry: ChiCTR2100042533, https://www.chictr.org.cn/showproj.html?proj=119995.

Humans↗

Lessons learned from the first year of implementation of the Centers for Disease Control and Prevention's standardized evaluation system for HIV prevention programs.

In December 1999 the Centers for Disease Control and Prevention's (CDC's) Division of HIV/AIDS Prevention initiated a standardized evaluation system for CDC-funded health department HIV prevention programs. This health department evaluation guidance asks health departments to develop comprehensive evaluation plans and to submit aggregated data on such activities as intervention planning, process monitoring, and outcome evaluation. During the first year of this system, of 65 health departments, 62 submitted evaluation plans, 37 submitted intervention plan data, and 20 submitted process monitoring data. Major issues affecting implementation of a national evaluation system include varying levels of evaluation capacity among health departments, differences between the CDC's taxonomy for national data collection and local definitions, and limitations regarding use of 1st-year data. The CDC has learned that implementation of a standardized evaluation system takes considerable time and that stakeholder involvement and technical assistance and capacity building support are essential.

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

A research-based tool for identifying and strengthening culturally competent and evaluation-ready HIV/AIDS prevention programs.

Recent literature on racial disparities in HIV/AIDS and effective HIV/AIDS health service delivery efforts has underscored the importance of cultural sensitivity, relevance and competence in reducing such disparities and providing effective health service delivery. Less work has been done on the role of cultural competence in the delivery of effective HIV/AIDS prevention programs, perhaps because few such prevention programs aimed at minority populations have to date been demonstrated as effective. This article surveys the various ways that the concept of cultural competence has been studied, extends the concept to the field of HIV/AIDS prevention, and presents a simple-to-use instrument that operationalizes the concept for use with HIV/AIDS prevention programs. The article also explores the idea of evaluation readiness among HIV/AIDS prevention programs in the hope of eventually enlarging the pool of minority-focused HIV/AIDS programs demonstrated as effective. The resultant tool can serve as a research-based framework that: (a) serves as a cost-effective way to select promising programs--especially promising minority-focused programs-for rigorous outcome evaluation; (b) advances the field of HIV/AIDS prevention research by providing a conceptual framework for studying the relationship between cultural competence and program effectiveness; and (c) serves as a framework for building capacity in HIV/AIDS prevention programs, pointing to ways in which such programs can be strengthened.

Cultural Diversity↗

Adapting the popular opinion leader intervention for Latino young migrant men who have sex with men.

Young Latino migrantmen who have sex with men are at high risk for HIV infection. The Popular Opinion Leader intervention, shown to be effective with White gay men, was adapted by the Farmworker Justice Fund, Inc., for this Latino migrant population. This project, called the Young Latino Promotores, was implemented over a 2-year period by community-based organizations in Vista, California, and McAllen, Texas, with capacity building assistance from the Farmworker Justice Fund, Inc. We report on challenges, preliminary findings, and lessons learned from adapting this intervention.

Adolescent↗

[Rehabilitation nursing: expanding horizons, legitimizing knowledge].

The author makes reflections on Rehabilitation Nursing, marking the trajectory of this area in Nursing in terms of care, teaching and research. She discusses concepts and their applicability in Rehabilitation Nursing practice and presents the current demand for care in rehabilitation, as well as the capacity-building of nurses to work in this market, highlighting the pioneering initiatives of public institutions and higher education establishments in the city of São Paulo, which has made possible the specialization of nurses in Rehabilitation.

Rehabilitation Nursing↗

[The meaning of competence for nursing management faculty members].

This study is aimed at identifying and analyzing the perceptions of professors who work on Nursing Management disciplines regarding the meaning of faculty competence at the undergraduate level. The objective is to suggest interventions that favor proposals for capacity building for the teaching of management that are compatible with teaching norms and with the current Curriculum Guidelines. In order to do so, the content analysis method was applied in twelve discourses of Nursing Management professors who teach in private institutions in the Greater São Paulo area between August and October of 2002. The meaning and perceptions reported were categorized, and the authors recommend a policy of human resources development that offers concrete opportunities that faculty development will lead to changes toward an emancipating education.

Clinical Competence↗

[The role of technical & financial cooperation to advance nursing profession in the area of demand reduction in Latin America: challenges and perspectives].

New framework of Technical & Financial Cooperation (TFC) has been used to develop a partnership between an international organization and universities in Latin America to advance the contribution of nursing profession in the area of demand reduction. TFC purpose is to support development on specific issues or areas that needs to produce impact within the society as a whole. The "Regional Research Capacity-Building Program" for nurses to study the drug phenomenon in Latin America represents an example of new framework of TFC to enhance nurses to use science and technology in areas of health promotion, prevention of drug use and abuse, and social integration in Latin America. TFC has becomes a powerful instrument to advance nursing professional in the area of demand reduction.

Financing, Organized↗

[Regional initiative on health care reform in Latin America and the Caribbean].

Many countries throughout Latin America and the Caribbean are introducing reforms that can profoundly influence how health services are provided and who receives them. Governments in the region identified the need for a network to support health reform by building capacity in analysis and training, both at the Summit of the Americas in 1994 and at the Special Meeting on Health Sector Reform, which was convened in 1995 by an interagency committee of the Pan American Health Organization/World Health Organization, the Inter-American Development Bank, the World Bank, and other multilateral and bilateral agencies. In response, in 1997 the Pan American Health Organization and the United States Agency for the International Development launched the Latin America and Caribbean Regional Health Sector Reform Initiative. The Initiative has approximately US$ 10 million in funding through the year 2002 to support activities in Bolivia, Brazil, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Paraguay, and Peru. Now in its third year of implementation, the Initiative supports regional activities seeking to promote more equitable and effective delivery of basic health services.

Caribbean Region↗

Developing regional workplace health and hazard surveillance in the Americas.

An objective of the Workers' Health Program at the Pan American Health Organization (PAHO) is to strengthen surveillance in workers' health in the Region of the Americas in order to implement prevention and control strategies. To date, four phases of projects have been organized to develop multinational workplace health and hazard surveillance in the Region. Phase 1 was a workshop held in 1999 in Washington, D.C., for the purpose of developing a methodology for identifying and prioritizing the top three occupational sentinel health events to be incorporated into the surveillance systems in the Region. Three surveillance protocols were developed, one each for fatal occupational injuries, pesticide poisoning, and low back pain, which were identified in the workshop as the most important occupational health problems. Phase 2 comprised projects to disseminate the findings and recommendations of the Washington Workshop, including publications, pilot projects, software development, electronic communication, and meetings. Phase 3 was a sub-regional meeting in 2000 in Rosario, Argentina, to follow up on the progress in carrying out the recommendations of the Washington workshop and to create a Virtual Regional Center for Latin America that could coordinate the efforts of member countries. Currently phase 4 includes a number of projects to achieve the objectives of this Center, such as pilot projects, capacity building, editing a compact disk, analyzing legal systems and intervention strategies, software training, and developing an internet course on surveillance. By documenting the joint efforts made to initiate and develop Regional multinational surveillance of occupational injuries and diseases in the Americas, this paper aims to provide experience and guidance for others wishing to initiate and develop regional multinational surveillance for other diseases or in other regions.

Accidents, Occupational↗

A nationwide population screening program for diabetes in Brazil.

OBJECTIVES: In 2001, persons throughout Brazil who were 40 years old or older were invited to participate in community screening for diabetes as part of the Brazilian Ministry of Health's Plan for the Reorganization of Care for Arterial Hypertension and Diabetes Mellitus. This report describes the overall participation rate and positivity rate of the screening campaign, as well as factors associated with the level of participation among the municipalities in Brazil. METHODS: Screening test positivity was defined as a fasting glucose of > or = 100 mg/dL or a casual glucose of > or = 140 mg/dL. Screening data were obtained from the Ministry of Health and were analyzed for each municipality. RESULTS: Out of the 5 561 municipalities in Brazil, 5 301 of them (95.3%) participated and reported results. Of the 30.2 million persons in the target population, 22.1 million of them (73.0%) were tested, and 3.5 million of the persons tested (15.7%) were positive. Higher odds of a high population participation rate (> or = 80%) were seen in municipalities that were of small size (risk ratio (RR) = 5.0, comparing extremes), were located in the North region of the country (RR = 1.8), were located outside of a metropolitan region (RR = 1.4), and had a higher proportion of their population who had completed elementary school (RR = 1.2) (P < 0.05). There was a parallel increase in glucose testing nationwide during and immediately after the campaign, presumably in part for diagnostic confirmation of cases identified during screening. CONCLUSIONS: The massive response to the campaign attests to the potential that this type of program has to raise diabetes awareness and to set the stage for capacity-building at the primary care level.

Adult↗

Fostering international collaboration in birth defects research and prevention: a perspective from the International Clearinghouse for Birth Defects Surveillance and Research.

The International Clearing-house for Birth Defects Surveillance and Research, formerly known as International Clearinghouse of Birth Defects Monitoring Systems, consists of 40 registries worldwide that collaborate in monitoring 40 types of birth defects. Clearinghouse activities include the sharing and joint monitoring of birth defect data, epidemiologic and public health research, and capacity building, with the goal of reducing disease and promoting healthy birth outcomes through primary prevention.We discuss 3 of these activities: the collaborative assessment of the potential teratogenicity of first-trimester use of medications (the MADRE project), an example of the intersection of surveillance and research; the international databases of people with orofacial clefts, an example of the evolution from surveillance to outcome research; and the study of genetic polymorphisms, an example of collaboration in public health genetics.

Abnormalities, Drug-Induced↗