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PubMedDate not supplied

Hospital assessments of children with learning problems: perspectives from special education administrators and hospital evaluators.

BACKGROUND: The schooling of 1 of every 8 children is influenced by the Individuals with Disabilities Education Act (IDEA). The IDEA also governs, to a degree, the relationship between interdisciplinary hospital clinics that evaluate many of these children and the schools that provide educational services. Little is known about how this relationship functions or how educational personnel perceive reports from hospital settings. OBJECTIVES: To describe special education administrator and hospital evaluator perspectives on hospital assessments of children with learning problems. METHODS: A survey of attendees at a 1998 meeting of the Massachusetts Association of Special Education Administrators was conducted by use of a questionnaire using closed and open-ended questions. Subsequently, focus groups were held with hospital evaluators. RESULTS: Special education administrators describe a high level of frustration with hospital-school relations. They state that hospital reports do not meet the needs of children in the educational setting. They seek closer collaboration with medical evaluators. Evaluators working in hospital settings acknowledge frustration perceived by school personnel. They state that communication with educational personnel improves the quality of their reports and outcomes for the child. CONCLUSIONS: Hospital assessments of children with learning problems are associated with high levels of frustration among special education administrators. These assessments might be made more useful if careful attention were paid to the needs of educators. Greater communication between hospital evaluators and school personnel may increase the usefulness of hospital clinic assessments of children with learning problems.

Attitude to Health↗

PubMedDate not supplied

Reproductive health and AIDS-related services for women: how well are they integrated?

To explore the relationship between human immunodeficiency virus (HIV) and AIDS services and reproductive health services, a survey was undertaken in 1994 of 30 health care facilities that are grantees under Title IIIb of the Ryan White Comprehensive AIDS Resource Emergency Act, 19 family planning clinics that offer at least some HIV services, and two family planning agencies that are also grantees under Title IIIb. The Title IIIb providers and the family planning agencies offer similar sets of services, but they tend to view reproductive health and HIV and STD services as distinctly different categories. Eliminating the perceptual distinctions between these services and viewing reproductive health services as key components of HIV and AIDS prevention could result in a more integrated system of helping women with HIV infection or AIDS as well as those at risk of HIV infection.

Comprehensive Health Care↗

PubMed1992

A collaborative effort between a state migrant health program and a baccalaureate nursing program.

This article reports on the way in which a unique collaborative effort between a service agency and a baccalaureate nursing program grew out of the needs of the two separate agencies. The first agency, the Colorado Migrant Health Program, was faced with a budget that was inadequate to meet the health-care needs of the migrant population. The second, a baccalaureate nursing program at the University of Colorado, was finding it increasingly difficult to locate appropriate generalized community health clinical placements with an opportunity for student discovery learning related to transcultural health care. Discussions of a collaborative effort ensued and it became evident that each had something to gain from such an effort. Now, after almost 10 years of cooperation, the commitment to the endeavor on the part of both agencies remains strong as the benefits to each continue to increase. The ultimate beneficiaries, however, are the migrant families receiving care and the students providing care. The way in which the program has evolved over time, a description of the current program, and a discussion of the resources that help to maintain the program are presented. In addition, the curriculum course design, and teaching strategy modifications necessary to facilitate the collaborative program are discussed.

Colorado↗

PubMed2004

The misalignment of institutional "pillars": consequences for the U.S. health care field.

This paper uses an institutional perspective (Scott, 1994; 2001; DiMaggio and Powell, 1991) to analyze the history and current state of the American health care field in terms of the alignment of its normative, cognitive, and regulatory elements. I depict the relation between institutional elements in each of three historical eras of the health care field (Scott et al. 2000): the era of professional dominance (1945--1965), the era of federal involvement (1966--1982), and the era of managerial control and market mechanisms (after 1983 to the present). I argue that a weakening of alignment between these elements, beginning in the 1970s and increasing in the 1980s, led to consumer and provider dissatisfaction with managed care, and that the state of the field in the beginning of the 21st century suggests that a new era is emerging with renewed alignment between normative beliefs and values, cognitive models, and regulation. Implications for the future of health care and institutional theory are discussed.

Cognition↗

PubMed1981

Senile lens changes and diabetes in two population studies.

Clinical and epidemiologic studies of the association between senile cataract and diabetes have produced what initially appears to be conflicting evidence. Three studies of extracted cataract have found a positive association in persons less than 70 years old. Conversely, two studies of senile lens changes (including aphakia) reported no association with diabetes. These apparently disparate findings led to the hypothesis that the diseases are in fact not associated, but that diabetics are more likely to be referred to ophthalmologists and therefore to have cataracts removed. We tested this hypothesis with data from two population surveys, the Framingham Eye Study and the Health and Nutrition Examination Survey (HANES). Both studies showed a marked excess prevalence of senile cataract (including aphakia) in diabetics less than 65 years old (relative risks of 4.02 and 2.97, respectively). Beyond the age of 64 years, the HANES study but not the Framingham study showed an excess prevalence, although it was less marked (relative risks of 1.63 and 1.02, respectively). For senile lens changes other than cataract, both studies showed little, if any, association with diabetes. Our results for cataract (whether removed or not) were generally consistent with those of previous studies of extracted cataract for persons under the age of 70 years and for persons aged 70 years or more. The two studies that reported no association between lens changes and diabetes provided information inadequate to support or refute the foregoing findings. The various studies failed to support increased referral of diabetics to ophthalmologists as an explanation for the observed association. All these studies found the association in persons less than 70 years old, whether the cataract had been removed or not.

Age Factors↗

PubMed2003

Multi-agency training for quality: reflections and recommendations.

Clinical governance within the National Health Service (NHS) and best value across local authorities in England have emphasised the need for decisions and actions being demonstrably evidence based. In an attempt to progress these related initiatives and facilitate a closer working relationship between NHS Trusts and local government departments, a multi-agency and interprofessional training event on evidence-based practice (EBP) was organised across three boroughs within Tyne and Wear. While there are advantages to different agencies learning and working in partnership to develop quality systems for health improvement, the reality of introducing EBP concepts and creating an evaluative culture within and across public sector organisations represents a major challenge. This article has adopted a case study approach to describe the key lessons learnt through critically reflecting on the planning and delivery of this training event, and it is hoped that it will be of value to other attempting similar projects in the future.

Cooperative Behavior↗

PubMed2001

Postmarketing surveillance of new food ingredients: design and implementation of the program for the fat replacer olestra.

Following U.S. Food and Drug Administration (FDA) approval for the use of olestra, a noncaloric fat substitute (brand name Olean) in food snacks, the manufacturer agreed to provide safety updates on market experience to the FDA. However, guidelines for food product postmarketing surveillance (PMS) are not available and those typically used with medical products were only partly applicable. In modeling the Olean program, we drew from experience with consumer products and incorporated elements typical of medical product PMS. A cooperative effort was established with Olean snack manufacturers and a two-tiered, multidisciplinary approach enlisting Consumer Relations and Medical Affairs personnel was used to maximize use of specialized skills. The result of this effort was implementation of a reliable PMS system which could handle a high volume of reports from consumers while providing pertinent data required for medical interpretation of these reports. Summaries of data for the Olean snack manufacturers and FDA were generated in timely fashion. In addition to collection of the spontaneous reports from consumers, a clinical studies program was undertaken and an independent medical advisory panel was established. Through these, we gained perspective on the spontaneous reports and additional confirmation of the safety of olestra in savory snacks.

Clinical Trials as Topic↗

PubMed2000

New Zealand children's health camps: therapeutic landscapes meet the contract state.

This paper surveys the history and current status of children's health camps in New Zealand, and places these sites within the theoretical context of therapeutic landscapes. The first health camp was established in 1919, and the seven current camps provide respite, education and health care for approximately 4000 children each year. We analyse the health-place relations inherent in the health camp concept and suggest that the 'therapeutic landscape' idea developed by Gesler provides a useful framework to explain the development of camps as sites for enhancing child and family welfare. Specifically, we contend that changing understandings of health and children have been closely linked with changing perceptions of what is therapeutic about the camps. Survey data demonstrate that contemporary restructuring of the welfare state has recast the role of health camps and placed them in a precarious position in terms of both financial viability and public acceptability. We conclude that the current status of health camps is ambiguous given the pressures of deinstitutionalisation philosophies and the regulatory environment of formal contracts between funders and providers.

Child↗

PubMed2004

Project northland in Croatia: a community-based adolescent alcohol prevention intervention.

War and social transition in Croatia have increased unemployment and rates of substance abuse. A decrease in prevention programs places adolescents at an increased risk. Data collected from the 2002 Split Youth Behavior Risk Survey (YRBS) showed that adolescents are at risk for alcohol use and related problems. Thus, there is a need to strengthen primary and secondary prevention activities to empower adolescents and counteract negative societal change. A public health partnership between the University of Medicine and Dentistry of New Jersey-School of Public Health (UMDNJ-SPH) and Split, Croatia was formed in 2001. Adolescent alcohol prevention was identified as our focus and Project Northland, a model U.S. program, was selected. A strong network of NGOs and government officials support the project. Qualitative evaluation showed strong parent, teacher, and student satisfaction. Preliminary analysis shows a heightened awareness on the part of students that will likely contribute to the overall success of the program.

Adolescent↗

PubMed1992

A partnership with minority populations: a community model of effectiveness research.

This paper describes a community-based approach, including a partnership of an academic medical institution and a high-risk, urban, African-American population, directed at decreasing premature morbidity and mortality and enhancing health and functional status. The intervention approach is based on a model of community-based leadership and "ownership" of interventions and programs to enhance sustainability of effective approaches, and it follows specific stages to assure appropriate assessment and evaluation. Initial efforts were directed at the control of hypertension and were coordinated through decentralized mayor's stations in Baltimore, Maryland. This approach was successful in significantly enhancing control of hypertension and reducing related morbidity and mortality. Over time, an enhanced partnership has been coordinated through churches in the community and organized around a program entitled "Heart, Body, and Soul." Current efforts are directed at the major risk factors and preventable and/or controllable problems in the population, such as hypertension, smoking, obesity, diabetes, hyperlipidemia, and cervical and breast cancer. Key components include the training of neighborhood health workers to provide screening, counseling, monitoring, support, and follow-up; enhanced access to care; training of high school students as health counselors; and use of media to promote healthier life-styles.

Academic Medical Centers↗

PubMed2000

A collaborative approach to developing nursing skills to meet service needs.

Academics, educators and health service managers came together to explore, within their local area, the nature of the perceptions of beginning registered nurses (BRNs) and Nursing Unit Managers (NUMs) to the skills utilised by BRNs within the first six months of practice. A group of 71 BRNs and nine NUMs participated in a cross-sectional survey. BRNs were also asked to rate their preparedness in each particular skill, dependent on the method of teaching--theory/lectures, nursing laboratories and clinical experience. Some 21 skills, relating to medication/fluid administration and skin and wound care, were perceived by 95 per cent or more of the graduates as being used within the first six months. Similar perceptions existed for NUMs and BRNs for 52.4 per cent of the listed skills. Differences in perceptions have led to academics altering the scope of skills being taught and focusing assessment on critical skills for BRNs, and managers increasing awareness among NUMs as to the source of the differences and developing programs to improve clinical interpretation skills. Improvements in the experience of the BRN are likely to occur when all parties work together to bring about positive change. By Barbara Somerville,

Adult↗

PubMedDate not supplied

Enhanced undergraduate public health nursing experience: a collaborative experience with the Kentucky Department for Public Health.

The Kentucky Department for Public Health and the University of Kentucky College of Nursing entered into a collaborative partnership to provide an enhanced public health nursing experience for a select group of undergraduate students. The purpose of the project was to strengthen the public health nursing practices component of the baccalaureate nursing program in the College of Nursing at the University of Kentucky. The objectives of the project related to planning, implementing, and evaluating of this program in partnership with the Kentucky Cabinet for Health Services, State Health Department in Frankfort, Kentucky. The selected baccalaureate students were paired with a preceptor and a state, local, or district public health agency with an identified need in the student's area of interest. The students participated in a mentoring experience with a practicing public health nurse consultant. The experience afforded the students an opportunity to interact at both the practice and policy development levels. An ongoing partnership developed between the state health department, local health departments, and the college of nursing. This partnership led to ongoing practicum placements for students, beneficial for both the health departments and the college of nursing.

Community Health Services↗

PubMed2004

Creation and development of an All-Wales Health Library Catalogue.

This article focuses on the collaboration between the University of Wales College of Medicine (UWCM) libraries and the Welsh National Health Service (NHS) libraries to create a joint library catalogue. The goal was to create an all-Wales resource that gave users one access point to search for the location and availability of health-related material in any Welsh medical library. This venture grew out of the existing collaborative scheme, the All-Wales Health Information and Library Extension Services (AWHILES). Currently, all seven UWCM libraries and 17 NHS libraries contribute to the catalogue. Four more libraries are due to join in late 2003 or early 2004. All UWCM and AWHILES libraries would then be contributing members of the joint catalogue. The article discusses the background and motivation to the creation of the database. It explores the positives and negatives of the project plus what was learnt as the venture progressed. It reviews the establishment and operations of the Welsh Health Voyager User Group (WHVUG) created to involve all contributing members in the running and future development of the library catalogue.

Catalogs, Library↗

PubMed2002

Care teams and pastoral professionals: response to the health care changes of this decade.

Demographic changes already in motion will result in unprecedented population changes in the next four decades and beyond for which we have little time to prepare. In particular, as the population aged 65 and over grows, a significant cohort will manifest health-related needs of older age. Even in families with adequate health insurance, confronted with the chronic illness of loved ones, the need for continuous in-home support, including pastoral care, will become dire. For many families whose situations are complicated by low incomes, under-insurance, and membership of minority populations, pastoral support will tax their congregations beyond present capabilities. Interfaith Care Partners' Care Team model of in-home pastoral support is the most effective means of delivering the pastoral support such families need. It calls for a creative linking of hospital out-patient services with individuals' congregations, and, particularly, of a stronger connection between hospital chaplaincy services and community clergy.

Aged↗

PubMed2003

Creating healthy communities, healthy homes, healthy people: initiating a research agenda on the built environment and public health.

Mounting evidence suggests physical and mental health problems relate to the built environment, including human-modified places such as homes, schools, workplaces, parks, industrial areas, farms, roads and highways. The public health relevance of the built environment requires examination. Preliminary research demonstrates the health benefits of sustainable communities. However, the impact of mediating and moderating factors within the built environment on health must be explored further. Given the complexity of the built environment, understanding its influence on human health requires a community-based, multilevel, interdisciplinary research approach. The authors offer recommendations, based upon a recent conference sponsored by the National Institute of Environmental Health Sciences (NIEHS), for research and policy approaches, and suggest interagency research alliances for greater public health impact.

City Planning↗

PubMed2004

HIV prevention nongovernmental organizations in Central and Eastern Europe: programs, resources and challenges.

HIV incidence is rising more rapidly in some areas of Central and Eastern Europe than anywhere else in the world. Carrying out effective HIV prevention programs requires the presence of "bridges" that can reach community populations most vulnerable to the disease. Nongovernmental organizations (NGOs) are in a natural role to conduct HIV prevention programs. The Directors of 29 HIV prevention NGOs representing almost all countries in Central and Eastern Europe participated in in-depth interviews by telephone. The broad topics of these interviews included descriptions of the three largest programs conducted by each NGO during the past six months, at-risk target populations served, major barriers faced, and funding sources that sponsored HIV prevention activities. NGO programs most often targeted injection drug users (IDUs); other stigmatized groups were less frequently served by NGOs in the sample. The most common types of prevention activities were needle exchange, HIV prevention peer education, and delivering AIDS presentations and distributing educational materials. Among the major barriers that hampered effective conduct of HIV prevention programs were a shortage of available financial resources, governmental indifference or opposition, and AIDS-related stigma. National governments rarely provided substantial funds for NGO programs, and most funding came from United Nations agencies or private foundations. The information sources reported to be most helpful in assisting NGOs in program development were sharing ideas with other NGOs, participating in conferences, and accessing information from the Internet. A number of programs reported by the NGO Directors were innovative, outstanding, and comprehensive. Five such exemplary programs are described in this article. HIV epidemics in the region are still potentially controllable. NGOs need immediate support so that they can carry out their community-based activities on a larger scale.

Communicable Disease Control↗

PubMed1996

Conflicts of interest: conceptual and normative issues.

Growing university-industry ties, particularly in biomedical areas, naturally raise concerns about conflicts of interest. Such conflicts are essentially problems in business and professional ethics. As of the fall of 1995, all institutions seeking funding from either the Public Health Service or the National Science Foundation have been required to maintain and enforce a written policy on conflicts of interest. The PHS and the NSF also require the disclosure of "significant" financial interests that might affect the research. Although the PHS and NSF requirements may prove helpful, they are not sufficient for monitoring the full range of serious conflicts of interest that can arise in university-industry relations. The PHS and the NSF are basically concerned with potential bias in the design, conduct, and reporting of research. Their disclosure requirements are restricted to financial considerations of $10,000 or more. However, bias in research can result from conflicts of interest when much less is at stake financially. Furthermore, it can arise at both individual and institutional levels. This article attempts to provide a conceptual and normative analysis of conflicts of interest that better enables us to understand the subtleties that can be involved. This article is one of three in this issue of Academic Medicine that deal with issues of conflict of interest in university-industry research relationships. These articles are discussed in an overview that precedes them.

Biomedical Research↗

PubMedDate not supplied

[Cooperation between the occupational health department and the technical assistance office to confront the problem of pollution by anesthetics].

In the past years the problem related to occupational exposure to anaesthetic gases in operating rooms has been dealt with in different ways by each hospital administration, and frequently with little cooperation between the health departments involved. At the Spedali Civili of Brescia in the five year period, 1987-1991, a monitoring activity of nitrous oxide (N2O) and halogenated anaesthetics was performed in 30 operating rooms. This lead to a noticeable reduction of environmental concentrations of these substances. Favourable results have been achieved principally by maintenance and/or substitution of anesthesiological machine parts. In order to organize and facilitate this program a close collaboration was accomplished between the Medical Direction of the Hospital and the Occupational Health Department, with the support of the Technical Assistance Department.

Air Pollutants, Occupational↗