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PubMed2002

Pedophilia on the Internet.

The Internet provides adults and children with a medium for professional and personal communication throughout the world. As widespread communication in cyberspace grows exponentially, the potential for Internet-related crimes, such as cyberstalkng, has accelerated. Children are particularly vulnerable to sexual predators, such as pedophiles, on the Internet. This article reports cases of pedophiles who used the information superhighway to exploit child victims. Two models of pedophilia on the Internet are discussed: a trust-based seductive model and a direct sexual model. This article explores the role that mental health professionals may play in the assessment of Internet pedophilia. For example, mental health professionals may provide psychiatric treatment to victims of Internet pedophiles. Psychiatrists may be involved in the evaluation of perpetrators of Internet crimes in a clinical or forensic setting. Governmental agencies, the criminal justice system, school, or the media may request consultations by mental health professionals as part of a multi-disciplinary approach to prevention. Methods of government intervention are discussed.

Child↗

PubMed1996

Inter-agency assessment of respite care needs of families of children with special needs in Fife.

BACKGROUND: In response to concern about the respite care provision for parents of children with special needs in Fife a survey was undertaken jointly by the Fife Regional Council social work department and education department and Fife Health Board. METHODS: A postal questionnaire survey was carried out of families of children with special needs in Fife and a retrospective case review of paediatric admission in two Fife hospitals undertaken to identify episodes of respite care in hospital. RESULTS: Results confirmed the considerable demand for additional respite services and the need for a variety of types of respite care provision to cater for the differing needs of families. The two most commonly requested services were a small homely respite care centre and holiday playschemes. The quality of services currently provided was generally considered to be good. The numbers of (usually multiply handicapped) children with a specific need for a health professional input during respite care are relatively few but nevertheless are an important group which often receive respite care inappropriately in a hospital setting. CONCLUSIONS: The results of the survey informed the interagency community care planning process and led to the developments of a Fife-wide family-based respite care scheme and a small residential facility in Kirkcaldy district. The latter is jointly funded by the Regional Council and Health Board. The Health Board will provide nursing support to the small residential service so that the needs of the few severely and multiply handicapped children can be better met. The project represents an example of successful interagency collaboration which was based on a joint commitment to assessing health and social care needs and planning services to meet these needs.

Adolescent↗

PubMed2003

Tribal participatory research: mechanisms of a collaborative model.

Although much social science research has been conducted within American Indian and Alaska Native (AIAN) communities, relatively little research has been conducted by or for those communities. We describe an approach that facilitates the active involvement of AIAN communities in the research process, from conceptualizing the issues to be investigated to developing a research design, and from collecting, analyzing, and interpreting the data to disseminating the results. The Tribal Participatory Research (TPR) approach is consistent with recent developments in psychology that emphasize the inclusion of community members and the social construction of knowledge. We describe the foundations of the approach and present specific mechanisms that can be employed in collaborations between researchers and AIAN communities. We conclude with a discussion of the implications of the use of TPR regarding project timelines and budgets, interpretation of the data, and ultimately the relationships between tribes and researchers.

Community Participation↗

PubMed2003

The success of emergency telemedicine at the State University of New York at Buffalo.

The Telemedicine Program at the State University of New York at Buffalo, School of Medicine, and the Erie County Medical Center (UB/ECMC) represents a "quiet success story" for telemedicine development. Though a relatively young program starting in 1992, it demonstrates steady and consistent progress in the areas of clinical services, education and research as it continues to develop as a comprehensive university telemedicine program. The Emergency Telemedicine program provided 2,294 consultations in 2001. Other services included clinics in Gastroenterology, Infectious Disease (HIV/AIDS), Psychiatry, Orthopedic Hand Surgery, Dermatology, and Neurology. The UB/ECMC program has sponsored regular education activities with a focus on internet protocol (IP) videoconferencing for grand rounds in emergency medicine and traffic injury research, nursing education, distance precepting of nurse practitioner students on clinical rotations, Megaconference I and II presentations, and the continuing exploration of advanced tools for educational presentation over the internet. The program's research activities have focused on portable, roll-about telemedicine systems and virtual palpation using a data glove.

Academic Medical Centers↗

PubMed2006

Public health preparedness in Alberta: a systems-level study.

BACKGROUND: Recent international and national events have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of contemporary public health threats. This article describes the study design and methods being used to conduct a systems-level analysis of public health preparedness in the province of Alberta, Canada. The project is being funded under the Health Research Fund, Alberta Heritage Foundation for Medical Research. METHODS/DESIGN: We use an embedded, multiple-case study design, integrating qualitative and quantitative methods to measure empirically the degree of inter-organizational coordination existing among public health agencies in Alberta, Canada. We situate our measures of inter-organizational network ties within a systems-level framework to assess the relative influence of inter-organizational ties, individual organizational attributes, and institutional environmental features on public health preparedness. The relative contribution of each component is examined for two potential public health threats: pandemic influenza and West Nile virus. DISCUSSION: The organizational dimensions of public health preparedness depend on a complex mix of individual organizational characteristics, inter-agency relationships, and institutional environmental factors. Our study is designed to discriminate among these different system components and assess the independent influence of each on the other, as well as the overall level of public health preparedness in Alberta. While all agree that competent organizations and functioning networks are important components of public health preparedness, this study is one of the first to use formal network analysis to study the role of inter-agency networks in the development of prepared public health systems.

Alberta↗

PubMed1992

Community-based health services for people with HIV/AIDS: a review from a health service perspective.

Health services for people with HIV/AIDS have been mainly hospital based, but it is now recognized that much care can be provided outside hospitals. There are well documented problems in delivering care in the community to other client groups such as the elderly and the mentally ill, but there are particular difficulties with HIV/AIDS care. These stem in part from the clinical demands of AIDS-related illnesses, but also from the stigma associated with the disease. This review looks at three key areas of relevance to those planning community-based health services for people with HIV/AIDS. These are: the need for collaboration between the statutory and voluntary sectors; the need for co-ordination between providers at the point of service delivery; and whether care should be provided by generic or specialist providers. While certain universal principles apply, and are necessary to ensure a good standard of care, patterns of service delivery will inevitably vary according both to the local prevalence rates and the existing service infrastructure. There is more than one good model of care; all models must be flexible enough to deal with needs on an individual basis.

Community Health Services↗

PubMed1996

Attitudes of Florida Academic Physicians toward the Florida Medical Association.

An Ad Hoc Committee on Academic Physicians was given the charge in 1992 of studying Florida academic physician's participation in the Florida Medical Association. It was postulated that academic physicians may participate less in organized medicine than community physicians and, therefore, may be a group that should be selectively targeted during membership campaigns. Data was obtained from the American Medical Association Masterfiles about Florida academic and community physician membership in the FMA and AMA. Academic physicians at the four academic medical centers in Florida were surveyed about their attitudes toward organized medicine, especially the Florida Medical Association. Unlike any other state in the Federation, more academic physicians than community physicians were members of the state society (46.9% v 43.5%) p < 0.05, which was accounted for mainly women academic physicians. There were substantial differences across the academic medical centers with the University of Florida at Gainesville and Jacksonville being overrepresented, the University of South Florida having average membership, and the University of Miami being underrepresented. Florida academic and community physician membership in the AMA was 34.6% and 38.5% respectively, which was consistent with national trends. Academic physicians at the University of Florida campuses rated their relationship and communication with the FMA as being better than academic physicians at the University of South Florida and Miami. Academic physicians at all four medical centers rated membership dues as being too high relative to the benefits derived, but there was indirect evidence to suggest that this was an apparent and not real barrier. Also, academic physicians thought that the FMA represented community physicians more effectively than academic physicians. The state of Florida is unique in that more academic physicians than community physicians are members of the state medical society. The differences by academic medical centers may be accounted for by variations in leadership at the different medical centers. Decreasing the membership dues for academic physicians probably will not have a significant effect on membership of academic physicians. The FMA should direct efforts at informing academic physicians about how the FMA is representing their interest in forums such as governmental and other regulatory agencies, and third party payers like the insurance industry.

Academic Medical Centers↗

PubMed2004

[Hepatitis (Hep-Net) competence network].

In Germany almost 1 million people are affected by chronic viral hepatitis. Despite of the improved therapy options for the treatment of hepatitis B and C, several questions regarding epidemiology, pathophysiology and therapy are still unclear. Vaccines against hepatitis C and D viruses are still not available. Additionally, many patients and their relatives need information about infectiosity, course of the disease and therapy options. By the integration of doctors' practices and patient advocacy groups, Hep-Net aims at the educational information on the infection and tries to give access to qualified therapy strategies for all patients with an indication for therapy. After 18 months the Hep-Net Homepage already shows more than 9000 hits per day. Consultation hours via telephone, email-services and numerous activities in cooperation with the Deutsche Leberhilfe e.V. are highly frequented. In the Hep-Net study-house high-standard clinical studies with first successful results are centrally organized. Further, basic questions in the fields of epidemiology, virology and immunology are processed in cooperative research projects within the network.

Biomedical Research↗

PubMed2001

Clinical standards for specialist community rehabilitation services in the UK.

OBJECTIVE: To develop a set of clinical standards for specialist community rehabilitation services in the UK and to undertake a preliminary survey of consultants who provide those services. DESIGN AND METHODS: The proposed set of standards was adapted from the previously published standards for inpatient services, by a working party of the British Society for Rehabilitation Medicine (BSRM). Consensus was then achieved by an iterative consultation process in five rounds. A postal survey was conducted on behalf of the BSRM amongst its consultant members providing community rehabilitation services in the UK, who were asked to assess their services in relation to these standards, and to comment on the standards themselves, their usefulness and applicability. RESULTS: Fifty consultants who ran specialist community rehabilitation services agreed to participate, of whom 29 (58%) actually responded. Overall, the standards appeared to be acceptable to most, and mainly struck the right level, being attained by the majority of services. Twenty-five (89%) felt the standards were helpful and 26 (93%) felt that they covered the main aspects of specialist community rehabilitation services: 23 (79%) found them at least partially applicable to their own service. CONCLUSIONS: Proposed clinical standards have been developed for specialist community rehabilitation services in the UK. It is likely that they will require further refinement with time, and modification is required to adapt them to different subspecialities and settings.

Community Health Services↗

PubMed1996

Linking clinical and public health approaches to improve access to health care for socially disadvantaged mothers and children. A feasibility study.

OBJECTIVE: To test the feasibility of combining home- and office-based interventions to improve access to health care and health outcomes of Medicaid-eligible mothers and infants. DESIGN: Randomized trial in 2 counties in North Carolina (1 rural, 1 urban). Information on health and developmental outcomes was obtained by face-to-face interviews, medical chart abstractions, hospital medical records, and state data tapes. PARTICIPANTS: Ninety-three Medicaid-eligible first-time pregnant women in their third trimester and their subsequently born infants, who were followed up until they were 6 months old, and 3 pediatric practices and 1 family practice. INTERVENTIONS: Coordinated home visit and office intervention, office intervention, and usual care. Home visits by 3 public health nurses provided parental education and social support and linked families with needed community resources. Women in the office intervention group were encouraged to seek health care for their infants from one of the primary care practices. Participating offices received assistance with Medicaid billing, help developing a system to improve preventive care, and customized patient education materials. RESULTS: Mothers reported that the nurses helped them in areas related to the content of the program. An office system for prevention was developed and implemented in all 4 practices for study patients. Families in the intervention groups were more likely than control families to have had a prenatal visit with a pediatrician (P = .01, chi 2), a primary care office as the regular source of sick care (P = .02, chi 2), and less waiting time (P = .02, Student t test). They were also more likely to recall receiving patient education materials (P = .007, chi 2). CONCLUSIONS: It is feasible to link clinical and public health approaches to improve the quality and effectiveness of care for socially disadvantaged children. Such interventions should be tested in defined populations.

Child Health Services↗

PubMed1999

Academic medicine and managed care: seeking common ground.

The authors report the highlights of a one-day symposium, "Academic Medicine and Managed Care: Seeking Common Ground," sponsored in early 1997 by Tulane University Medical Center. The meeting was held to foster better understanding of the gap between managed care organizations (MCOs) and academic health centers (AHCs) and to define their common ground. There were 62 participants, mainly executives froin AHCs and MCOs, plus government officials and policy researchers interested in the interface of academic medicine and managed care. The participants agreed that there are indeed some common areas in which the two types of organizations can develop programs and interests that serve the missions of both. These include (1) a commitment to high-quality health care, objectively measured by outcomes; (2) issues of "customer service"; (3) certain areas of research (e.g., examining outcomes of medical interventions; measuring cost and cost-effectiveness; measuring quality of care); and (4) preventive medicine, an area in which both AHCs and MCOs are still relatively weak. On the other hand, large elements of AHCs' basic missions of education and research are not seen by MCOs as areas for developing a common agenda. Participants agreed that AHCs must do their best to improve and demonstrate the quality of their care, address the challenges of the market (i.e., take "customer service" seriously), address the issue of how many specialists and how many generalists should be trained, and define the cost of each of their missions. On the other hand, managed care must acknowledge that the missions of AHCs greatly benefit patients and society. Participants agreed that all approaches to AHC-MCO interfaces must be flexible and local, that common ground does exist, and that understanding can grow between these two kinds of organizations if acrimonious exchanges are avoided and serious efforts are made to work together for solutions.

Academic Medical Centers↗

PubMed1994

A shotgun marriage--community health workers and government health services. Qualitative evaluation of a community health worker project in Khayelitsha.

In 1988 the Western Cape Regional Services Council (RSC) initiated a community health worker (CHW) project in Khayelitsha in order to extend its preventive services to people in the community and promote 'community upliftment'. An evaluation of this project was undertaken in 1991 and 1992 in order to examine the potential of this local health authority-run CHW project to be an appropriate primary health care model. Qualitative research methods were used to explore the nature of the work done by the CHWs, whether they were accepted in their communities, and whether the project functioned as part of an integrated health service infrastructure in Khayelitsha. The CHWs were found to provide the basis for a potentially effective, community-responsive service. However, several structural problems mitigated against this service. Relations between the CHWs and nurses in all the formal public health services in the area were superficial and fraught with problems. There were significant differences and conflicting policies between the RSC's CHW project and other neighbouring non-government CHW projects, and these posed various threats to both the RSC and the non-government projects. One of the most serious of these differences was that the RSC project had no structures or plans for community involvement in the running of the project. Before a CHW project is initiated, several critical issues need to be carefully considered and discussed with all the relevant stakeholders. Furthermore, CHWs need to be flexible, and accountable to the communities in which they work. Before employing CHWs, formal public health authorities need to consider carefully whether they are able to meet these criteria.

Community Health Services↗

PubMed1998

Family practice in the new South Africa.

Remarkable changes are taking place in the new South Africa. Planned changes in the health care arena present the new, relatively small discipline* of family practice with great opportunity for development and growth. With established generalist roots and recent formal recognition in South Africa, family practice should be well suited for a lead role in the government's efforts to extend health care access to those denied it under apartheid. Whether family practice moves into that role will depend on whether as a discipline it can project a vision of how it can meet the country's health care needs. Close examination of family practice in South Africa shows how the field reflects many of the societal problems of the past and the challenges of the future. With a clear vision of its role in the new South Africa, family practice could overcome these challenges, as well as answer a broader question about the place of family practice outside of the first world setting.

Family Practice↗

PubMed2002

Linking private and public sectors in tuberculosis treatment in Kathmandu Valley, Nepal.

Tuberculosis (TB) is a major public health problem and the world's foremost cause of death from a single infectious agent. Despite the increasing number of TB patients who seek help in the private sector, there are few practical examples of how to create a public/private linkage of TB services. The paper presents a pilot service-linkage project between the public and private sector in TB control in Kathmandu Valley, Nepal. The study documents and examines the process of the service-linkage project through the undertaking of a longitudinal analytical case study. A detailed description of the project from formulation to a short-term evaluation is given. The analysis relates the activities and early outcomes of the service-linkage project to the context, characteristics and interactions of the organizations involved. The study reveals that although the involved organizations initially agreed on the objective of the service-linkage project, differences in capacity, motivation, environment and needs had implications for the implementation and short-term success of the project. The public sector, despite the will, did not have the structure or resources to engage with the private sector. The private sector lacked interest in public health aspects of TB treatment and trust in the public sector. The study points to two different organizations that have the potential capacities to act as mediators between the public and private sectors: international research institutions and non-governmental organizations.

Antitubercular Agents↗

PubMed2000

Understanding dual enrollees' use of Medicare home health services: the effects of differences in Medicaid home care programs.

OBJECTIVES: Both the Medicare and Medicaid programs have experienced considerable growth in spending on home care in recent years. As policymakers adopt measures (such as those legislated in the Balanced Budget Act of 1997) to curb the rate of spending growth on home care services, it is important to understand interactions between the Medicare and Medicaid home care programs in serving the dually enrolled population. This study examines the potential effects of the Medicaid home care program on Medicare home health utilization using multivariate models. METHODS: The study relied on data from the Health Care Financing Administration's Medicare Current Beneficiary Survey (MCBS), a longitudinal survey of Medicare enrollees. The primary MCBS file used was from Round 1 of the survey, which was fielded between September and December 1991. The unit of analysis was individuals. The authors used descriptive and multivariate methods to explore the relationship between Medicare coverage and state home care program characteristics. Included were variables that have been found to be significant determinants of Medicare home health utilization in other studies as well as variables to indicate the availability and generosity of Medicaid home care services in each state represented in the survey. RESULTS: The findings were consistent with those of previous studies, in that dual enrollees were disproportionate users of Medicare home health services, accounting for only 16% of enrollees but receiving 40% of all visits. In addition, lower levels of Medicare home health use were observed in states with relatively higher Medicaid spending on home health and personal care services, but this relationship appeared to be heavily dominated by the inclusion of enrollees living in New York State. When individuals from New York were excluded from the analysis, we found a negative but statistically significant relationship between Medicaid outlays on home health and personal care services and Medicare home health utilization. CONCLUSIONS: Because the Medicare and Medicaid programs are interconnected through the sizable dual enrollee population, changes in one program are likely to have ramifications for the other. This study presents another step in exploring how the two programs interact and emphasizes the fact that costs can be shifted between the two programs as policy changes are made to control the rate of home care spending growth.

Aged↗

PubMed2001

Strange bedfellows: the history of collaboration between the Massachusetts Restaurant Association and the tobacco industry.

OBJECTIVES: This article examines the historical relationship between the tobacco industry and the Massachusetts Restaurant Association, a nonprofit trade association aligned with the food and beverage industry. METHODS: The study analyzed data from Web-based tobacco industry documents, public relations materials, news articles, testimony from public hearings, requests for injunctions, court decisions, economic impact studies, handbooks, and private correspondence. RESULTS: Tobacco industry documents that became public after various state lawsuits reveal that a long history of collaboration exists between the Massachusetts Restaurant Association and the tobacco industry. For more than 20 years, their joint efforts have focused primarily on the battle to defeat state and local laws that would restrict smoking in public places, particularly in beverage and food service establishments. The resources of the tobacco industry, combined with the association's grassroots mobilization of its membership, have fueled their opposition to many state and local smoke-free restaurant, bar, and workplace laws in Massachusetts. CONCLUSIONS: The universal opposition of the Massachusetts Restaurant Association to smoking bans in food and beverage establishments is a reflection of its historic relationship with the tobacco industry.

Cooperative Behavior↗

PubMed2002

The institutionalization of public health training and the health sciences.

The health of the population is determined by a number of ecological determinants in addition to medical care. Therefore a close relationship exists with the social and political context in a society. With regard to the health care system, schools of public health as institutions for training, research, and services have to focus on four main deficits in the area of information, prevention, social gradients, and the regulation of health care delivery. A task profile derives which comprises (a) training for research and services, (b) monitoring population health and setting of priorities, (c) applied research on public health, (d) consulting the decision makers, and (e) intervention and public accountability. How to perform in these areas has to be related to basic ethical principles, notably, equity, participation, subsidiarity, sustainability, and efficiency. Furthermore, international trends in modern education have to be considered as for the European Union in the Bologna Declaration of 1999, with reference to academization and internationalization of advanced studies. The resulting institutional profile of modern schools of public health is characterized by their academic basis, interdisciplinarity, and multi-professionality. The paradigm of the New Public Health is an equal merger of medical and social sciences, a predominantly postgraduate study program, an international scope, close links to the government, local networks with service institutions, and a focus on contemporary health issues. In the former socialist economies of Central and Eastern Europe a regional collaboration beyond borders (the concept of regionality) is apt to support the achievement of international standards of excellence for newly developing schools of public health.

Education, Public Health Professional↗

PubMed2002

Clinical issues in aged care: managing the interface between acute, subacute, community and residential care.

Although there is considerable evidence for the use of geriatric assessment and rehabilitation in many clinical settings, there exists relatively poor access in various regions of Australia. There has been considerable growth of community support services to assist in personal care of older people. Unfortunately, a lack of uniform assessment has hindered prioritization of clients, with the resultant need, and delivery, of post-acute hospital care services. In addition, there has been considerable progress in the clinical management of the age dependent disabling problems, such as dementia, osteoporosis, incontinence and falls, but the appropriate mix of funding between primary, secondary and tertiary interventions has not been determined. The health care needs of older people in residential care have been totally neglected, placing the sector at considerable risk. There need to be a fundamental rethink in managing the interface between acute, subacute, community and residential care.

Aged↗