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PubMed2002

Mobilizing women for minority health and social justice in california.

Women's Health Leadership is building the leadership capacity of diverse community leaders in California committed to promoting health and social justice in their communities. This program provides opportunities for cross-cultural exchanges of ideas, resources, and expertise. Graduates continue to receive technical support and to engage in peer learning via an alumnae network. The network is dedicated to advancing social justice issues and to addressing health disparities. It is also a way to mobilize trained grassroots leaders to provide expertise to influence policy decisions, to provide technical support and resources to local communities, and to foster new partnerships across the state.

California↗

PubMed1999

Ergonomic strategies for improving working conditions in some developing countries in Asia.

Ergonomic action is growing in Asia in response to increasing local needs. Recent studies in some developing countries in Asia commonly developed and applied widely-applicable measures for assessing local needs in field conditions including small enterprises and agriculture. For this purpose, carefully examining the actual workplace conditions of the local people was essential. Consequently, a number of field studies could contributed to improving the working conditions of the local people in materials handling, workstation design, work organization and work environment by using available local resources. Building on local capacity and practice, action-oriented ergonomics training has also been developing and spreading into many workplaces. Various non-expert human resources including local government units, trade unions, industrial associations and the agricultural sectors have been mobilized to act as participatory trainers in the action-oriented ergonomic training programmes. Training tools such as action checklists, good local examples and group work dynamics have been developed and applied to such training activities. Learning from local achievements and focusing on locally available resources, ergonomists have facilitated these local action processes by developing action-oriented training tools and training local trainers. It was confirmed that a number of ergonomic improvements could be formulated by the self-help initiative of the local people when participatory action tools and training were provided. Developing flexible and dynamic ergonomic research and training methods to meet the diversifying needs of the local people will continuously be important. Ergonomists' efforts to cover the wider population and workplaces need to be strengthened and accelerated.

Asia↗

PubMed2006

Veterinary medicine educational requirements to meet the needs of the US Agency for International Development.

The US Agency for International Development (USAID) works within the overall purpose of US foreign assistance to improve the lives of the citizens of the developing world. Through partnerships with other agencies, organizations, and governments, and using its field offices around the world, USAID strives to develop local capacity and thus build sustainable development. Two specific USAID programs pertinent to veterinary medicine are global health and agriculture. In the area of global health, veterinarians can aid USAID's work to improve the quality, availability, and use of essential health services that specifically target maternal and child health, HIV/AIDS, family planning and reproductive health, infectious diseases, environmental health, nutrition, and other life-saving areas. The challenge of making the agricultural sector in a developing country more productive is a critical one for USAID and a clear area for input from the veterinary profession. Animal agriculture is the largest single sector of agricultural economies in most developing countries, and livestock remains a critical component of poverty alleviation. There are educational requirements that benefit anyone working at USAID and can be met prior to admittance to a DVM program, as part of a DVM curriculum, or in post-graduate training/employment, such as proficiency in a foreign language; environmental sciences background; familiarity with accounting and management techniques; expertise in foreign animal diseases, zoonotic diseases, epidemiology, food safety, and nutrition, as well as the application to human health of those areas; an advanced degree such as an MPH; and management experience. Appropriately trained veterinarians can make enormous contributions to USAID's global efforts to improve the health and agriculture sectors of developing nations.

Agriculture↗

PubMed1984

Reducing the cost of health care capital.

Although one may ask four financial experts their opinion on the future of the hospital capital market and receive five answers, the blatant need for financial strategic planning is evident. Clearly, the hospital or system with sound financial management will be better positioned to gain and/or maintain an edge in the competitive environment of the health care sector. The trends of the future include hospitals attempting to: Maximize the efficiency of invested capital. Use the expertise of Board members. Use alternative capital sources. Maximize rate of return on investments. Increase productivity. Adjust to changes in reimbursements. Restructure to use optimal financing for capital needs, i.e., using short-term to build up debt capacity if long-term financing is needed in the future. Take advantage of arbitrage (obtain capital and reinvest it until the funds are needed). Delay actual underwriting until funds are to be used. Better management of accounts receivable and accounts payable to avoid short-term financing for cash flow shortfalls. Use for-profit subsidiaries to obtain venture capital by issuing stock. Use product line management. Use leasing to obtain balance sheet advantages. These trends indicate a need for hospital executives to possess a thorough understanding of the capital formation process. In essence, the bottom line is that the short-term viability and long-term survival of a health care organization will greatly depend on the financial expertise of its decision-makers.

Capital Financing↗

PubMed1999

Prevalence and effects of child exposure to domestic violence.

In recent years, researchers have focused attention on children who are exposed to domestic violence. Although presently there are no scientifically credible estimates of the national prevalence of children exposed to domestic violence, existing data suggest that large numbers of American children are affected. This article discusses the limitations of current databases and describes a promising model for the collection of reliable and valid prevalence data, the Spousal Assault Replication Program, which uses data collected through collaboration between police and university researchers. Research examining the effects of childhood exposure to domestic violence is also limited by a range of methodological problems. Despite this, however, sufficient evidence from the body of studies exists to conclude that such exposure has adverse effects. The specific effects may differ depending on a host of variables, such as the children's ages, the nature and severity of the violence, the existence of other risk factors in the children's lives (for example, poverty, parental substance abuse), and whether the children are also directly physically abused. In general, childhood exposure to domestic violence can be associated with increased display of aggressive behavior, increased emotional problems such as depression and/or anxiety, lower levels of social competence, and poorer academic functioning. A scientifically credible body of research on the prevalence and effects of childhood exposure to domestic violence is necessary to promote the development of effective interventions and to permit the proper channeling of public and private funds. This article identifies some of the steps that can be taken to build the research capacity necessary to obtain the needed data.

Child↗

PubMed2001

Domestic preparedness: the grand illusion.

The problems posed by terrorism to not only the emergency response community, but to national security at large can be overwhelming. Adoption of what would be considered prudent and effective business practices by implementing a disciplined and effectively structured central strategy cannot be overencouraged. The emerging strategy must take into account the existing emergency response infrastructures and build upon existing capacity in an effort to achieve greater readiness. This technique is no different than the training and issuance of radiological response equipment to emergency responders in the 1950s by the then Civil Defense Agency. The training that is offered, especially to EMS providers, needs to be institutionalized to ensure that our peers, on a regular basis, revisit curriculum content. Incorporating a training module within the existing DOT NHTSA initial and refresher EMT and paramedic educational curricula could easily achieve this goal. Implementing fiscal support to the local emergency response agencies in a sustainable manner is a must. The costs associated with training, equipping and servicing the equipment and medication stores are budget-busters. This is a threat to national security and, as such, the federal government needs to rise to the challenge of supporting the local response organizations that will meet this threat head-on during the aftermath of an attack. As previously mentioned, when the U.S. faced its last large national security threat (Soviet nuclear missiles), we witnessed the materialization of a comprehensive agenda that provided most of the attributes we desire with the contemporary problem of terrorism. There is no single solution to the problem of terrorism. In fact, it will take many individuals and functional areas to come together and stop viewing the threat as a "cash cow." The improved response capacity for acts of terrorism will have an inevitable "spillover benefit" of better trained and equipped emergency responders for everyday emergencies; which will inevitably be our "payday."

Disaster Planning↗

PubMedDate not supplied

Economic analysis of cancer treatment costs: another tool for oncology managers.

Oncology managers increasingly need more information about how much and why treatment costs vary across cancer patients. In response to this need, our Center is building an analytic capacity for investigating economic aspects of cancer treatment. Economic analysis is characterized by a simultaneous consideration of treatment costs and outcomes; it focuses on how treatment cost/outcome ratios vary across patient populations with similar diseases. In this paper, we present an overview of our work, with special emphasis on the measurement of outcomes and the inputs or costs of treatment, the variability of cost/outcome ratios, and the analysis of the factors that predict or explain this observed variation. We illustrate how the analysis is conducted, set out selected results relating to lung and breast cancer patients, and assess some of the advantages and disadvantages of the approach. Among other things, we conclude that economic analysis of cancer treatment costs is feasible and that it can provide useful data for managerial decision making.

Aged↗

PubMedDate not supplied

Occupational health in the Philippines.

The practice of occupational health and safety (OHS) in the Philippines is shaped by both success and failures. Government initiatives have achieved specific goals, particularly in providing better access by local industries to technical services and manpower development. However, the ability to sustain these achievements has been constrained by lack of adequate resources, both financial and human. Large-scale industrial establishments have better success in the implementation of OHS programs in their organizations. Small- and medium-scale enterprises suffer from limited resources to invest in measures for the health and safety of workers. Similarly, the government has little influence on the health and safety conditions migrant workers experience in another nation. The informal sector is the most deprived in terms of access to OHS measures. The deprivation may be alleviated by economic solutions, as their existence is a result of economic situations. Occupational health development in the Philippines is progressing and will be strengthened by better regulation, by increasing awareness among all sector workers of the importance of OHS, and by adequately building up the capacity of government and vital human resources.

Government Agencies↗

PubMed2003

Review of North-South and South-South cooperation and conditions necessary to sustain research capability in developing countries.

The paper extracted pertinent aspects of 21 years (1981-2001) of scientific cooperation among Zimbabwe's Blair Research Laboratory (BRL), the Biomedical Research and Training Institute (BRTI), and the Danish Bilharziasis Laboratory (DBL). DBL supported the building of research capacity at BRL through PhD-level training and short courses on research training organized by BRTI. The BRL-BRTI-DBL cooperation involved institutional support, scientific training, joint research programmes, and technology transfer, and forms a basis for the discussion of North-South and South-South collaboration in this paper. As the collaboration matured, DBL researchers began cooperating with their counterparts at BRL in internationally funded research programmes and partnerships based on mutual interests and responsibilities. Several research projects were formulated under co-principal investigators from the two institutions and later extended to other European and US institutions. An impressive outturn (18 PhDs) of postgraduate students undertaking field-based PhD work was accomplished from 1990 to 2001. As the socioeconomic situation in Zimbabwe deteriorated from 1999, significant attrition of senior scientists began to affect some of BRL's core functions in support of the Ministry of Health's programmes. In solidarity with BRL, DBL and BRTI jointly implemented a management-strengthening project to reduce deterioration of research productivity by retaining mid-level research managers. BRTI, able to respond rapidly to research needs in the Southern Africa Development Community (SADC), is not in competition with national research institutions and universities. An advisory committee of SADC stakeholders sets its priorities. The framework for South-South cooperation is research training to facilitate national scientists to attract resources from local and international funding agencies. It has established a National Institutes of Health-accredited ethical review board that provides ethical assurance for BRTI and non-BRTI-administered projects. Over the last eight years, BRTI has established regional and international legitimacy, and many funding agencies accept the role of the organization in 'Third Country Training for South-South Cooperation'. The article concludes by identifying essential conditions for sustaining research capability at BRL and similar institutions in developing countries. In rolling out a new ethos for research, great expectation is placed on the success of the New Partnership for Africa Development.

Communicable Disease Control↗

PubMed2004

Community services. Buried treasure.

Central Cornwall PCT suffers from a historical under-investment in community services. Fines related to delayed discharge will bring in pounds sterling 2m, which will help build up community capacity. A reorganisation of community hospitals is being planned.

Aged↗

PubMedDate not supplied

Building a health research relationship between First Nations and the University in Manitoba.

This paper describes the emergence of a formal partnership between Manitoba First Nations and researchers in the Department of Community Health Sciences at the University of Manitoba. This partnership reflects two decades of a working relationship in Manitoba involving university researchers and First Nations communities, as well as new and innovative approaches to developing organizations, training initiatives and projects that strengthen First Nations principles of governance. The emerging trust that has developed between the Manitoba First Nations and the University has made it possible to extend this partnership into building further research capacity and evidence-based decision-making among First Nations. Discussions between the Assembly of Manitoba Chiefs and the Northern Health Research Unit resulted in the development of a Manitoba First Nations Centre for Aboriginal Health Research. Its mission is to initiate, coordinate and support research activities designed to assist First Nations and Aboriginal communities and organizations in their efforts to promote healing, wellness and improved health services in their communities. Much of the health research described in this journal was facilitated through this partnership, which demonstrated the value of partnerships and new funding opportunities to better address the health information needs of First Nations communities, particularly at a time when Aboriginal communities were highly skeptical of the value of academic research.

Community Participation↗

PubMed2004

Situation of the Kinh poor and minority women and their use of the Maternal Care and Family Planning Service in Nam Dong Mountainous District, Thuathien-Hue Province, Vietnam.

INTRODUCTION: This study aimed to determine the barriers to the use of maternal care and family planning (MCFP) services by the disadvantaged Kinh people and Katu ethnic minority people in the remote and mountainous area of Nam Dong District in Central Vietnam. METHODS: A survey was conducted using a random sample of 420 mothers with at least one child under the age of 5 years. These data were supplemented by interviews with key informants, focus group discussions and observations. RESULTS: Many barriers were identified. The difficulty of the terrain made travel to healthcare centers difficult. The cost of treatment was a barrier for the poorest people. The quality of the services and facilities, as well as the management of these services was perceived to be unsatisfactory. Traditional practices were often described as being contrary to the doctor's advice, and were presented as the reason for unsafe and unassisted home deliveries. Communication was difficult because of the minority languages of the client groups, the prevalence of illiteracy, and the absence of mass communication in this region. Finally, consulting a male healthcare worker was reported to bring the women shame. CONCLUSION: There is an urgent need for the MCFP services to build both clinical capacity and health promotion activities in a way that is gender sensitive, cognisant of traditional practices and accessible by both illiterate and minority language speaking people.

Journal Article↗

PubMed2005

Do benefits accrue from longer rotations for students in Rural Clinical Schools?

INTRODUCTION: The Australian Government has provided funding for Rural Clinical Schools (RCS) to provide substantial rural clinical experience to medical students. The strategy aims to acculturate students into rural living with the intended long-term outcome of increasing the availability and viability of rural health services. When evaluators from two of the Rural Clinical Schools discussed findings and insights relating to rural rotations from their in-depth evaluation studies of their respective schools they found a range of similarities. This article is a collaboration that articulates parallel findings from evaluations over 2 years, using three different approaches to students' placements across the two RCS: (1) students based long term in one centre (with only a few days away at a time); (2) students based long term in one centre with short-term rotations of 3-6 weeks away from home base; and (3) week rotations without a home base. METHOD: The two RCS, as part of their initial establishment, put comprehensive internal evaluation processes in place, including the employment of dedicated evaluators extant from the teaching and assessment of the rural medical curriculum. Data were collected and analysed according to standard education evaluation procedures. RESULTS: Home-base preference: most students preferred having a home base in one centre and having as little time as possible away from that centre, while recognising that sometimes the requirement to go and learn elsewhere was useful. The reasons for this were three-fold: academic, clinical and social. Academic benefits: students enjoyed the excellence of teaching and learning opportunities in their rural sites and did not want their discipline of learning interrupted by what they perceived as unnecessary change. Students with a home base used their learning opportunities qualitatively differently from those students who had 6 week rotations. Their learning became self-directed and students sought opportunities to extend and consolidate areas of need. Clinical benefits: contributions to the clinical team: students in their clinical years want to feel useful and to be allowed to become contributors to the medical care, even as they are learning. A longer rotation allows them to become known to their teachers who are then able to easily assess the type of contribution that is appropriate for their students to undertake. Students then become full participating members of the healthcare team, rather than observing learners. Social benefits: all students with a home base actively participated in a wide range of community activities outside their role as medical students. Those students undertaking short rotations without a home base seldom connected in the same way to any rural community. CONCLUSION: Evaluation from these two RCS has shown that short rotations are likely to be less optimal than longer rotations for meeting the broader goals of the RCS to build future workforce capacity. Our results suggest that one opportunity to acculturate students into the rural lifestyle is lost when students' placements are insufficiently long for them to put down roots in their community, and to understand how to 'live' there more broadly. Good rural experiences and teaching and learning opportunities are not sufficient in themselves. Students' emotional attachment to rural living comes from experience related to time and the connection to local people that comes as a result of time spent in the community. Students on short rotations do not make that local connection.

Australia↗

PubMedDate not supplied

Making road safety a public health concern for policy-makers in India.

BACKGROUND: Road traffic injuries contribute substantially to the disease burden in India. This paper describes the road safety issues discussed by members of the Indian Parliament, and highlights the gaps that need to be addressed to make road safety visible as a public health problem to policy-makers in India. METHODS: All questions asked to and information provided by the Ministry of Road Transport and Highways, and questions relating to accident asked to the Ministry of Health and Family Welfare of the Government of India were reviewed for the two Houses of the Indian Parliament for the years 2002 to 2004. RESULTS: Of the 1529 questions asked to the Ministry of Road Transport and Highways, only 140 (9.1%) were related to road safety, whereas 1076 (70.5%), 181 (11.8%), 51 (3.3%) and 81 (5.3%) were related to other aspects of the national highways, state roads, vehicles and other issues, respectively. Data on the magnitude of road crashes dealt only with the number of crashes and fatalities and not with the age, sex and type of road users affected by road traffic injuries. The parliamentarians were informed that human error was the main cause of road crashes in India; however, the robustness of this information is questionable. Strategies to prevent road crashes focused mainly on training of drivers with little attention to other factors that cause road crashes. The discussion on legislations also focused on drivers, ignoring other road users. Ten of the 4741 questions (0.2%) asked to Ministry of Health and Family Welfare were related to accident, the majority of which were about the setting up of trauma care services. CONCLUSION: An appropriate policy and intervention response by policy-makers is not possible with data that are presented in a manner that do not highlight the true nature of the problem, and are neither comprehensive nor robust. Majority of the proposed road safety interventions by the Ministry of Road Transport and Highways are based on the traditional view of human error as a major cause of road crashes highlighting the lack of a scientific public health approach towards prevention of road crashes. It would be useful to build the technical capacity of the Ministry of Road Transport and Highways in road safety to use the available data more effectively, and to facilitate generation of further relevant data about the magnitude, underlying causes and impact of road traffic injuries, for policy-makers to better understand the critical issues for planning effective road safety policies and interventions to reduce the high burden of mortality and morbidity due to road crashes in India.

Accidents, Traffic↗

PubMed2007

Indicators for occupational health surveillance.

Each year, millions of the estimated 140 million U.S. workers are injured on the job or become ill from exposure to hazards at work. These work-related injuries and illnesses result in substantial human and economic costs for workers, employers, and society; estimated direct and indirect costs of work-related injuries and illnesses are approximately $170 billion annually. In 1998, the Council of State and Territorial Epidemiologists (CSTE) and CDC's National Institute for Occupational Safety and Health (NIOSH) convened a work group that identified priority occupational health conditions to be placed under surveillance, addressed cross-cutting surveillance concerns, and made recommendations regarding the role of states in a comprehensive nationwide surveillance system for work-related disease, injuries, and hazards. CSTE recommendations led to the generation of 19 occupational health indicators (OHIs) and one Employment Demographic Profile, which were developed during 2001-2003. The OHIs complement other guidelines for state-based occupational health surveillance to address overall state and national goals to improve public health. These OHIs are intended to help states build occupational health capacity by providing them with tools to collect and generate important, basic information concerning the occupational health status of the state population and to identify areas in which to focus prevention efforts. In 2005, CSTE released a report compiling OHI data from 13 states. NIOSH provides funding for the OHIs because they are now a required component of state-based cooperative agreements for occupational health surveillance. This report introduces the OHIs and describes CSTE's approach to developing this new occupational health surveillance tool.

Accidents, Occupational↗

PubMedDate not supplied

The 1990 objectives for the nation for injury prevention: a progress review.

Unintentional injuries are the principal cause of preventable early death. Beyond terms of human suffering and death, injuries place enormous burdens on this country's economic and health care resources. Demographic, sociological, environmental, and behavioral factors that influence our society contribute to the complexity and scope of the injury problem. Progress in injury prevention will be achieved only through the combined efforts of individuals, organizations, and government at every level of our society. The Federal Government is an important contributor to this process through its role of leading, catalyzing, and providing strategic support. Within the Department of Health and Human Services, numerous agencies have major injury prevention components with a broad range of responsibilities, including the direct delivery of services, establishment of safety standards, sponsorship of education and information efforts, building of the capacity of other sectors, basic and applied research, and surveillance. The Centers for Disease Control, as the lead agency, assists State and local health departments in their injury prevention efforts and coordinates activities undertaken jointly by Federal agencies, State and local governments, and private-sector organizations. To meet the 1990 Objectives for the Nation with respect to injury prevention, both the public health and private-sector providers must recognize the injury problem of the 1980s. Without the support and involvement of the public health and provider communities and of the private sector, injuries and their costs will continue at their present alarming rates. The opportunity is great for promoting health, preventing injuries, and reducing associated costs to society. Making the best of this opportunity is our challenge during this decade.

Accident Prevention↗

PubMed1993

Participatory action-research for health.

Participatory action-research, developed primarily by peoples of the Third World, combines adult education with investigation and sociopolitical action. With the goal of personal and social transformation it builds on the capacity of people to think and work together for a better life and the equitable sharing of knowledge, skills and resources so as to support fair social structures, which, ultimately, are health determinants.

Community Participation↗

PubMed1997

Family practice residency program directors' views on research.

BACKGROUND AND OBJECTIVES: The culture of family practice training programs does little to convince residents that research is a worthwhile and important activity. The traditional dichotomy between research and clinical medicine persists today, despite an identified clinical mission for research. METHODS: As part of an effort to build the research capacity of family practice training programs, a telephone survey was administered in August 1995 to the program directors of all residency programs listed in the American Academy of Family Physicians 1995 Directory of Family Practice Residency Programs. The directors were asked about their program's research environment, features designed to promote research activity, and the level of resident research productivity. RESULTS: More than half (53.6%) of the program directors felt that their training program actively promotes research. Three out of four indicated that involving residents in research is a goal of their program. However, only four of 10 (40.8%) programs provide specific time for research, and family practice residents appear to be relatively inactive by conventional measures of research productivity. CONCLUSIONS: Research appears to be developing a limited role in family practice training programs. Resident research productivity remains relatively low and may be a result of residency programs not providing specific time for participating in research. However, the program directors' supportive attitudes may contribute to research and scholarly activity becoming an integral part of a family physician's training.

Attitude of Health Personnel↗