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Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary health care. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary health care development are described.
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CONTEXT: This study followed up on a summer 1997 advocacy project by the Children's Defense Fund--New York, which assisted families in New York City in enrolling their children in government-sponsored health insurance programs (Medicaid and Child Health Plus). OBJECTIVE: To determine how many participants from the 1997 project acquired insurance, to document their experiences during the application process, and to solicit their suggestions on improving the application process. DESIGN: Guided telephone interviews in summer 1998 with all families from the 1997 program that could be located. PARTICIPANTS: Fifty-five families from New York City that, with the assistance of the Children's Defense Fund--New York, applied for Medicaid or Child Health Plus in summer 1997. RESULTS: Of the 55 families, 46 acquired insurance for their children at some point during the year. A number of families changed insurance status several times during the year, and some insured originally through government-sponsored programs later acquired private insurance. The families experienced many difficulties in dealing with the health insurance bureaucracies. CONCLUSION: The process of applying for Medicaid and Child Health Plus is more difficult and time consuming than may be realized, and many families may go through the application repeatedly. Current efforts to decrease the number of uninsured children in the US must take into account the bureaucratic barriers faced by families that are eligible for these programs and must consider ways to make the application process less formidable.
The Canadian broiler chicken and turkey industries are distributed approximately according to human population. Individual components of these industries tend to be smaller than their U.S. counterparts and not to be vertically integrated. The outlook of the poultry meat industries is positive because of increasing per capita consumption of chicken and the potential for gains in turkey consumption. The number of permanently employed poultry scientists at publicly funded institutions has declined in Western Canada. University training in Poultry Science is restricted to four major institutions where it has been integrated into Animal Science and Veterinary Medicine programs. For the most part, poultry scientists have developed successful research programs and this research has been enhanced by scientists employed in term positions. Publicly funded poultry extension has declined but this reduction has been compensated to some degree by industry-sponsored programs and the private sector. The majority of research funding, which was once derived from government, is now provided by industry; government contributions are frequently contingent on initial industry support. The consequence of this type of funding arrangement is a trend to more short-term and less long-term research. Canada has no strategic plan regarding poultry training, research, or extension and this needs to be addressed before there is a further reduction in the country's infrastructure. Modern communication technology offers promise to reduce the isolation of scientists in different parts of Canada.
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BACKGROUND AND OBJECTIVES: Many faculty development (FD) programs depend on external private and public sponsors that routinely require systematic studies on FD outcomes. The results of evaluation studies can influence whether or not programs continue to be funded. To better evaluate program outcomes on academic productivity, this paper presents and illustrates an evaluation method that uses the curricula vitae (CVs) of FD program graduates. METHODS: The evaluation method is implemented by first preparing a record-review template of coding categories that is applied to FD graduates' updated CVs. Next, semi-structured interviews are held with subjects to resolve uncertain CV codes. Finally, coded data are entered into standardized forms and analyzed to yield descriptive findings. The method was piloted with two groups of FD graduates (n = 17) to determine its utility and limitations. RESULTS: Results show excellent inter-rater reliability (Cohen's Kappa = .79). There was an overall increase in productivity, measured by the CV, during and after the FD program. CONCLUSIONS: CV analysis can be a useful method for assessing FD program outcomes. Several limitations of the method, such as incomplete CVs and self-report bias, must be considered.
PURPOSE: To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. DESIGN: Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. SETTING: The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. SUBJECTS: Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. MEASURES: Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. RESULTS: Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. CONCLUSIONS: Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.
Demand for economic and outcomes data in support of drug formulary listing in private and government-sponsored health programs has led to fundamental changes in drug development. In part as a response to these pressures, the pharmaceutical industry has begun to include economic and quality-of-life endpoints in clinical trials with the hope of providing information to answer health policy questions on the economic value of its products. Here, the design and health economic techniques that will be used to analyze the START (inhaled Steroid Treatment As Regular Therapy in early asthma) study-a multinational (31 countries), randomized, placebo-controlled trial of 7240 patients with mild asthma over 3 years-will be presented. START compares the effect of once-daily administration of an inhaled glucocorticosteroid (Pulmicort Turbuhaler to conventional therapy in the management of newly diagnosed asthma, for which the use of this therapy is currently not the standard. The START study will examine both clinical effectiveness (measured as symptom-free days) and asthma-related costs for both treatment arms, aggregated for all patients across all countries. We believe that presenting the analytical plan prior to disseminating the results is an important way of increasing the credibility of economic evaluations. However, using clinical trials for collecting economic data poses several challenges, and the methods for conducting such evaluations are being developed. This paper will present and discuss several methodological options and the current state of the art for conducting economic evaluations alongside multinational clinical trials.
Minorities have long been excluded from biomedical research programs, both as researchers and as study participants. One reason for the dearth of minority researchers is their lack of awareness that federal and private financial assistance programs exist on their behalf. To provide opportunities for minorities in biomedical research, minority institutions must be given expanded opportunities to participate in federally sponsored biomedical research programs. Thus both governmental and private agencies need to appraise minority research institutions of the kinds of assistance available and how to access funds. One means of disseminating such information would be to post it on the Internet. Minority institutions, for their part, must make basic research a priority and engage in mentorship programs that encourage minority precollege students to pursue careers in the sciences. Researchers can gain the trust of African Americans through outreach programs, which may lead to the greater inclusion of this population in clinical trials.
Health services in Brazil are characterized by a multiplicity of providers. While many are ultimately funded from public sources, notably the National Social Security Scheme, a large proportion are provided by the private sector. This variety of providers of health care has hindered the development of comprehensive care and the coverage of those in greatest need. In recent years increasing attention has been given to ways of reducing the undesirable aspects of this situation. The Federal and State Governments have established committees to improve coordination between services and set up several pilot programmes. One concerned with improving the effective coverage of maternal and child services has been established in Sorocaba. Sorocaba is a medium-sized city which is typical of the many urban centres in the state of São Paulo. This paper describes a study which has provided information from a representative sample of women, who had recently had a baby, on their eligibility for care from the various health services available in the city and on their actual use of those services. This information has been used in the implementation of a pilot programme. Most mothers attended some service for antenatal care. Almost 20% used several services because their entitlement varied from scheme to scheme and some services provided only specific components of care. This applied also to preventive and curative infant care.
OBJECTIVE: To determine the incidence, nature, demographics, severity, and hospital charges associated with inpatient treatment of firearm-related injuries. DESIGN: A retrospective, 1-year, population-based study of firearm-related hospitalizations based on the 1991 California Hospital Discharge Abstract Data Tapes. SETTING: California acute care hospitals that reported firearm-related discharges. PATIENTS: A total of 9562 patients discharged with firearm-related injuries. MAIN OUTCOME MEASURES: Per capita hospital discharge rates, according to age, race, and sex. RESULTS: A total of 9562 firearm-injured persons were discharged from California hospitals in 1991, representing a rate of 32 discharges per 100 000 population. Males aged 15 to 24 years accounted for 72% of the hospitalizations. For all causes of firearm-related injury, the highest age- and race-specific discharge rate was 439 per 100,000 for black persons aged 15 to 24 years. The highest county discharge rate was 55 per 100,000 for Los Angeles County. Statewide, there were 1.8 hospital discharges per firearm-related fatality (both in the hospital and in the community). Assaults accounted for 74% of cases. Among black males aged 15 to 24 years, assaults accounted for 598 discharges per 100 000 population. Hospital charges for 9193 patients exceeded $164 million; mean and median charges per patient discharged were $17,888 and $8535, respectively. Publicly financed health insurance programs sponsored 56% of patients; 25% had private insurance, and 19% were uninsured. Fifty-three percent of the discharges occurred at 13 of the 371 hospitals that discharged patients with firearm-related injuries. CONCLUSIONS: Firearm-related violence is a major cause of hospitalization of young urban black males and represents a significant cost to publicly financed health care. The impact on individual hospitals is highly disproportionate. While hospital discharge data can be used for population-based surveillance of firearm-related trauma, there is need for improvement in local, state, and national surveillance of these injuries.
A growing number of firms in private industry now sponsor or contract with groups of mental health professionals to provide employee assistance programs (EAPs). Factors that have influenced the increasing demand for EAPs include corporations' humanitarian concern for employees with mental health problems, a desire to contain rising health costs and reduce corporate losses, and the need for effective supervisory systems for managing troubled employees. To assist corporate consumers in judging the quality of EAP services and to guide mental health practitioners who wish to enter the EAP field, criteria are provided for evaluating the following aspects of EAP programs: policy development, employee orientation, supervisor training, availability during nonbusiness hours, assessment and diagnostic services, crisis counseling, referral, quality assurance, program evaluation, and cost.
/ Bald eagle ( Haliaeetus leucocephalus) conservation in Arizona, USA, is a prime example of a successful, cooperative environmental management effort. The Salt River Project (SRP) is an active participant in the statewide bald eagle management activities. This paper summarizes the major components of the statewide program and highlights SRP's participation in these efforts. The Southwestern Bald Eagle Management Committee (SWBEMC) was formed as a means of coordinating interagency projects. Chaired by the Arizona Game and Fish Department (AGFD), the SWBEMC is comprised of 15 state, federal, tribal, and private agencies. Together, these agencies sponsor the Nest Watch Program, a unique and effective program dedicated to the study, conservation, and recovery of bald eagles in the southwest. Other significant components of the bald eagle management program include nest monitoring, nest search activities, winter counts, and demography studies.KEY WORDS: Bald eagle conservation; Participatory; Cooperative effort; SRP
Five years ago a small group of employees (health professionals and others) from Saint Joseph's Hospital, Atlanta, volunteered to prepare a meal for the homeless at one of the city's shelters. The experience led to a group decision to volunteer time to provide basic healthcare to the homeless. This soon led to the hospital-based Mercy Mobile Health Project, which, with community involvement, eventually became the Atlanta Community Health Program for the Homeless. Although the Saint Joseph's Mercy Care Corporation sponsors the program, a number of public and private agencies and professional groups are involved. All strive to expand efforts to address the problems of the homeless, to break the cycle of homelessness, and to provide continuing healthcare services where necessary. The number of clinic sites has more than doubled, while patient encounters have quadrupled.
Despite the availability of rabies vaccination through private veterinarians and government-sponsored rabies control programs, rabies was reported in an average of 338 cats and dogs per year from 1980 through 1987 in the United States. Information was collected on 90% of the 183 cats and 97% of the 119 dogs that were reported to have rabies in the continental United States in 1988. The median age of rabid cats and dogs was 1 year, and 81% were from rural areas. Compared with rabid cats, rabid dogs were more likely to have been male (66 vs 42%, odds ratio = 2.6), to have been kept as pets (84 vs 43%, odds ratio = 6.8), and to have had reported contact with wildlife before onset of illness (38 vs 14%, odds ratio = 3.8). Rabid cats accounted for a greater proportion of human rabies postexposure prophylaxis, bites to people, and exposures to other animals than did rabid dogs. Although the clinical signs of rabies varied, rabid cats were more likely than dogs to have had aggressive behavior (55 vs 31%, odds ratio = 2.8). In contrast, rabid dogs were more likely than cats to have had an illness consistent with a paralytic process. The median period between onset of illness and death was 3 days (range, less than 1 to 10) in rabid cats and dogs that were allowed to die of rabies. Vaccine failures were documented in 3 (1%) rabid animals (2 cats and 1 dog). All animals had received only a single dose of vaccine in their lifetime and were vaccinated when they were between 3 and 6 months old.
OBJECTIVES: To determine the relative impact of parental characteristics, provider behavior, and the provision of free vaccines through state-sponsored vaccine volume programs (VVPs) on the immunization status of children followed by private pediatricians. STUDY DESIGN: Retrospective and cross-sectional surveys of immunization data. SETTING: The offices of 15 private pediatricians, from 11 states, who were members of the Pediatric Research in Office Settings network. Seven of these physicians used vaccines provided through VVPs. PATIENTS: Children 2 to 3 years old followed by the participating physicians. METHODS: The immunization status of children was assessed from two separate samples. For sample 1, immunization data were abstracted from the medical records of 60 consecutive eligible children seen in each office. Parents of the selected children indicated the method of payment for immunizations and the education levels of the mothers. Because this cross-sectional survey might have oversampled frequent health care users, a retrospective chart review of up to 75 randomly selected children in each pediatrician's practice was also conducted (sample 2). Additional data were collected from the parents of children in sample 2 by telephone interviews. For both samples, patients were considered to be fully immunized if they had received four diphtheria-tetanus-pertussis/diphtheria-tetanus vaccines, three oral poliovirus/inactivated poliovirus vaccines, and one measles-mumps-rubella vaccine before their second birthdays. Before collecting vaccination data, pediatricians completed a survey detailing their immunization beliefs and practices. Logistic regression was used to identify factors that were independently associated with a child being fully immunized. RESULTS: For sample 1, 81.7% of the 857 children surveyed were fully immunized. Practitioner-specific immunization rates varied widely, ranging from 51% to 97%. The immunization rate of children who received vaccines provided by VVPs was similar to that of children whose immunizations were not provided by VVPs (81.2% vs 82.2%; odds ratio [OR] for a VVP as a predictor for being fully immunized, 0.94, 95% confidence interval [CI], 0.66 to 1.32). In addition, parents who paid for immunizations out of pocket were as likely to have fully immunized children as those who had little or no out-of-pocket expenditures for vaccines (OR, 1.13; 95% CI, 0.75 to 1.13). In the logistic model, only individual pediatrician and size of the metropolitan area in which the pediatrician's practice was located were significant predictors of a child's immunization status. The results from sample 2 were similar; 82.1% of the 772 surveyed patients were fully immunized. With sample 2, individual pediatrician and age of the child at the time of the survey were the only predictors of immunization status. The OR of a VVP as a predictor of a child being fully immunized was 1.37 (95% CI, 0.65 to 2.90). CONCLUSIONS: Individual provider behavior may be the most important determinant of the immunization status of children followed by private pediatricians. In our samples, the effect of parental characteristics was limited. State-sponsored VVPs were not associated with higher immunization rates, perhaps because cost of vaccines did not seem to be a significant barrier to immunization in this population.
The percentage of older people in the population will permanently increase. An attendant phenomenon is a rising demand for special exercise programs. In 1991, a survey of those programs was done in the unified FRG. The investigation was ordered by the Sportministerkonferenz der Länder to substantiate further promotion. Organizers and sponsors of exercise programs for older people originate from public and private non-profit institutions in the fields of sports (administration), social welfare, public health, and educational work. Concerning the structure and the extent of special exercise programs there exist large regional differences between the eastern vs. western part of the FRG and rural vs. urban areas. People of over 50 years of age have to be separated into different groups corresponding to their age, physical condition, experience, and needs; not all of them find appropriate programs. The Deutsche Turner-Bund, private charitable institutions, and a few private health-care organizations preferentially serve untrained and/or inexperienced women over 60-65 years of age with recreationally oriented exercise programs. The younger, more athletic find more competitively oriented programs within the scope of other sports federations. Recreational sports programs in age-independent groups are often attended by older physically fit people.
Social service administrators and planners in both the private and public sector are increasingly being held fiscally and programmatically accountable by both sponsors and consumers of services. This paper provides an examination of the trend toward program budgeting and its various techniques which can assist the administrator-planner in developing a more accountable program. A specific approach to cost analysis and planning for multi-program social service agencies is explored through its application in an actual agency setting. The model's application to other social service programs is also discussed.