Using the vision of healthy people to build healthier communities

The national vision of Healthy People 2000 provides the specifics for the public health vision of healthy people in healthy communities. An understanding of the role of public health as system builder, and the use of objectives and vision to work toward outcomes of improved health facilitate nurses' contribution to the health of the communities in which they practice. The advanced practice nurse has this opportunity, even when primarily engaged in the provision of care to individuals, or to individuals and families.     

Clinico-audiological characteristics of secretory otitis media in children

At the 1995 status review of the Healthy People 2000 nutrition objectives, progress was reported in several areas. These include dietary fat consumption, calcium intake, use of nutrition label information, incidence of coronary and stroke mortalities and blood pressure and cholesterol levels. However, a lack of progress was reported in the incidence of overweight in both men and women. Physicians can help their older patients achieve better health by providing assessments for under- or over-nutrition and education in age-appropriate dietary practices.     

The need for health promotion in oral cancer prevention and early detection

OBJECTIVES: This review paper provides a rationale for using health promotion to help reduce morbidity and mortality due to oral cancers by identifying barriers to prevention and early detection of these cancers and discussing strategies for change. METHODS: A literature review of the following areas was conducted: epidemiology of and risk factors for oral cancers; knowledge, opinions, and practices of health care providers and the public regarding prevention, early detection, and control of oral cancers; and policies and regulations that either enhance or act as barriers to the prevention and early detection of oral cancers. RESULTS: Overall, the public is ill-informed about risk factors for and signs and symptoms of oral cancers and relatively few US adults have had an oral cancer examination. Further, health care providers are remiss in providing oral cancer examinations and detecting early oral cancers. CONCLUSIONS: To achieve the 13 oral cancer objectives contained in "Healthy People 2000," health care providers and the public must know the risk factors for these cancers as well as their signs and symptoms. Further, health care providers need to provide oral cancer examinations routinely and competently. Equally important, the public needs to know that an examination for oral cancer is available and that they can request one routinely. Thus, a vigorous agenda that includes education, policy, and research initiatives is needed to enhance oral cancer prevention and early detection.     

Interaction of vimentin with actin and phospholipids

Nicaragua is one of the poorest nations in the Western Hemisphere. The health of the population suffers as a result of poor nutrition, epidemic diseases, natural and manmade disasters, sporadic violence, urban industrial growth, and inadequate government funding for even basic medical equipment and supplies. Within this environment, emergency services development has been recognized as an important and cost-effective public health intervention. In recent years, government and nongovernmental agencies working together have had a dramatic positive impact on the quality of emergency care provided.     

A national imperative: Public funding of psychological services.

This article discusses the history of Canadian psychology and the publicly funded health care system. Reasons are provided for the current situation, in which psychology is largely not publicly funded, and the current situation in psychology is contrasted with that history, to make the argument that modifications are possible. Different models and methods of funding, related to service providers, service recipients, and the actual services themselves are reviewed. An argument is made that public funding should be provided to clinical psychologists who provide empirically supported services to patients with diagnosable mental health problems. The article concludes with a response to some anticipated criticisms of the position taken, and ideas about political advocacy to advance the agenda of public funding of psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Which parishes are most healthy?

Raw data for 21 health outcomes are ranked from 1 to 64 within each measure for all Louisiana parishes. The average of all ranked outcome measures is reported along with the individual ranked scores. This average rank for all parishes is also reported as a quartile score. The ranked measures are grouped in eight categories suggested by the Healthy People 2000 program, and a quartile score is reported for the average of each of the categories. The purpose of this rankings is to enable comparisons of health outcomes between and within the parishes. The diversity of the measures within parishes suggests strengths and weaknesses for each community. As suggested by the Healthy People 2000 program, health outcomes, when organized in the conceptual categories, suggest how behavior and attitude impact on health status.     

Health promotion, health protection, and preventive services

Health promotion, health protection, and preventive services reflect the 21 priority areas of Healthy People 2000. This article focuses on the cost-effectiveness of health promotion and the role that primary care physicians can play in this initiative.     

Medical management of obesity

CONTEXT: Since the initiation of managed health care, little information has been available on whether family planning agencies are seeking ways to serve (and obtain reimbursement for serving) the growing number of clients who are managed care enrollees. METHODS: A 1995 mail survey sought information from a nationally representative sample of publicly funded family planning agencies about the agencies' involvement with managed health care plans and related clinic services, policies and practices. Completed surveys were received from 603 agencies, for an overall response rate of 68%. RESULTS: One-half of all publicly funded family planning agencies had served known enrollees or managed care plans. One-quarter (24%) had served managed care enrollees under contract, while others sought out-of-plan reimbursement for services provided to enrollees (13%) or used other sources to cover the cost of these services (12%). Family planning clinics administered by hospitals and community health centers were more likely than other types of clinics to have contracts to provide full primary-care services to managed care enrollees, whereas Planned Parenthood affiliates were more likely to have contracts that covered the provision of contraceptive care only. Clinics administered by health departments rarely had secured managed care contracts (10%), and only 36% reported even serving managed care enrollees. CONCLUSIONS: The challenges presented by managed care, and agencies' responses to these challenges, vary according to the type of organization providing contraceptive care. Family planning agencies need to seek relationships with managed care organizations based on those services that their clinics can best supply.     

Accidental contact with syringes used by intravenous drug users (IDU): a decade of study]

BACKGROUND: Frailty prevention and remedial programs based on exercise, hormone replacement, and vitamin supplementation are becoming available for use with older patients, but success of these programs depends largely on seniors' willingness to participate. METHODS: We evaluated preferences for specific aspects of these programs using a sample of 359 older persons recruited from potential delivery sites. Main effects and subgroup analyses were done. RESULTS: Subjects preferred stretching, chair-based, walking, and dynamic balance exercises over lifting weights, dancing, hormone and vitamin therapy; exercising alone in their own homes over exercising in groups; and vitamins over hormones. Preferences were affected to some extent by sex, race, recruitment site, and functional status. However, subjects' willingness even to consider exercise was rarely as high as the desired levels of participation set forth in Healthy People 2000. CONCLUSIONS: Physicians and public health authorities need to educate older persons about effective methods to prevent or treat frailty.     

Contributions consulting psychologists can make toward helping national security agencies develop a more networked workplace.

This article describes the roles consulting psychologists can play in working with national security agencies (national security agencies: law enforcement and intelligence organizations) on several key issues to facilitate the movement to a more networked organization invested in information sharing as mandated by the U.S. President in 2007, to the Director of National Intelligence. This would include helping to develop information-sharing environment and managing a secure workforce. The goal is to share and manage information more effectively in the service of national security while managing a secure workforce to mitigate the loss of assets by violations of trusted insiders. This will be accomplished by evolving culture change around the growth of technology to assist these organizations meet their mission objectives to protect national security and public safety. Several different areas of specialization are described including organizational development, strategic planning, change management, developing programs, enhancing training, or in other support roles to enhance daily operations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevention of mental health problems in Canada: A survey of provincial policies, structures, and programs.

The purpose of this research was to obtain a profile of the state of prevention in mental health in Canada. In all the provinces and territories, we obtained information from the departments of children's mental health, adult mental health, and health promotion regarding administrative supports, personnel, policies, budgets, inter-ministerial collaboration, training, and programs allocated for prevention. The findings indicate that the rhetoric of prevention is present in many government policy documents and there are many interesting prevention projects that have been implemented. However, there has not been a reallocation of funding in the health field from treatment and rehabilitation services to prevention programs, and funding for prevention remains at a very low level. Recommendations to improve the state of prevention are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

NIOSH research initiatives to prevent back injuries to nursing assistants, aides, and orderlies in nursing homes

Over the past 100 years, advances in nutrition, modern medicine, public health, and a multitude of public health improvements have increased the life expectancy of U.S. residents. The fact that Americans are living longer has resulted in extensive growth in our elderly population and a rapid employment growth that delivered about 2 million new jobs between 1980 and 1989 in the health care workforce. The Bureau of Labor Statistics Injury and Illness Data for nursing homes rose from 10.7 to 18.6 injuries or illnesses per 100 full-time workers between 1980 and 1992. The injury and illness rates among nursing home workers are partly due to the physical stress of providing round-the-clock assistance with the basic activities of daily living, such as getting in and out of a bed or chair, as well as bathing and toileting. The National Institute for Occupational Safety and Health (NIOSH) is conducting a series of research studies to identify strategies to reduce the risk of musculoskeletal injuries to workers in nursing homes. NIOSH has funded two laboratory evaluations of resident transferring methods and one field study in an actual nursing home. The purpose of this paper is to describe the key findings from past NIOSH research initiatives and to present an overview of future research.     

Laparoscopic surgery and the systemic immune response

New York Online Access to Health (NOAH) is a Web site that provides accurate, timely, relevant, and unbiased full-text health information in both English and Spanish. A joint project of The City University of New York Office of Library Services, The New York Academy of Medicine Library, the Metropolitan New York Library Council, and The New York Public Library, NOAH brings consumer health information to the public in New York City and around the world via the Internet. NOAH is an example of a successful collaboration among different types of libraries (academic, public, medical society) and voluntary health agencies to use new technologies to reach a very broad public. This paper discusses the involvement of the library partners in terms of the management and funding of the site. Web site construction is described including how the information is gathered and organized. Future plans and funding issues for NOAH are considered in terms of the expected increase in the need for consumer health information. NOAH can be reached at: www.noah.cuny.edu.     

General practitioner funding policy: from where to whither?

Six public policy objectives relating to general practitioner (GP) funding since 1938 have been identified. They concern national health insurance, rural GP shortages, care for the poor, health promotion, cost effectiveness and community control. Each of these objectives is examined in turn, focusing on the extent to which each has been met. In all cases past policies have been, at best, only partially successful in meeting their objectives and have required little in the way of dismantling prior to the introduction of new GP funding initiatives subsequent to 1993. Theoretical principles relating to the development of efficient and coherent public policy are discussed. New Zealand policy relating to funding of GP services has rarely conformed to such principles. There is an emerging consensus between social democrats and libertarians that targeted programmes for the poor is the equitable and efficient way to proceed. A key policy decision concerns the balance between planned primary care services for low income groups and more traditional market style arrangements for others.     

Restructuring public mental health and substance abuse service systems

The authors originally circulated the concepts in this proposal during May 1995. The purpose was to support an open, public dialogue regarding the restructuring of the mental health and substance abuse services in Illinois in anticipation of Medicaid funding changes. Restructuring mental health and substance abuse service systems should follow certain key principles. These principles are applicable to other states, particularly those large in territory and population. The authors propose the temporary use of multiple managed care companies serving as administrative services only (ASO) organizations, each of whom would have responsibility for a given geographic portion of a state. The role of the ASOs would be to organize providers into networks on a regional basis and transfer managed care expertise in financing and clinical management to the relevant state departments and provider groups. Changes in the service delivery system would be phased in over time with reorganization of key components of the system during each phase. Where the provision of mental health, substance abuse, and social services is split among multiple state agencies, these agencies would be merged to achieve unified funding and administrative efficiency. Patients and advocacy organizations would play a key role in overseeing and shaping system restructuring at all levels, including a governmental board reporting to the governor, overseeing ASO organizations' operations and assuring quality and access at the provider level. The authors propose funding of public behavioral health services through use of a tiered, integrated funding model.     

Overview: Forging research priorities for women's mental health.

After a decade of reports underscoring the inadequacy of existing scientific knowledge for understanding gender differences in mental disorder and its treatment, the National Institute of Mental Health has developed a women's mental health research agenda with five priority areas for research: diagnosis and treatment of mental disorder, mental health issues for older women, violence against women, multiple roles, and poverty. This overview highlights some of the major findings in each of these five areas and introduces the more in-depth treatment given in this Psychology in the Public Forum section to the areas of violence, poverty, and multiple roles. It also underscores the importance of identifying sources of gender bias in all mental health research. Women's mental health issues have become officially recognized as part of the NIMH research agenda. Only time and continued monitoring will determine how these official policy priorities will become translated into actual funding and research initiatives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The challenge for education in a transformed health care system

A focus on health promotion, disease prevention, and health education for all members of society has emerged from the federal guidelines of Healthy People 2000 and, more important, from the demonstrated needs of vulnerable populations. New and potent organisms and diseases have stressed the health care system. Nursing administrators face significant challenges in managing health care delivery and nursing within the multidisciplinary team in the transformed system. In all areas, education must be directed to meet the challenges and nursing must assume the leadership for ensuring the health care needs of individuals and communities, now and in the future.     

Psychologist supply, managed care, and the effects of income: Fault lines beneath California psychologists.

Data from the 2000 Calffornia Survey of Psychological Practice (D. Pingitore, R. Scheffler, M. Haley, T. Sentell, & D. Schwalm, 2001) were used to measure psychologists' income variation associated with demographic characteristics, managed care participation rate, and mental health workforce supply concentrations. A 10% increase in the supply of psychologists in a psychologists' market of practice resulted in a $1,749 reduction in income compared with a $1,330 income reduction due to a 10% increase in managed care participation. The authors discuss how psychologists' income and other aspects of practice are shaped by market dynamics, trends in the psychologist workforce, and public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CNS role in women's health promotion and maintenance in a collaborative practice

The clinical nurse specialist (CNS) has an instrumental role in health promotion and maintenance for women. In the obstetrical/gynecological private practice setting, working in collaboration with a physician and other healthcare providers, the CNS has the opportunity to exercise the subroles of clinician, educator, consultant, and researcher. The CNS, as primary caregiver, can be influential in meeting the guidelines of Healthy People 2000 and implementing the interventions suggested in the Guide to Clinical Preventative Services for women.     

Breast Cancer Screening among Employed American Women

From the 1990 National Health Interview Survey Health Promotion and Disease Prevention supplement, the authors estimated the 1990 baseline prevalence of breast cancer screening among employed U.S. women aged 50-70 years. Proportions of women screened for breast cancer were calculated by occupational category and demographic characteristics, and were compared with the Healthy People 2000 objective that 60% of women aged 50 and older have had mammography and a clinical breast examination within the preceding two years. The objective was exceeded for white-collar workers (61.8%) and workers with some college (64.1%), but was not met by any blue-collar/service workers (40.8%); or any workers with only a high school diploma (54.7%) or less than a high school diploma (38.5%). Identification of occupational categories and demographic subgroups among working women will be helpful to those planning breast cancer screening programs, in both the public and the private sectors.