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Deals with the position paper presented to the President's Committee on Health Education in Boston, Massachusetts on January 6, 1972 concerning health promotion in the U.S. Basis of the health promotion recommendations of the paper; Importance of having a massive consumer health education effort; Establishment of state health education training centers.

The article presents news briefs regarding community health nursing. A report which has been released by the Centers for Disease Control and Prevention (CDC) regarding the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) is discussed. Guidelines which have been provided by the American Nurses Association (ANA) regarding the way in which health care workers should respond to emergencies and disasters are mentioned.

In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging ‘bubble’ of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care. [ABSTRACT FROM AUTHOR]

This paper proposes a new framework for describing well-being and hardship among low-income families. We describe previously unmeasured costs of being poor as latent, those costs that are hidden and not counted in other poverty measures, and sequential, those costs that are consequential and have subsequent cost implications. Using data from in-depth interviews with cash assistance recipients and working poor heads of household, we explore latent and sequential costs of poverty related to health. Families experience a wide variety of latent and sequential costs associated with their dental, vision, and general health needs. [ABSTRACT FROM AUTHOR]

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens. [ABSTRACT FROM PUBLISHER]

Since 1999, the estimates of annual preventable deaths in U.S. hospitals suggest that healthcare services add some risk to the patient's clinical condition. Such risks are often associated with harm resulting from errors in medication, diagnosis, and clinical procedures, among others. Preventing harm to patients demands the timely identification of risks to support the selection and implementation of effective strategies. While identifying and assessing risks in healthcare are particularly challenging due to the ambiguity and uncertainty that characterize such systems, most of the risk analysis methods currently used or proposed in healthcare have been developed for systems where unsafe conditions and risk metrics are well-defined. Therefore, their actual use in healthcare systems is inconsistent. The objective of this paper is to provide systems engineers, and researchers from related fields, with an overview of the current state of healthcare risk analysis and to highlight research contributions needed to support the proactive identification and assessment of risks in healthcare systems. [ABSTRACT FROM AUTHOR]

The U.S. Department of Health and Human Services implemented the Healthy People initiative to set national health objectives for four different decades since 1979. This national effort has promoted a shared vision for improving the health of all Americans in a very fragmented health care delivery system. The current Healthy People 2020 initiative being implemented by the Department's Office of Disease Prevention and Health Promotion differs from previous efforts in several important ways. This paper explores one of these changes: implementation of a new communication strategy based in modern information technology. This strategy conceptualized a Healthy People 2020 online space that would be a user-focused, 'one-stop shop' for public health and health care professionals, policymakers, and community members to learn about the objectives, plan interventions, and implement strategies to reach the 2020 objectives. The communication strategy incorporated new digital media, including building a following on LinkedIn and Twitter. At present, membership in the Healthy People LinkedIn group is more than 7700 people, and the Healthy People Twitter account (@gohealthypeople) has nearly 50 000 followers. In addition to the growth in number of users, the success of the communication strategy is also confirmed by the consistently high customer satisfaction rankings the site receives from the American Customer Satisfaction Index E-government Satisfaction Index. New developments in digital communication technology have the potential to advance three principal functions originally conceptualized for Healthy People 2020 online: benchmarking, advocacy, and connecting with others. Several exciting digital tools can be used to implement each of these key Healthy People 2020 functions, including mobile Web site optimization, smartphone/tablet apps, social media, and cloud computing. Ultimately, HHS can conduct research with Healthy People target audiences and stakeholders to inform the types of digital tools that will be most helpful to Healthy People 2020 users. [ABSTRACT FROM AUTHOR]

There is a very clear need for the expanded application of information technology (IT) in healthcare. Clinical workflow still depends largely on manual, paper-based medical record systems in an activity that is economically inefficient and produces significant variances in medical outcomes. IT spend currently represents around 1.3% of total healthcare spend on average. As shown in Table ES.1, this equates to a global market for healthcare information products and services of $47.5 billion in 2002. The value is forecast to grow by an average of 9.4% per annum to reach $74.5 billion in 2007. As may be expected, the US dominates the market, taking just under 50% of the 2002 global revenues, but will marginally fall back to take under 49% of the total by 2007. During this period, the US market is forecast to grow by an average of 8.9% per annum from $23.7 billion in 2002, to $48.7 billion in 2007. In contrast, the European market will grow at an average of 10.1% per annum, Japan by 8.5% per annum, but the rest of the world, which is currently under-provided with IT, by 10.5% per annum. Table ES.1. World healthcare IT market by region, 2002 and 2007. Year 2002 2007 Region Revenues ($ billion) Total (%) Revenues ($ billion) Total (%) Average per annum growth (%) Source: Author's estimates. US 23.7 49.9 36.3 48.7 8.9 Europe 14.3 30.1 23.2 31.1 10.1 Japan 3.9 8.2 5.9 7.9 8.5 Rest of the world 5.6 11.8 9.2 12.4 10.5 World total 47.5 100.0 74.6 100.0 9.4 [ABSTRACT FROM AUTHOR]

Copyright of Culture, Health & Sexuality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Focuses on application of advances in technology to facilitate the implementation of a large-scale, community research project. Application of technology by members of the social sciences; Improvement of the way scientists conduct community research in the U.S.

The interdisciplinary education of health professionals in the USA has increasingly been tied to renewed efforts directed toward quality improvement in the healthcare system, where problems with communication, collaboration, and cooperation are seen as endemic. Many of the published reports and recommendations on interdisciplinary programming, however, have omitted or downplayed the difficulties and challenges of developing and sustaining efforts in this area. Through the presentation of a detailed case study and the exploration of two laws of interdisciplinary programming proposed from it, this paper explores the fundamental difficulties of developing and, more importantly, sustaining interdisciplinary health professions programs in higher educational settings. The utilization of strategies based on emerging forces in the healthcare system and in higher education itself is suggested for initiating interdisciplinary projects, and structural and procedural factors are explored as critical in guaranteeing the long-term sustainability of such programs. Recommendations for the successful development and implementation of interdisciplinary programs in higher educational contexts are suggested, focusing particularly on the role of an advocate in the top down and bottom up development and maintenance of the resources needed for the success of such programs. [ABSTRACT FROM AUTHOR]

Twice in recent times, the federal government mailed critical health-related information to every household in the United States. The mailings, the 1988 brochure Understanding AIDS and the 2001 postcard A Message to Americans, were designed to provide the general public with important information about needed action. This paper compares the development process undertaken for each mailing. The authors assess content and format in light of communication principles and the functional literacy skills of average adults. The authors, noting that the reading grade level of the postcard exceeds the reading ability of the average adult, recommend that plain language guidelines be combined with health and risk communication principles in all future efforts to alert the public. [ABSTRACT FROM AUTHOR]

There has been considerable progress in reducing barriers to care for African and Hispanics Americans. Yet current research indicates that overall African and Hispanic Americans are disproportionately encountering barriers to care. Unfortunately very little is known regarding the status of African and Hispanic Americans with disabilities. The purpose of this paper is to assess by using data from the 1987 National Medical Expenditure Survey (NMES), the degree of disability for African, Hispanic and Native Americans and the extent to which it is correlated with the use of services. The findings report that as in the case of other African and Hispanic Americans, African and Hispanic Americans with disabilities dis-proportionately encounter barriers to care. They are more likely than whites to lack insurance, a regular provider and less likely to see a doctor during the year. The implications of these findings for the care of persons with disabilities are discussed. [ABSTRACT FROM AUTHOR]

This paper gives estimates by industry of cost and price impacts of mandatory workplace health insurance, which is part of the National Health Plan (NHP), a legislative proposal of the previous administration. The NHP proposal insures that most US residents have, at minimum, protection against catastrophic medical expenses. The paper briefly (a) describes major aspects of the workplace proposal; (b) discusses its economic effects, including alternative shifting and incidence situations; (c) presents the methodology of the estimates; and (d) summarizes simulation results. [ABSTRACT FROM AUTHOR]

This article addresses the challenges solidarity poses for the development of Precision Medicine (PM). Solidarity is invoked in calls for a new 'social contract' for PM, seeking to promote participation in PM by emphasizing reciprocity between contributions to and benefits from this new branch of medicine. In this context, there is a need for further conceptualization with regard to what qualifies as solidarity and how solidarity is performed in Precision Medicine initiatives. We address these conceptual gaps that have important practical implications for PM's development, most notably for agendas of public engagement and trust. We argue that solidarity does not only represent a value but also takes on infrastructural forms, shaping how PM is practiced in, for example, healthcare delivery systems. Next, we empirically probe how solidarity is invoked in PM initiatives in the United States ('All of Us'-Program) and Europe (the UK 100,000 Genomes Project and the French 2025 Genomics Plan). Based on this analysis, we argue that the infrastructural dimension of solidarity forms a vital precondition to build trust in PM. Echoing the famous motto of The Three Musketeers, 'One for all, all for one', PM policies cannot just proclaim solidarity for the gathering of data alone ('One for all') without caring about delivery of benefits of PM ('All for one'). We conclude by proposing an empirical research agenda for studying infrastructural formations to secure solidarity in the implementation of PM practices across national contexts. [ABSTRACT FROM AUTHOR]

Background: Several aspects of the opioid epidemic and of public health care organization in the United States (US) make the conduct of economic evaluation and the design of policies to respond to this crisis particularly challenging. Objectives: This commentary offers suggestions for how economic evaluation may address and overcome four key features of the opioid epidemic: 1) its magnitude and geographical distribution, 2) its intersection with multiple epidemics, 3) its rapidly changing dynamics, 4) its multi-sectoral causes and consequences. Results: We first offer pragmatic suggestions to address the difficulties in delivering a coordinated response given the fragmented nature of health care in the US. In view of the broad suite of responses required to address opioid use disorder and its associated comorbidities, we highlight the need for economic evaluations which consider interventions throughout the continuum of care (i.e. primary, secondary and tertiary levels of prevention). We examine how the use of predictive modelling alongside economic evaluation might be adopted to address the rapidly evolving situation affecting distinct populations and geographic areas and encourage investments in epidemic preparedness. Finally, we propose methods to capture the interdependence of various sectors of government affected by the opioid crisis in economic evaluations to ensure optimal levels of investment towards a comprehensive response. Conclusions: The opioid epidemic in the US represents an unprecedented public health challenge, but sound epidemiological modelling and economic analysis can help to guide use of limited resources committed to addressing it in ways that can have greatest impact in limiting its adverse consequences. [ABSTRACT FROM AUTHOR]

Health and health care delivery continue as dominant domestic issues in the United States. Health also represents a highly sophisticated social work practice area, requiring specific expertise for intervention with complex biopsychosocial patient care issues. Current social work curriculum content must reflect contemporary practice issues and educational resources must be improved to meet the documented need for adequately prepared health care professionals. This paper proposes a curriculum template for practice education and offers additional recommendations to enhance the educational process through increased field and academic collaboration. [ABSTRACT FROM AUTHOR]

Reports on the plan of the U.S. National Institutes of Health (NIH) to let NIH-financed research be available to the public. Views of NIH director Elias Zerhouni on the plan; Database used by the agency; Importance of the plan to the U.S. healthcare system.

This article focuses on medical care in the U.S. In the 1950s, the then Minister of Health, Iain Macleod, described the boundary between health and social care as perhaps the most baffling problem in the whole of the NHS. Against this background, recent policy has tended to transfer a number of local government functions to the NHS. In addition, local authority-led health services would lead to a reduction in the democratic deficit of the NHS, making sure that vital public services are overseen by elected representatives rather than centrally appointed and less open and accountable NHS boards.

We present a case of failed prehospital treatment of fentanyl induced apnea with intranasal (IN) naloxone. While IN administration of naloxone is becoming more common in both lay and pre-hospital settings, older EMS protocols utilized intravenous (IV) administration. Longer-acting, higher potency opioids, such as fentanyl, may not be as easily reversed as heroin, and studies evaluating IN administration in this population are lacking. In order to contribute to our understanding of the strengths and limitations of IN administration of naloxone, we present a case where it failed to restore ventilation. We also describe peer reviewed literature that supports the use of IV naloxone following heroin overdose and explore possible limitations of generalizing this literature to opioids other than heroin and to IN routes of administration. [ABSTRACT FROM AUTHOR]

Food security and health are complex interrelated issues. Individual characteristics exist within the physical and built environments. Title IV of the Food, Conservation, and Energy Act of 2008 is analyzed in terms of how it addresses systemic food insecurity and the opportunities the policy has for improving public health by increasing support for the availability of affordable local produce to low-income households. Structural changes need to occur for programs to be equitable, efficient, and effective. Interdisciplinary leadership within government agencies, school systems, social service agencies, health care agencies, and nonprofit networks is necessary to ensure food security and health for all Americans. Social work and public health practitioners have the opportunity to change the status quo, encourage community-level interventions, advocate for producers and consumers, and encourage more equitable distribution of food to create a healthier low-income population. [ABSTRACT FROM AUTHOR]

The ability of leaders in healthcare organizations to successfully articulate a vision - a desired future state - is central to organizational success in the rapidly changing world of healthcare. Public relations professionals playing the role of key policy and strategy advisors are in ideal positions to help create organizational visions. This pilot study explored the role of top public relations practitioners in the visioning process. In-depth interviews were conducted with US practitioners in various healthcare positions. The results indicate that professionals in top positions in healthcare organizations are not making optimal contributions to the visioning process. Some practitioners view their visioning roles as limited to communication and did not view the crucial task of bringing the views of stakeholders to the visioning process as part of their responsibilities. Others who indicated it was part of their role to bring views of stakeholders to the visioning process did not report using any systematic effort to prioritize stakeholder groups. The author urges professionals involved in visioning to use available material concerning stakeholder prioritization in order to maximize their contributions to visioning at their respective organizations. [ABSTRACT FROM AUTHOR]

Substance abuse represents a significant underlying cause of the health issues faced in the United States, which severely impacts the nation's health care system and economy. Recently enacted parity legislation mandates that benefits for addiction and mental health treatment be provided on an equal footing with those for treatment for physical health. Diversion and abuse of prescription medications is growing in young people, with much of the diversion occurring between family and friends. Addiction has been accepted by mainstream medicine as a brain disease, and is associated with many other medical disorders. Early intervention and treatment for addiction provides extraordinary cost-benefit outcomes. Additional training for addiction professionals will be necessary. Stigmatization of substance abusers continues to exist at the state and federal levels, although research during the past 10 years indicates that patient compliance and relapse rates for substance abusers are not significantly different than those for individuals with other chronic diseases, e.g. diabetes, hypertension, and cardiac issues. While parity for addiction treatment has become policy at the federal level, great challenges lie ahead in funding access, facilities, and training, as well as redirecting societal perceptions and legislated penalties. [ABSTRACT FROM AUTHOR]

ICD-9-CM diagnosis codes are increasingly used to estimate the burden of disease, as well as to evaluate the quality of care and outcomes of various conditions. Acute exacerbations of COPD (AE-COPD) are common and associated with substantial health and financial burden in the U.S. Whether published algorithms that employ different combinations of ICD-9-CM codes to identify patients hospitalized for AE-COPD yield similar or different estimates of disease burden is unclear. In this study, the Nationwide Inpatient Sample from years 2000–2006 was used to identify and compare the number of hospitalizations, healthcare utilization, and outcomes for patients hospitalized for AE-COPD in the U.S. AE-COPD was identified using five different published ICD-9-CM algorithms. Estimates of the annual number of hospitalizations for AE-COPD in the U.S. varied more than 2-fold (e.g., 421,000 to 870,000 in 2006). Outcomes and healthcare utilization of patients hospitalized for AE-COPD varied substantially, depending on the algorithm used (e.g., in-hospital mortality 2.0% to 5.1%, total hospital days 2.0 to 5.1 million in 2006). Observed trends in the number of hospitalizations over the 7-year period varied depending on which algorithm was used. In conclusion, the estimated health burden and trends in hospitalizations for AE-COPD in the United States differ, depending on which ICD-9-CM algorithm is used. To improve our understanding of the burden of AE-COPD and to ensure that quality of care initiatives are not misdirected, a validated approach to identifying patients hospitalized for AE-COPD is needed. [ABSTRACT FROM AUTHOR]

Efforts to describe health literacy in the last decade have helped us define the issue and recognize that our public's skills and abilities are not adequate for successfully navigating the growing demands and complexity of healthcare. There have been significant developments in health literacy over the last decade, with milestones of progress. Much of the work done in the 1990s focused on defining health literacy, initially measuring its prevalence and subsequently looking at its associations. Since then, health literacy has grown from an issue of an under-recognized “silent epidemic” to an issue of health policy and reform. Ideas and objectives proposed have actually been adopted in recent years, with significant policy developments. This article recognizes many achievements and milestones while developing recommendations for implementation in the decade ahead. [ABSTRACT FROM AUTHOR]

The Delaware Geography-Health Initiative is a Web- and GIS-based set of lesson units for teaching geographic concepts and research methods within the context of the state's high school geography standards. Each unit follows a research-based, inquiry-centered model addressing questions of health because of Delaware's high incidence of cancer, HIV/AIDS, and infant mortality. Topics focus on cancer and the environment, the geography of HIV/AIDS, the diffusion of West Nile fever, provision of emergency ambulance services, the location of the state's next hospital, infant mortality and the location of prenatal care, and identification of healthy places. Results from piloting and early formative assessments were used to modify the final product. Lessons learned in developing this project may assist those seeking to create GIS-based state-specific teaching units for geography and other related subjects. [ABSTRACT FROM AUTHOR]

Since the 2003 launch of NC Health Info, the National Library of Medicine (NLM) has encouraged the development of Go Local databases. A team of Go Local enthusiasts at North Dakota's only medical school library wanted to obtain NLM funding and build a resource for their rural state. Although short on staff, money, and time, the team found a way to realize a Go Local database that serves the state's residents and helps them “Discover Health Services Near You!” A team approach and collaboration with health providers and organizations worked well in this small rural state. North Dakota's Go Local project offers a low-cost model that stresses collaboration, teamwork, and technology. Part I, which appeared in the last issue, describes the rural setting, explains how the project was conceived, and the processes necessary to begin building the database. Part II, which appears in this issue, details how records were created including developing the input style guide and indexing decisions, the NLM testing and review process, the maintenance and auditing process, and publicity and promotion of the project. [ABSTRACT FROM AUTHOR]

The Drug Information Portal is a free Web resource from the National Library of Medicine (NLM) that provides a user-friendly gateway to current information for more than 15,000 drugs. The site guides users to related resources of NLM, the National Institutes of Health (NIH), and other government agencies. Current drug-related information regarding consumer health, clinical trials, AIDS, MeSH pharmacological actions, MEDLINE/PubMed biomedical literature, and physical properties and structure is easily retrieved by searching on a drug name. A varied selection of focused topics in medicine and drugs is also available from displayed subject headings. This column provides background information about the Drug Information Portal, as well as search basics. [ABSTRACT FROM AUTHOR]

The state of child and adolescent overall health in the United States evidences the need for both prevention and treatment. Although much time and energy has been spent in recent years discussing and improving health benefit coverage and affordability for children, physical access to services has not kept pace with these changes. This article will introduce four major physical health issues (obesity, diabetes, asthma, and teen pregnancy/STD) and five key mental health issues (suicide, depression, ADHD, aggression, and violence) facing young people today. In an effort to answer the question, “What can be done?” school-based health clinics and their impact on health and educational outcomes are examined. [ABSTRACT FROM AUTHOR]

Latinos are the largest minority group in the U.S. For Latino immigrants, a shift in migration from larger to smaller cities has recently occurred; the Latino immigrant population in Charlotte, North Carolina, has increased by 634% since 1990. The extent to which immigrants can achieve health and well-being is often related to employment, healthcare access, and social support. This study explored the human, social, and financial capital circumstances of Latino immigrants new to Charlotte and examined the effects of different aspects of capital on health outcomes. Findings indicate that capital is significantly associated with functional status and depression. Implications for social work are discussed. [ABSTRACT FROM AUTHOR]

Increasing HIV testing is a necessary step toward control of the disease. Many experts suggest routinely offering HIV testing to specific population segments. We explore provider discourse regarding an HIV test implementation project with the aim of illuminating a structurally emergent clinician strategy for promoting testing and the socio-cultural factors underlying it. Twenty US Veterans Affairs Healthcare System clinical care providers were interviewed. Using standard anthropological text analysis techniques, themes, their relationships, and the significance of these for increasing appropriately targeted HIV test offers were established. Presenting the HIV test offer to their patients as if routine ('routinisation') supported providers' desire to do no harm by lessening the test's potential stigma. Offering the test helped providers maintain professional integrity: it empowered veterans to realise access to care and fit with providers' sense of honour and duty. Routinising HIV testing also helped providers to manage scarce time effectively. Findings can be leveraged to support routine screening's successful roll-out. The carefully managed introduction of routine HIV test offering policies will formalise and legitimise productive strategies of destigmatisation already being enacted by some front-line providers. The fact that routinisation strategies are in use although HIV testing is not actually routine attests to the potential power routinisation has to reduce HIV's stigma, increase HIV test uptake, and thereby improve access to care. What I've learned about tough questions is: The more routine you make them, the easier it is to get the questions answered, the less destructive it is to the relationship and that's the sort of paradigm I've come to believe in and will use now into the future. (Marvin K, MD) [ABSTRACT FROM AUTHOR]

Agencies that deliver health care services to H1V-positive substance abusers living in rural areas of the United States face particular treatment challenges and barriers to care. Rural consumers of HIV/AIDS health care-related services identified long travel distances to medical facilities, lack of transportation, lack of availability of HlV-specific medical personnel, a shortage of mental health and substance abuse services, community stigma, and financial problems as leading barriers to access to care. This article discusses barriers to care for rural HIV-positive substance abusers, and challenges for rural health care providers. In addition, it presents a case study of Health Services Center. a model program that has devised innovative practices in the delivery of health care services to HIV-positive substance abusers in rural northeastern Alabama. [ABSTRACT FROM AUTHOR]

State-provided health insurance has now spread throughout much of the industrialized world. The United States is a particular exception to this trend. The U.S. uninsured represents one-sixth of its population. The uninsured exemplify those on the margins of the U.S. health care system. Based on qualitative research with 215 chronically ill, uninsured ethnic minorities, I argue that the U.S. system fosters an organized approach of containment toward the uninsured that not only marginalizes them but it keeps the problem of the uninsured in check by discouraging people from using health care services. Respondents viewed the treatment they received as an assault on their dignity and experienced discrimination, depersonalization, and disenfranchisement. They avoided using the health care system whenever possible despite chronic, life-threatening illnesses. I conclude that the uninsured, as a problem of the state, lies at its very heart, with implications for the health and well-being of the uninsured as well as for the governmental systems that attempt to manage and contain them. [ABSTRACT FROM AUTHOR]

The origins and development of interdisciplinary health care teams in the US is traced from World War II successes with multidisciplinary medical and surgical teams to President Johnson's vision of The Great Society, in which the poor and underserved would have access to benefits of good health through the creation of community health centers located in areas of need. The concept of interdisciplinary teams of health professionals was espoused as a means for providing comprehensive and continuous care to such populations. This movement had significant implications for the education and training of future health professionals and both the federal government and philanthropic foundations have endeavored to effect changes in traditional disciplinary models. Despite repeated efforts, there remain many barriers to interdisciplinary and interprofessional education and practice in the US. [ABSTRACT FROM AUTHOR]

Over the last ten years, partly in response to the backlash against restrictions on personal choice created by old forms of 'managed care', health plans in the USA have developed population health management programmes to target healthcare support services based on the level of patient need. Their large transaction processing functions create bases of data, linking primary, secondary, hospital, pharmacy and laboratory data for each individual they serve, giving them a unique capability to view and analyse the landscape of care for an entire population. Sophisticated new risk stratification techniques are used to identify health risk trajectories at the individual level so that at-risk individuals can be targeted with services to help them navigate the health system more efficiently and effectively. Interventions range from complex case management for individuals in the middle of acute episodes, disease management for individuals facing chronic care needs, health coaching for lifestyle-sensitive conditions, and personalised messaging services for primary and secondary prevention. These programmes show some improvement in adherence to recommended care paths, better management of chronic disease and aggregate savings at the population level. [ABSTRACT FROM AUTHOR]

While the digital divide remains a special problem in health care, providers' reluctance to refer patients to the Internet is an equally important problem. The Bridging the Digital Divide Project: Your Access to Cancer Information was designed with two target audiences in mind—consumers and health care providers. A total of 256 providers from varied health care settings enrolled in workshops over a 10-month period (2001–2002). Results suggest differences in awareness and use of on-line cancer information among providers and confirm that many providers need to become more comfortable with referring patients to on-line information. At completion of the workshops, all participants reported an increased awareness of cancer information websites, increased confidence in making judgments about the reliability and appropriateness of the sites, an increased willingness to discuss Internet information sources with patients and their family members, and an increased awareness of and intention to use the CIS. Providers from the community hospital were more likely than other groups to report that what they had learned about the Internet was helpful and that their comfort level using the Internet had increased. Partnerships between providers and the CIS may help to further increase this comfort level, ultimately benefiting cancer patients. [ABSTRACT FROM AUTHOR]

The author, a psychologist who has been specializing in end-of-life issues for over a decade, uses the death of his fiancée (Becky), following the withdrawal of a ventilator and the refusal to place her back on the machine, to discuss research and analysis of end-of-life care in the United States. After briefly discussing his own background, Becky's history, and their relationship, he details Becky's last weeks of life and the first weeks of his grieving process. This story provides a background for discussing end-of-life issues including what constitutes a “good death,” concerns about aggressive treatment and the cost of care near the end of life, prognosis, advance directives, and demographic issues. There is also a major section on psychosocial issues that arise when a person is dying. The author concludes with a set of “lessons learned” as a result of his relationship with Becky and going through the dying process with her and her family. [ABSTRACT FROM AUTHOR]

The first recognition of a bioterrorist attack may be sick patients. Recognition and subsequent notification of an attack at the earliest possible moment will assist in rapidly instituting protective measures. New methods of medical surveillance can assist with rapid detection. Syndromic surveillance is the use of newly created or pre-existing databases to track the health of communities. The data can include medical and non-medical information, but typically contains non-specific indicators of health status. These systems are currently being tested and fielded in multiple locations, and nationwide systems are being developed in the United States. Retrospective and prospective analyses have demonstrated the ability of the data to detect disease outbreaks, but the systems have yet to be proven to lead to more effective interventions. [ABSTRACT FROM AUTHOR]

Evidence-based practice (EBP) in mental health is generating much interest throughout the world. England is the world leader in EBPs. Key issues in implementing EBPs are summarized. Based on extensive interviews, EBPs and sources of information in the United Kingdom are reviewed, development of EBPs in the United States and the United Kingdom are compared, and the challenges of translating evidence of effectiveness to practice are discussed. [ABSTRACT FROM AUTHOR]

Objective.To examine the role of race/ethnicity in the use of informal long‐term care among African American and white elders, using an expanded Andersen model of health services use (Bradley et al., Health Services Research, vol. 37, pp. 1221–1242, 2002). Design.Four hundred respondents (n = 200 African American; n=200 white) aged 65 and older, who had been hospitalized within the last year. Data were collected using a cross‐sectional survey analyzed with ordered logistic regression. Independent variables included individuals' predisposing factors, enabling factors, need, and psychosocial factors. Intended use of informal long‐term care was defined based on responses to a hypothetical scenario of future use of unpaid services by family members, relatives, friends, or neighbors for help with daily needs. Results.African American respondents were more likely than white respondents to intend to use informal long‐term care. This effect persisted (p < 0.05) after controlling for predisposing, enabling, and need factors. However, race/ethnicity‐related differences in intended use were attenuated substantially (14–18%) after controlling for psychosocial differences. Further, in the fully adjusted models, race/ethnicity was no longer significantly associated with intended long‐term care use. Conclusions.Psychosocial factors, particularly social norms concerning family caregiving, mediated the relationship between race/ethnicity and intended use of informal long‐term care. A fuller appreciation of the multiple influences on healthcare decision making of older adults has the potential to inform policy efforts to appropriately meet the respective long‐term care needs of an ethnically diverse frail older population. [ABSTRACT FROM AUTHOR]

Caregiver workshops were offered to members by a group practice HMO as part of a larger demonstration of adding community care toHMOservices. Of 1,200 members indicating interest at four sites, 532 participated in workshops and 320 completed pre- and post- questionnaires on effectiveness. Analyses showed improvements in caregiving preparedness and reductions in sadness and depression. Engagement in the workshops (completing 3 or more sessions) and improvements were more likely for individuals with more independent lives and social capital. Alternative helping strategies are recommended for caregivers who are less likely to engage in classes due to burden or lack of respite or transportation. [ABSTRACT FROM PUBLISHER]

Little research has been conducted on the health status and health-related issues of urban American-Indian women, particularly those who are involved with alcohol or drugs (AOD). Given this gap in knowledge, this study assessed the health status along with health care needs and service provision of AOD-involved American-Indian women living in the southwestern United States. Results indicated high levels of AOD use; experiences of sexual misbehavior; multiple pregnancies with adverse outcomes, including stillbirth and loss of child custody; and need for additional health care services. Recommendations include enhancing the education of health care providers with regard to American-Indian women’s AOD use and the need for comprehensive, culturally competent, gender-specific AOD treatment services. [ABSTRACT FROM PUBLISHER]

For the people of the United States, the threat of bioterrorism has become a reality. To respond to the recent outbreak of anthrax cases and to prepare for future threats, the health care community, civil authorities, and general public need access to reliable, up-to-date information. The Web is one tool that can be used to deliver this information. This article briefly defines bioterrorism, identifies major biological agents, looks at the potential impact of an attack and provides a selected list of Web sites for consumers and health care professionals. The selection criteria used to evaluate the sites included sponsorship, currency, content (factual information), and audience. Most of the sites are from government organizations, educational institutions, or professional associations. [ABSTRACT FROM PUBLISHER]

This article presents information on the Cooperative Agreement Projects launched by the U.S. Department of Health and Human Services' (DHHS) Special Projects of National Significance program to fund 27 innovative models of HIV care. The organizations involved in HIV care aim to improve access to care, health and quality of life for traditionally underserved populations living with HIV/AIDS. It explains that the population being served by the projects have the following characteristics: 88.9% lacked private insurance, 72.5% were people of color and 85.7% were unemployed or unable to work due to a disability. It added that 22.1% had a history of sex work.

The article presents remarks and notes pertaining to sex research. Sexually transmitted diseases (STDs) are an acute problem in the U.S. Gonorrhea reached epidemic proportions by the mid-sixties and the numbers of cases continued to rise sharply between 1967 and 1975. Recently, herpes, acquired immunodeficiency syndrome and Chlamydia trachomatis infections also have become major health problems in the U.S. Many explanations have bean offered for the continuing and growing STD problem. They range from suggestions about official neglect to descriptions of conflicts among local and federal officials about the cause of the gonorrhea hazard, inadequate public health care facilities, to public apathy and ignorance of the problem. Socio-cultural explanation of STDs includes a number of historical factors that are potentially useful in understanding the STD problem. Scientists proposed several reasons for the unsuccessful efforts of public health officials to control STD, especially gonorrhea. Several reasons include the low status at the target population at risk, negative attitudes toward STDs persisting among more affluent members of the community and the low priority of venereal disease control.

The article discusses the issues generated by AIDS in college campuses in the U.S. The American College Health Association has established a Task Force on AIDS in late 1985 with the purpose of providing recommendations and guidelines for institutions to use in formulating a response to AIDS. The issues generated by AIDS cause discomfort and uncertainty for many school administrators, counselors and health care providers. The growing number of AIDS cases, the frightening fatality rate, and the extraordinary amount of media attention paid to it have subsequently combined to create a high degree of public awareness of the disease.

Provides insights into the health care system in the U.S. in the 1960s and the 1970s. Increase in the cost of health care; Limitations in the scope of medical care in terms of gravity of illness; Financial barriers to health care. INSETS: An Ounce of Prevention;THE TOP TEN.

This study looks at a variety of factors that may affect Health Maintenance Organization (HMO) efficiency, focusing on the economic incentives that derive from ownership. Previous studies have found that HMO efficiency depends largely on the extent to which ambulatory services substitute for inpatient services. Our analysis supports this conclusion, but takes it one step further. We demonstrate that owners who also provide health care services-specifically physicians and hospitals-may have an incentive to use more of their particular service. Our empirical results show that hospital-owned HMOs do in fact use more inpatient services than do HMOs owned by physicians or others, indicating that hospital-owned HMOs will be less efficient. [ABSTRACT FROM AUTHOR]

Medical geography frequently contributes to public health, but rarely are medical geographic concepts applied in clinical settings. This article describes the application of medical geographic concepts to an academic travel and tropical medicine clinical services at University Hospital in Seattle, and reviews the role of a medical geographer in this particular clinical setting. Applied concepts of medical geography improve the quality of patient care for overseas travelers and recent immigrants to the United States. [ABSTRACT FROM AUTHOR]