Digital Commons Network^™

Improving Quality Of Care For Family Planning Services In Uganda, Joel Okullo, Quinto Okello, Harriet Birungi, Ian Askew, Barbara Janowitz, Carmen Cuthbertson, Florence Ebanyat

Reproductive Health

The Regional Centre for Quality of Health Care at Makerere University, Uganda in collaboration with the Delivery of Improved Services for Health II Project, the Ministry of Health (MOH), and the Population Council’s FRONTIERS Program, conducted an operations research project to help the MOH improve the quality of family planning services with the aim of helping couples better attain their reproductive goals. The study developed a package of interventions (the Yellow Star Programme—YSP) that sought to increase the readiness of clinics to offer basic family planning services, to improve provider motivation, and to empower clients to request quality services. The …

Introducing Dmpa Injectable Contraceptives To Private Medical Practitioners In Urban Gujarat, Frontiers In Reproductive Health

Reproductive Health

Many public, NGO, and private-sector service-delivery systems are suitably matched to the requirements of providing injectable contraceptives in India, including the ability to ensure choice and service delivery quality. This operations research study was designed to demonstrate the feasibility of providing injectable contraceptives in private medical practices and to contribute to the body of scientific literature on the acceptability of this method in India. DKT India and EngenderHealth formed a partnership with the Population Council’s Frontiers in Reproductive Health program to conduct this study in Gujarat. The ability to generate recommendations is limited, however, by the special characteristics of the …

Replication Of The Tostan Programme In Burkina Faso: How 23 Villages Participated In A Human Rights-Based Education Programme And Abandoned The Practice Of Female Genital Cutting In Burkina Faso, Nafissatou J. Diop, Edmond Bagde, Djingri Ouoba, Molly Melching

Reproductive Health

This document is a summary of the process followed in implementing a community-based education program in Burkina Faso. The Population Council initiated a collaboration between two NGOs, Tostan in Senegal and Mwangaza Action in Burkina Faso, to replicate the program for improving women’s reproductive health and contributing to the end of female genital cutting (FGC). In Burkina Faso, the participants (men and women) held discussions to analyze the problems faced by their communities and to find appropriate solutions. Many positive changes occurred in the participating villages: the communities now promote reproductive health and human rights and work to improve public …

Cultural Norms And Behavior Regarding Vaginal Lubrication During Sex: Implications For The Acceptability Of Vaginal Microbicides For The Prevention Of Hiv/Stis, Sarah Braunstein, Janneke Van De Wijgert

Reproductive Health

This paper presents the results of an extensive review of the literature pertaining to the relationship between vaginal lubrication and the acceptability of microbicides, spermicides, and male and female condoms. The review highlights the need for research that better elucidates norms, preferences, and practices regarding lubrication during sex within and across countries. The second part of the report presents the results of the first phase of a qualitative study on lubrication during sex showing that diverse personal and cultural factors shape preferences and practices and may ultimately affect the acceptability of microbicides. The immediate challenge is to provide women with …

Changing Family Planning Scenario In India: An Overview Of Recent Evidence, K.G. Santhya

Reproductive Health

Over the decades, there has been a substantial increase in contraceptive use in India. The direction, emphasis and strategies of the Family Welfare Programme have changed over time. However, meeting the contraceptive needs of considerable proportions of women and men and improving the quality of family planning services continue to be a challenge. The 1990s witnessed a growing recognition of this, and several innovative policy and programme initiatives have been launched to address these issues. This paper reviews and synthesises evidence from surveys and studies conducted in the 1990s and thereafter on contraceptive use dynamics and the unmet need for …

Actions That Protect: Promoting Sexual And Reproductive Health And Choice Among Young People In India, Shireen J. Jejeebhoy, Mary Philip Sebastian

Reproductive Health

This paper synthesises the evidence on the sexual and reproductive health situation of young people in India, and explores what we know about underlying factors that place them at risk of or protect them from unsafe and unwanted sexual and reproductive health experiences. The picture that emerges suggests that substantial proportions of young people experience risky or unwanted sexual activity, do not receive prompt or appropriate care, and experience adverse reproductive health outcomes. Contextual factors such as poverty, gender imbalances and lack of education or livelihood opportunities clearly increase the vulnerability of youth. Other factors at the family, community and …

Évaluation Des Indices De Contrainte Thermique En Mines Profondes, Pierre C. Dessureault, Mathieu Doucet

Rapports de recherche scientifique

L’Association Minière du Québec a logé une demande à l’effet d’utiliser le Air Cooling Power (ACP) comme indice de contrainte thermique dans les mines souterraines. Cet indice est en fait une adaptation de l’approche analytique basée sur le calcul du bilan thermique entre l’homme et son environnement. L’objectif premier de cette étude est de déterminer si cette approche rationnelle est au moins équivalente ou encore plus appropriée aux conditions de travail en mine profonde que l’application de l’indice WBGT. Elle doit aussi vérifier que le niveau d’astreinte thermique des travailleurs soit en deçà des limites généralement acceptées sous l’un ou …

Cancer Mortality Among American Indians And Alaska Natives: Regional Differences, 1994-1998, D.K. Espey, R.E. Paisano, N. Cobb

Native Health Database Full Text

This monograph delineates cancer mortality rates among American Indians and Alaska Native within the different regions served by the Indian Health Service (IHS). The table and charts depict broader geographic regions than in previous IHS cancer mortality monographs. The estimated IHS service population for each region and the cancer mortality rates from 1994 to 1998 are presented. Comparisons are made to the general U.S. population for the same time period. The intention of this publication is to provide detailed information about thew impact of cancer among Native American peoples, with a focus on the regional variability of cancer incidence for …

Urinary Excretion Of Dithiocarbamates And Selfreported Cruciferous Vegetable Intake: Application Of The ‘Method Of Triads’ To A Foodspecific Biomarker, Jay H. Fowke, James R. Hébert, Jed W. Fahey

Faculty Publications

Objective: Greater intake of Cruciferous vegetables (e.g. broccoli) may prevent cancer at several sites. Urinary excretion of isothiocyanate conjugates (dithiocarbamates, DTC) provides a specific biomarker of Cruciferous vegetable consumption suitable for epidemiological investigations. However, no gold-standard referent is available for evaluating urinary DTC levels as an estimator of Cruciferous vegetable consumption. We compared urinary DTC levels to intake as measured by two selfreported dietary assessment techniques. Design: Cruciferous vegetable consumption was measured before and after a behavioural dietary intervention using multiple 24-hour recalls (24HR), a foodcounting questionnaire (VFQ) and urinary DTC excretion levels. Analysis included a structural equation approach (Method …

Analysis Of Longitudinal Marginal Structural Models , Jennifer F. Bryan, Zhuo Yu, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

In this article we construct and study estimators of the causal effect of a time-dependent treatment on survival in longitudinal studies. We employ a particular marginal structural model (MSM), and follow a general methodology for constructing estimating functions in censored data models. The inverse probability of treatment weighted (IPTW) estimator is used as an initial estimator and the corresponding treatment-orthogonalized, one-step estimator is consistent and asymptotically linear when the treatment mechanism is consistently estimated. We extend these methods to handle informative censoring. A simulation study demonstrates that the the treatment-orthogonalized, one-step estimator is superior to the IPTW estimator in terms …

U.S. Childhood Vaccine Availability: Legal, Regulatory, And Economic Complexities, Robin J. Strongin

National Health Policy Forum

Despite the vital role they play in public health, childhood vaccines travel a complicated road from laboratory to provider and patient. From the fall of 2000 until well into 2002, a combination of factors, including market dynamics, legal challenges, and regulatory hurdles, led to a shortage of some childhood vaccines. This paper examines each of these factors, focusing on the important roles of both the public and the private sectors.

Activity Patterns And Correlates Among Youth: Differences By Weight Status, Wendell C. Taylor, James F. Sallis, Marsha Dowda, Patty S. Freedson, Karen Eason, Russell R. Pate

Faculty Publications

The purposes of the study were to assess differences in physical activity levels and correlates of physical activity among overweight (‡ 85th percentile of body mass index for their sex and age) and non-overweight (< 85th percentile) youth. The sample included 509 seventh through twelfth graders. Activity was measured by a 7-day, 46-item activity checklist. Overweight girls were more sedentary than non-overweight girls (p<.03), and non-overweight girls engaged in more vigorous physical activity than overweight girls (p<.03). For boys, there were no significant differences in activity. The regression analyses for vigorous activity yielded the largest total R²'s (R²=.049 for overweight and R²=.27 for non-overweight.) The significant factor for overweight youth was greater athletic coordination (p<.01). For non-overweight youth, the significant factors were greater family support (p<.05), greater peer support (p<.001), fewer barriers (p<.03), and greater athletic coordination (p<.01). Correlates of physical activity vary by weight status of young people.

An Empirical Study Of Marginal Structural Models For Time-Independent Treatment, Tanya A. Henneman, Mark J. Van Der Laan

U.C. Berkeley Division of Biostatistics Working Paper Series

In non-randomized treatment studies a significant problem for statisticians is determining how best to adjust for confounders. Marginal structural models (MSMs) and inverse probability of treatment weighted (IPTW) estimators are useful in analyzing the causal effect of treatment in observational studies. Given an IPTW estimator a doubly robust augmented IPTW (AIPTW) estimator orthogonalizes it resulting in a more e±cient estimator than the IPTW estimator. One purpose of this paper is to make a practical comparison between the IPTW estimator and the doubly robust AIPTW estimator via a series of Monte- Carlo simulations. We also consider the selection of the optimal …

Laboratory Response To Anthrax Bioterrorism, New York City, 2001, Michael B. Heller, Michel L. Bunning, Martin E.B. France, Debra M. Niemeyer, Leonard Peruski, Tim Naimi, Phillip M. Talboy, Patrick H. Murray, Harald W. Pietz, John Kornblum, William Oleszko, Sara T. Beatrice, Joint Microbiological Rapid Response Team, New York City Anthrax Investigation Working Group, Denis Nash

Publications and Research

In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory’s (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as …

Running On Empty: The State Budget Crisis Worsens, Randy Desonia

National Health Policy Forum

This issue brief reviews the status of state budget shortfalls and their growing impact on the Medicaid program. It describes the magnitude of the shortfalls, the forces behind them, and how states have responded with spending cuts and tax increases. It also discusses how long the budget crisis is expected to continue and what budget balancing options remain for fiscal year 2003.

Erisa Health Plans: Key Structural Variations And Their Effect On Liability, Phyllis Borzi

Health Policy and Management Faculty Publications

No abstract provided.

Schip Turns Five: Taking Stock, Moving Ahead, Jennifer Ryan

National Health Policy Forum

This issue brief notes the five-year anniversary of the effective date of Title XXI of the Social Security Act, the State Children's Health Insurance Program (SCHIP). It looks at the successes of the program, as well as some of the obstacles SCHIP will face as it moves from childhood into adolescence and attempts to maintain its effectiveness in providing health coverage to uninsured children and families. The paper explores the critical funding impasse created by the downturns in the economy and the financing structure of the SCHIP statute. It also highlights the emerging issue of program retention and the need …

Dose Coefficient (Dc) Methodology Report, John P. Shanahan, Phillip W. Patton, Mark Rudin

Transmutation Sciences Physics (TRP)

The purpose of this report is to present the methodology developed to calculate internal and external dose coefficients for radionuclides produced in the spallation process. Much of the information regarding computer codes in this report comes from various technical manuals and professional papers. References are provided at the beginning of each section for documentation and for the user who requires more specific information. The report also includes the results of applying the methodology to determine dose coefficients for five radionuclides. This effort identified potential areas of concern that will need to be addressed when the methodology is used in the …

Justification For The Continuance Of A Pediatric Physician's Office Laboratory, Veronica C. Santilli

Seton Hall University Dissertations and Theses (ETDs)

The continued viability of the Physician's Office Laboratory (POL) has been questioned because of barriers imposed by managed care organizations, oversight by regulatory agencies and competition for professionally trained laboratory staff. Pediatricians view the POL as an important adjunct to quality healthcare services for children and do not consider the POL as a "profit center", whose priority is generation of revenues for the The practice. parents of pediatric patients consider an on-site laboratory a convenience and valuable service. Through an analysis of patients' satisfaction, physicians' perceptions of enhancement to quality care, managed care reimbursement data and costs associated with maintenance …

Retirees And Pharmaceutical Costs: Is There Really A Crisis?, Justine Maiello

Seton Hall University Dissertations and Theses (ETDs)

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Reducing Childhood Pedestrian Injuries: Proceedings Of A Multidisciplinary Conference, Richard A. Schieber, Maria Vegega

United States Public Health Resources

EXECUTIVE SUMMARY
Motor vehicle crashes are associated with one of every five deaths among children 1 to 14 years of age in the United States, and pedestrian injuries account for a third of them. Compared with occupant injuries, pedestrian injuries are more severe; death is five times more likely to occur among those injured. In 1999, 533 child pedestrians were killed, and at least 30,000 children were nonfatally injured in traffic. Another 200 were killed in non-traffic areas, including driveways, sidewalks, and parking lots. Traumatic brain injury accounts for more than half the fatalities.
Dr. Schieber noted that the decline …

Managing Advanced Illness: A Quality And Cost Challenge To Medicare, Medicaid, And Private Insurers, Karen Matherlee

National Health Policy Forum

This issue brief examines approaches to delivering and financing health services for persons with advanced chronic illness. It focuses on the nature and structure of the Medicare hospice benefit and its use as a model for Medicaid and other federal programs. The paper also looks at palliative-care approaches along the continuum of inpatient and post-acute services and raises cost, quality, and access issues for end-of-life care. In addition, it provides an overview of coverage through private insurance, including indemnity, point-of-service, and preferred-provider-organization products.

Contracting For Quality: Medicare's Quality Improvement Organizations, Lisa Sprague

National Health Policy Forum

This paper examines the role of quality improvement organizations (QIOs, formerly known as PROs, or peer review organizations) in improving the quality of medical care delivered to Medicare beneficiaries in both fee-for-service and managed care environments. It looks at the expansion of the QIOs' portfolio in their seventh contract cycle to include quality improvement activities in nursing homes, home health services, and physicians' offices as well as responsibilities for public education. The paper explores the evolution of QIOs, changes in their priorities over time, and the projects in which they are engaged. It also considers their role in the formulation …

The Impact Of The State Children's Health Insurance Program (Schip) On Community Health Centers, Lea Nolan, Jennel Harvey, Karen Jones, Lissette Vaquerano, Ann Zuvekas

Health Policy and Management Faculty Publications

Nearly 12 million children in the United States do not have health insurance, and therefore often lack access to health care. In response, Congress enacted the State Children’s Health Insurance Program (SCHIP) in August 1997, the largest expansion of health insurance coverage since the inception of the Medicare and Medicaid programs. The SCHIP provides states with federal matching funds for children’s insurance either by expanding the existing Medicaid program, by creating a separate state program, or a combination of both.

The George Washington University’s Center for Health Services Research and Policy (CHSRP) was funded by the Health Resources and Services …

Whose Duty Is It Anyway?: The Kennedy Krieger Opinion And Its Implications For Public Health Research, Diane E. Hoffmann, Karen H. Rothenberg

Faculty Scholarship

In this article, the authors discuss the Maryland Court of Appeals decision in the case of Grimes v. Kennedy Krieger Institute, Inc. and its implications for the tort duty owed by researchers, in particular public health researchers, to their subjects. The Opinion resulted from two lawsuits alleging lead poisoning of children enrolled in a study conducted by the Kennedy Krieger Institute, a world renown pediatric research and treatment facility. The opinion shocked the research establishment with its scathing characterization of researchers and its apparent holding that in Maryland a parent cannot consent to the participation of a child in "nontherapeutic …

Development Of Dose Coefficients For Radionuclides Produced In Spallation Neutron Sources, Phillip W. Patton

Transmutation Sciences Physics (TRP)

A research consortium comprised of representatives from several universities and national laboratories has been established as part of this on-going project to generate internal and external dose conversion coefficients for radionuclides produced in spallation neutron sources. Information obtained from this multi-year study will be used to support the siting and licensing of future accelerator-driven nuclear initiatives within the U.S. Department of Energy complex, including the Spallation Neutron Source (SNS) and Accelerator Production of Tritium (APT) Projects. Determination of these coefficients will also fill data gaps for several hundred radionuclides that exist in Federal Guide Report No. 11 and in Publications …

A Case Study Of An Ergonomic Evaluation For A Shop Floor Facility, Ivan Siguencia

Theses

The aim of this paper is to discuss and recommend solutions for the ergonomic hazards present in a shop floor type of manufacturing facility. This type of study is important since the ergonomic issues that concern the shop floor worker are different than those faced by the assembly line worker. The shop floor employee for the most part enjoys work satisfaction, task variety, and is able to control his own work pace. From an ergonomic standpoint, this is the preferred work environment.

The focus of this paper is a case study. This study is a one-day ergonomic assessment of a …

How Vulnerable Is The Nation's Food Supply? Linking Food Safety And Food Security, Robin J. Strongin

National Health Policy Forum

This paper reviews the food safety regulatory apparatus in place today, especially the activities of the two lead agencies in assuring food safety — the Food and Drug Administration within the Department of Health and Human Services and the Food Safety and Inspection Service within the Department of Agriculture. It examines the system's strengths and vulnerabilities, particularly in light of the post–September 11 environment that includes the heightened threat of terrorism. The paper also touches upon legislative and budgetary proposals aimed at improving food security, including the growing but debated interest in a single food safety agency.

Applying Managed Fee-For-Service Delivery Models To Improve Care For Dually Eligible Beneficiaries, Stuart Bratesman, Paul Saucier

Disability & Aging

No abstract provided.

Production Of A Monoclonal Antibody Against Benzo[Α]Pyrene Diol Epoxide Dna Adducts, Brian Peden Austin

Chemistry & Biochemistry Theses & Dissertations

Benzo[α]pyrene is a ubiquitous pollutant produced from the incomplete combustion of organic material such as fossil fuels. It is found in the workplace, urban air, drinking water, and the food supply. Recently, it has been proposed that benzo[α]pyrene may be the causative agent in the formation of lung adenocarcinomas among some Taiwanese women exposed to cooking oil fumes without adequate ventilation. In this study, calf thymus DNA was modified in vitro with benzo[α]pyrene-diol epoxide (BPDE) to a level consistent with that found in biological samples. This DNA of low modification was used as an immunogen in the production of a …