Digital Commons Network^™

The Economics Of Quality: Changing Incentives In Cincinnati, Lisa Sprague, Nora Super

National Health Policy Forum

This site visit focused on private market dynamics and quality improvement initiatives. Cincinnati is characterized by strong players in all sectors of the market: employers such as Procter and Gamble and General Electric, hospital systems, health plans, and physician groups with the power to “push back” in contract negotiations. The city is a pilot site for Bridges to Excellence, a pay-for-performance initiative spearheaded by GE. Cincinnati Children’s Hospital Medical Center is a grantee under the Robert Wood Johnson Foundation’s Pursuing Perfection program. Among the issues explored were physician supply, incentive structures, specialty hospitals, and information technology.

International Art Therapy Program Development: An Exploratory Cultural Encounter In Ayacucho, Peru, Haley Johnstone

EVMS School of Health Professions Theses & Dissertations

Humanitarian aid organizations, both domestic and international, provide health care, mental health services, education, and community development for traumatized children worldwide living in regions affected by political violence. Sparse information exists regarding the role of an art therapist within these organizations. The profession of art therapy lacks research specific to the benefits of intervention and program development within the context of an international humanitarian aid team. This thesis reviews the ethnographic research of an art therapy graduate student who explored the opportunities for art therapy within such a team.

Cultural competency was an essential component of the researcher’s success while …

Use Of Hospitals, Physician Visits, And Hospice Care During Last Six Months Of Life Among Cohorts Loyal To Highly Respected Hospitals In The United States, J. E. Wennberg, Elliot S. Fisher, Therese A. Stukel, Jonathan S. Skinner

Dartmouth Scholarship

Objective: To evaluate the use of healthcare resources during the last six months of life among patients of US hospitals with strong reputations for high quality care in managing chronic illness.

Unequal Access: The Crisis Of Health Care Inequality For Low-Income African-American Residents Of The District Of Columbia, Robyn Whipple Diaz

Journal of Health Care Law and Policy

No abstract provided.

Trends And Transitions In Children's Coresidence With Older Adults In Beijing Municipality, Zachary Zimmer, Xianghua Fang, Toshiko Kaneda, Zhe Tang, Julia Kwong

Poverty, Gender, and Youth

The reduction in family size in China and concurrent social and economic change are raising concerns that traditional sources of support may be eroding. This Population Council working paper paper examines a) whether rates of coresidence between older adults and their adult children in the Beijing municipality of China have been declining, and b) the determinants of coresidence and coresidence transitions. Results suggest that family support structures for the elderly, when they are facilitated through coresidence, remain basically intact, particularly for those who require the greatest amount of support. Further assessment is required to elucidate the effects of availability, need, …

Urban Poverty And Health In Developing Countries: Household And Neighborhood Effects, Mark R. Montgomery, Paul C. Hewett

Poverty, Gender, and Youth

In the United States and other high-income countries, where most people live in cities, there is intense scholarly and program interest in the effects of household and neighborhood living standards on health. This paper investigates whether in these cities the health of women and young children is influenced by both household and neighborhood standards of living. To judge from our results, it appears that as a rule, poor urban households do not tend to live in uniformly poor communities; indeed, about one in ten of a poor household’s neighbors is relatively affluent, belonging to the upper quartile of the urban …

Youth Behavioral Risks And Psychosocial Resources In Peru's Alternative-Development Zones, Federico R. Leon, Mary L. Claux

Reproductive Health

Alternative-development programs are being offered to the population of seven regions of central-eastern Peru involved in coca cropping. The youth of these regions are above the national average in risk of pregnancy and sexually transmitted infections, use of alcohol and drugs, and violence against women. This study sought to identify and describe protective factors expected to function as counterforces to such risks; develop reliable indicators and provide a baseline concerning the risk behaviors and protective factors; compare youth by gender, developmental stage, urbanization, and geography to determine whether segmented interventions are required; and recommend specific intervention strategies. The results of …

Data Analysis In The Antes System, Yavuz Tor

Theses and Dissertations - UTB/UTPA

Acanthosis nigricans is a skin condition that can be used as an indicator for the risk of developing type 2 diabetes in the future. Border Health Office, in University of Texas - Pan American, organizes screenings in schools for acanthosis nigricans. Screening results are, then, collected and evaluated in the Border Health Office. The ANTES System is a computer system that stores and manages the data collected in those screenings.

This study is on the analysis of those collected data to track the progress of data entry, to evaluate the progress on obesity and related problems, and to discover the …

Medical Response For Terrorist And Public Health Threats: One Region's Experience (Pittsburgh), Eileen Salinsky, Lisa Sprague

National Health Policy Forum

This site visit, planned and convened in conjunction with the Agency for Healthcare Research and Quality’s User Liaison Program, examined the efforts underway in the greater Pittsburgh area to develop emergency medical response capabilities for mass causality events. The site visit explored efforts to improve infectious disease surveillance capabilities and looked at the Region 13 collaborative’s development of a regionalized approach to emergency management planning and response. Hospital preparedness activities were also studied, including a discussion of lessons learned from a recent drill to test response to a radiological event and an exploration of conceptual frameworks to guide hospital planning …

The Geography Of Medicare: Explaining Differences In Payment And Costs, Nora Super

National Health Policy Forum

This issue brief examines the sources of variation in Medicare payment and costs across different geographic areas and different sites of care. It discusses the payment policies that address variation in the cost of providing care, such as input price adjustments and special payments to hospitals. It also considers differences due to beneficiaries’ health status and in physician practice patterns. Finally, it explores policy options to address Medicare geographic variation.

The U.S. Health Workforce: Definitions, Dollars, And Dilemmas, Karen Matherlee

National Health Policy Forum

This background paper provides a comprehensive view of the structure of the health workforce. It explores public and private insurance coverage and payment policies, as well as discretionary grant programs, that govern it. The paper also looks at health workforce concerns: supplies of certain types of physicians, health workforce mix, challenges from complementary and alternative medicine, shortages of nurses and pharmacists (and some other practitioners), maldistribution issues, and lack of diversity in response to demographic changes. It presents proposals that are on the table to reform the health workforce, at a time when it is demanding greater attention from health …

A Comparative History Of Aids In Latin America: Brazil And Cuba, Shawn Smallman

International & Global Studies Faculty Publications and Presentations

According to a joint report of the World Health Organization and the Pan American Health Organization in September 2002 there were approximately 1.4 million HIV+ people in Latin America, and a further 420,000 HIV+ people in the Caribbean. The number of infections had increased by nearly 10% from the previous year in Latin America, and 16% in the Caribbean. While striking, these figures may obscure the diversity of the HIV epidemic in the region. Latin America has a varied pattern of infections, which means that the experience of Bolivia, Ecuador and Mexico is quite different from that of Honduras, Haiti …

Evidence-Based Development Of Health And Family Planning Programs In Bangladesh And Ghana, James F. Phillips, Tanya C. Jones, Frank K. Nyonator, Shruti Ravikumar

Poverty, Gender, and Youth

This paper describes two initiatives that have used experimental studies to guide the development of community-based health and family planning programs. In Bangladesh and Ghana, factorial experiments were implemented in stages. An exploratory phase developed a service system for community-based health care; an experimental phase assessed the demographic impact of the system; a replication phase examined the transferability of the experimental program to a non-research setting; and a scaling-up phase facilitated the extension of the new system to the national health care program. All stages were guided by research, with questions, mechanisms, and outcomes shifting as the process developed. Large-scale …

The Feasibility Of Computer-Assisted Survey Interviewing In Africa: Experience From Two Rural Districts In Kenya, Paul C. Hewett, Annabel Erulkar, Barbara Mensch

Poverty, Gender, and Youth

This paper explores the use of an audio computer-assisted self-interviewing (audio-CASI) methodology in a household survey of adolescents in two districts of Kenya. Computer software was developed as part of a research project comparing audio-CASI with traditional methods of interviewing about sensitive behaviors, including sexual initiation, risky sexual behavior, coerced sex, and drug and alcohol use. The paper describes the experience of carrying out a household-based study using computers and explores the technical challenges faced by the data collection teams. Few problems emerged with the computer hardware and software, despite the difficult interviewing conditions. The adolescent respondents easily adapted to …

Condom Use And Abstinence Among Unmarried Young People In Zimbabwe: Which Strategy, Whose Agenda?, Ravai Marindo, Steve Pearson, John B. Casterline

Poverty, Gender, and Youth

This paper compares the views about abstinence and condom use expressed by young people in Zimbabwe in focus-group discussions with the views underlying national policies and religious and traditional beliefs. Young people’s decisions to adopt one or the other of these risk-reduction strategies may not necessarily indicate genuine individual choices, but rather their deference to adults’ interests as they understand those interests. Policymakers and traditional and Christian leaders promote abstinence as the exclusive strategy for all young people, whereas nongovernmental organizations and the private sector promote condom use. Evidence from the focus-group discussions indicates that adolescents are aware of this …

Testing A Model For The Delivery Of Emergency Obstetric Care And Family Planning Services In The Bolivian Public Health System, Deborah L. Billings, Eliana Del Pozo, Hugo Arevalo

Reproductive Health

Unsafe abortion is a serious public health problem in Bolivia, accounting for up to 25 percent of maternal mortality. Postabortion care (PAC) was recognized as a priority public health action in Bolivia in 1994 and the operations research project summarized in this report was undertaken at the request of the Ministry of Health to help guide the improvement of PAC services in the country’s revised health plan. Improvements were made in the following areas: informing women of their health status after the uterine evacuation procedure; elements of the procedure itself (instrument to be used, pain control, possible risks); and informing …

An Ethnographic Investigation Of The Relevance Of Shop Floor Culture To Effective Safety Communication In An Australian Minerals Refinery, David R. Leith

Theses: Doctorates and Masters

Many organisations which aim to achieve excellent workplace safety choose 'culture change' as the means to achieve this. They make use of employee communication media to help re-form the values, beliefs, norms and behaviours which are generally thought to comprise culture. However, culture is a complex and profound phenomenon. Successful communication between two culturally separate groups requires each to achieve an understanding of the other, no less so in workplaces than in societies composed of different cultures.Yet even employers who believe in communicating fully with their workforces find it difficult to convey viewpoints other than their own. Their communication tends …

Expanding Health Coverage For The Uninsured: Fundamentals Of The Tax Credit Option, Beth Fuchs, Julie James

National Health Policy Forum

This paper seeks to provide the basics for understanding the current debate over tax credits as a vehicle for reducing the number of uninsured Americans and focuses attention on some of the associated issues: How is health insurance treated under current tax law? Why tax credits and not deductions? What are the major issues in designing tax credits? Who should be eligible and for what size credit? What changes, if any, would be needed to the insurance market to ensure that policies are available and affordable for people eligible for tax credits? What are the major issues related to administering …

Residential Radon Exposure And Lung Cancer: Variation In Risk Estimates Using Alternative Exposure Scenarios, R. William Field, Brian J. Smith, Daniel J. Steck, Charles F. Lynch

Physics Faculty Publications

The most direct way to derive risk estimates for residential radon progeny exposure is through epidemiologic studies that examine the association between residential radon exposure and lung cancer. However, the National Research Council concluded that the inconsistency among prior residential radon case-control studies was largely a consequence of errors in radon dosimetry. This paper examines the impact of applying various epidemiologic dosimetry models for radon exposure assessment using a common data set from the Iowa Radon Lung Cancer Study (IRLCS). The IRLCS uniquely combined enhanced dosimetric techniques, individual mobility assessment, and expert histologic review to examine the relationship between cumulative …

Comparing Bottled Water And Tap Water: Experiments In Risk Communication, Branden B. Johnson

RISK: Health, Safety & Environment (1990-2002)

The author discusses results of experiments in risk communication comparing bottled water and tap water.

'Bus Fare, Please': The Economics Of Sex And Gifts Among Adolescents In Urban South Africa, Carol E. Kaufman, Stavros E. Stavrou

Poverty, Gender, and Youth

Force or coercion are often a part of sexual relationships in South Africa, especially among adolescents. This coercion is also often pinioned by an economic exchange: gifts or favours for sex. Studies have pointed out the negative consequences of the exchanges which are often characterised by large age differences (‘sugar daddies’) or power imbalances. Perhaps more pervasive but largely ignored, gift-giving in same-age relationships also may be associated with sexual leverage, an exchange which somehow entitles one partner physical and sexual rights to the other’s body. The circumstances surrounding gifts and favours may shape young women’s and men’s sexual experiences, …

Lombalgies Et Accidents Musculosquelettiques Chez Les Pompiers : Identification Et Analyse Des Situations À Risque Lors De L'Accès Aux Véhicules Et De La Manutention D'Outils, Denis Giguère, Denis Marchand

Rapports de recherche scientifique

La nature du travail des pompiers est propice à l’apparition de problèmes musculo-squelettiques. Les statistiques de la CSST montrent que les foulures et les entorses viennent au premier rang du type de lésion, le dos en est la cible principale suivi des pieds et des chevilles et les agents causals les plus souvent impliqués sont les mouvements du corps, les surfaces de travail et les véhicules. Une étude de l’IRSST (Cloutier et Champoux, 1996) révèle l’existence d’un scénario d’accident, parmi d’autres, impliquant « un effort excessif » et dont les résultats sont des douleurs et des entorses, en particulier au …

Demographic Factors In East Asian Regional Integration, Geoffrey Mcnicoll

Poverty, Gender, and Youth

The Remapping Asia project, to which this paper is a contribution, investigates broad spatial changes in the ways that East Asia’s political and social life are organized and economies operate. Such changes are attributable to planned action of governments, firms, and other organized groups and to the unorganized but in some measure predictable behavior of myriad families and individuals. The project’s particular interest is in processes of regionalization-both through the deliberate construction of political institutions and through the largely unplanned emergence of regional affiliations and identities. Demographic factors play a potentially significant part both in promoting and in impeding regional …

Mission Possible? Maintaining The Safety Net In Urban And Rural Colorado, Karen Matherlee

National Health Policy Forum

This site visit examined urban safety-net concerns in Denver and rural safety-net issues in three communities in the eastern part of Colorado. The Denver segment featured Denver Health, an integrated health system that provides a continuum of services to diverse vulnerable populations. It explored delivery and financing issues for the system itself and in relation to payers, providers, and consumers (particularly through Community Voices) in its catchment area. The eastern Colorado segment focused on delivery and financing issues in Rocky Ford (community health center/migrant health services concerns), Limon (certified rural health center topics), and Hugo (critical-access hospital matters). The visit …

History Of Love Canal And Suny At Buffalo's Response: History, The University Role, And Health Research, A. Theodore Steegmann Jr.

Buffalo Environmental Law Journal

No abstract provided.

Science And Health Risks Research Since Love Canal, John E. Vena

Buffalo Environmental Law Journal

No abstract provided.

Humanitarian Health Education Programming: Diffusion Of Health Messages Through Folk Media, Archana Daya Shankar

International Journal of Global Health

For several decades, numerous health programs for the underserved have been launched in rural areas of developing countries. World organization, NGO's and government agencies have been allocating a significant portion of their budgets for developing health education programs for underserved population in different parts of the world. The success rate of reaching the goals of these programs has been very slow. For example, in India experience in rural health development has clearly indicated that isolated urban health programs do not provide appropriate assistance to the underserved sections of society (Hedge, 1997).

Out Of Africa: Origins Of The Taenia Tapeworms In Humans, Eric P. Hoberg, Nancy L. Alkire, Alan De Queiroz, Arlene Jones

Harold W. Manter Laboratory of Parasitology: Faculty Publications

Phylogenetic and divergence date analyses indicate that the occurrence of Taenia tapeworms in humans pre-dates the development of agriculture, animal husbandry and domestication of cattle (Bos spp.) or swine (Sus scrofa) Taeniid tapeworms in Africa twice independently colonized hominids and the genus Homo prior to the origin of modern humans. Dietary and behavioural shifts, from herbivory to scavenging and carnivory, as early Homo entered the carnivore guild in the Pliocene/Pleistocene, were drivers for host switching by tapeworms to hominids from carnivores including hyaenids and felids. Parasitological data provide a unique means of elucidating the historical ecology, foraging behavior …

Justice In Health Care Access Measuring Attitudes Of Health Care Professionals, Sandra Blanton

Masters Theses & Specialist Projects

To measure attitudes toward justice in access to health care services in managed care plans in a convenience sample of medical professionals at Clark Memorial Hospital in Jeffersonville, Indiana. Methods. A sixteen item, self-administered instrument based on Morreim's four concepts of justice in health care access was administered to 147 health care professionals, representing physicians, allied health, and hospital administration. SPSS was used to analyze the results. Results. The attitudes of the respondents were negative toward managed care. They did not feel that managed care had been a positive development in the United States or that managed care had improved …

Reinventing Medicaid: Hoosier Healthwise And Children's Health Insurance In Indiana, Judith D. Moore, Lisa Sprague

National Health Policy Forum

This site visit explored the factors that have made Indiana so successful in enrolling children in its Medicaid and SCHIP plans under the brand name Hoosier Healthwise. Site visitors met with legislators and state officials to gain understanding of the genesis and development of Hoosier Healthwise and its aggressive outreach component. A panel of representatives from partner organizations engaged in enrolling children provided further insight into this process. The site visit participants traveled to observe enrollment and operations in both urban (Marion) and rural (Clay) county offices. They also met with health care executives at hospitals, clinics, and neighborhood health …