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Articles 44101 - 44130 of 54803
Full-Text Articles in Entire DC Network
Exposure Risks And The Chain Of Healthcare-Associated Infection, Amber Hogan Mitchell, Drph, Mph, Cph
Exposure Risks And The Chain Of Healthcare-Associated Infection, Amber Hogan Mitchell, Drph, Mph, Cph
Building the Chain of Safety: Stakeholders Summit
Amber Hogan Mitchell, DrPH(c), MPH, CPH is the Worldwide Director of Professional Education and Learning Solutions for Advanced Sterilization Products (ASP), a Johnson & Johnson Company located in Irvine, CA. Amber is responsible for educational initiatives for ASP and its customers related to infection prevention, healthcare associated infections, sterilization, disinfection, environmental hygiene, and quality initiatives in healthcare related to safe care and quality patient outcomes. Amber is a Doctor of Public Health Candidate (all but dissertation) in occupational and environmental health sciences at the University of Texas School of Public Health in Houston, TX. She was a Centers for Disease …
Progress In Controlling Healthcare Associated Infections: A Historical Perspective, Richard Wenzel, Md
Progress In Controlling Healthcare Associated Infections: A Historical Perspective, Richard Wenzel, Md
Building the Chain of Safety: Stakeholders Summit
Richard P. Wenzel, MD, MSc, is professor and former chairman of the Department of Internal Medicine at the Medical College of Virginia, Virginia Commonwealth University, in Richmond, Virginia (1995-2009). From 2003-2008, he was President of MCV Physicians, the clinical practice plan for over 600 physicians, and Senior Associate Dean for Clinical Affairs.
For eight years (1992 to 2000), he was a member of the editorial board of The New England Journal of Medicine, and, in September 2001, became the journal’s first Editor-at-Large, a position he still holds. He is the prolific author of over 500 publications, the editor of …
The State Of Safety, John Combes, Md
The State Of Safety, John Combes, Md
Building the Chain of Safety: Stakeholders Summit
John Combes, MD, is a Senior Vice President at the American Hospital Association (AHA) and the President of the Center for Healthcare Governance (CHG), an AHA affiliate organization. CHG is a dynamic community of board members, executives and thought leaders dedicated to advancing excellence, innovation and accountability in healthcare governance through education, tool development and research. Dr. Combes also serves as Senior Fellow at the Hospital Research and Education Trust (HRET), and in that role focuses on quality and leadership issues in Patient Safety, End of Life Care and Clinical Performance Improvement.
Dr. Combes received his medical degree from Cornell …
La Charge De Travail Et La Dépense Énergétique De L’Éducateur Physique, François Trudeau, Louis Laurencelle
La Charge De Travail Et La Dépense Énergétique De L’Éducateur Physique, François Trudeau, Louis Laurencelle
Rapports de recherche scientifique
La documentation scientifique ne rapporte aucune étude sur le niveau de dépense énergétique chez les éducateurs physiques, non plus que sur les différences probables de charge entre les enseignants des différents niveaux et entre les hommes et les femmes. Les auteurs de cette étude voulaient quantifier la dépense énergétique de la tâche de l’éducateur physique dans son milieu de travail, en fonction de sa condition physique déterminée par des tests de laboratoire, mais aussi selon différents critères dont les tâches pédagogiques réalisées.
Il en résulte que la dépense énergétique moyenne des éducateurs physiques varie de faible à modéré, mais comprend …
Stabilité Des Chariots Élévateurs : Élaboration D’Un Module De Formation À L’Aide D’Une Démarche De Didactique Participative, Denys Denis, Sylvie Beaugrand, Henri Boudreault, Christian Larue
Stabilité Des Chariots Élévateurs : Élaboration D’Un Module De Formation À L’Aide D’Une Démarche De Didactique Participative, Denys Denis, Sylvie Beaugrand, Henri Boudreault, Christian Larue
Rapports de recherche scientifique
Initiée par une demande de membres du défunt comité SISEC, qui disaient éprouver des difficultés à enseigner et à faire apprendre aux caristes les notions en lien avec la stabilité des chariots élévateurs, une démarche d'accompagnement leur a été proposée. Cette dernière, développée par un spécialiste en didactique lors de ses études doctorales et expérimentée à maintes reprises antérieurement au projet actuel, visait à développer – en collaboration avec des formateurs impliqués dans ce type de formations – un nouvel environnement didactique. La formation dont il est question est de nature théorique et porte sur la conduite sécuritaire des chariots …
International Evidence On Medical Spending., Robert D. Lieberthal, Phd
International Evidence On Medical Spending., Robert D. Lieberthal, Phd
College of Population Health Lectures, Presentations, Workshops
Presented for the Casualty Actuarial Society 2011 Seminar on Reinsurance, Philadelphia, PA.
Handouts are also available at: http://www.casact.org/education/reinsure/2011/handouts/C17-Lieberthal.pdf
the audio is available at: http://www.casact.org/education/reinsure/2011/audio/C17.mp3
and it is associated with the paper: http://jdc.jefferson.edu/healthpolicyfaculty/45/
23 PowerPoint slides.
A Tale Of Two Cities? The Heterogeneous Impact Of Medicaid Managed Care In Kentucky, James Marton, Aaron Yelowitz, Jeffery C. Talbert
A Tale Of Two Cities? The Heterogeneous Impact Of Medicaid Managed Care In Kentucky, James Marton, Aaron Yelowitz, Jeffery C. Talbert
University of Kentucky Center for Poverty Research Discussion Paper Series
Does managed care produce lower health care utilization and costs through better aligned financial incentives and alternative delivery methods (the “pure” HMO effect) or by attracting more healthy enrollees (enrollee selection)? The purpose of this paper is to shed new light on this fundamental question using a quasi-experimental approach that exploits the timing and county specific implementation of Medicaid managed care plans in two distinct sub-sets of Kentucky counties in the late 1990s. We find large differences in the relative success of each region in reducing utilization that are likely driven by important differences in plan design. Asthmatic children enrolled …
Peer Support In Centers For Independent Living: What Do We Know?, Craig Ravesloot Ph.D., Bob Liston, University Of Montana Rural Institute
Peer Support In Centers For Independent Living: What Do We Know?, Craig Ravesloot Ph.D., Bob Liston, University Of Montana Rural Institute
Health and Wellness
Peer support is ubiquitous.It is defined as a helping relationship between an individual who has experience living under certain conditions assisting another person to cope with and adapt to similar circumstances.It has been gaining in popularity and use since its early adoption in Alcoholics Anonymous (AA), and has been used widely, and with good effect, with people experiencing a variety of both physical and mental health conditions.
Comparison Of Workplace Protection Factors For Different Biological Contaminants, Kyungmin Jacob Cho, Tiina Reponen, Roy Mckay, Alok Dwivedi, Atin Adhikari, Umesh Singh, Rakesh Shukla, M. Susan Jones, Gordon Jones, Sergey A. Grinshpun
Comparison Of Workplace Protection Factors For Different Biological Contaminants, Kyungmin Jacob Cho, Tiina Reponen, Roy Mckay, Alok Dwivedi, Atin Adhikari, Umesh Singh, Rakesh Shukla, M. Susan Jones, Gordon Jones, Sergey A. Grinshpun
Nursing Faculty Publications
This study compared workplace protection factors (WPFs) for five different contaminants (endotoxin, fungal spores, (1→3)-β-D-glucan, total particle mass, and total particle number) provided by an N95 elastomeric respirator (ER) and an N95 filtering facepiece respirator (FFR). We previously reported size-selective WPFs for total particle numbers for the ER and FFR, whereas the current article is focused on WPFs for bioaerosols and total particle mass. Farm workers (n = 25) wore the ER and FFR while performing activities at eight locations representing horse farms, pig barns, and grain handling facilities. For the determination of WPFs, particles were collected on filters simultaneously …
Caloric Restriction, Aerobic Exercise Training And Soluble Lectin-Like Oxidized Ldl Receptor-1 Levels In Overweight And Obese Post-Menopausal Women, Tina E. Brinkley, Xuewen Wang, Noriaki Kume, Hirokazu Mitsuoka, Barbara J. Nicklas
Caloric Restriction, Aerobic Exercise Training And Soluble Lectin-Like Oxidized Ldl Receptor-1 Levels In Overweight And Obese Post-Menopausal Women, Tina E. Brinkley, Xuewen Wang, Noriaki Kume, Hirokazu Mitsuoka, Barbara J. Nicklas
Faculty Publications
Background—Elevated circulating levels of soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) have been observed in obese persons and are reduced by weight loss. However, it is not known if combining caloric restriction (CR) with exercise training is better in reducing sLOX-1 levels than CR alone.
Objective—We examined whether the addition of aerobic exercise to a weight loss intervention differentially affects sLOX-1 levels in 61 abdominally obese postmenopausal women randomly assigned to a CR only (n=22), CR + moderate-intensity exercise (n=22), or CR + vigorous intensity exercise (n=17) intervention for 20 weeks. The caloric deficit was ~2,800 kcal/week for …
Chd Knowledge And Risk Factors Among Filipino-Americans Connected To Primary Care Services, Alona Dalusung-Angosta
Chd Knowledge And Risk Factors Among Filipino-Americans Connected To Primary Care Services, Alona Dalusung-Angosta
Nursing Faculty Presentations
Problem:
Despite growing numbers of FAs in the U.S. and high CHD prevalence, only limited studies are available in the the literature.
Contributing factors?
- Lack of knowledge
- Sociodemographic (SD)/Socioeconomic (SE) variables
Weaning Onto Solid Foods In Ireland: Some Of The Challenges, A. E. Bennett, A. O'Connor, N. J. Canning, E. M. Keaveney, Katherine Younger, M. Flynn
Weaning Onto Solid Foods In Ireland: Some Of The Challenges, A. E. Bennett, A. O'Connor, N. J. Canning, E. M. Keaveney, Katherine Younger, M. Flynn
Conference Papers
No abstract provided.
Chronic Disease Self-Management Programs: Relevance For Persons With Dementia, Nina M. Silverstein, Alison S. Gottlieb
Chronic Disease Self-Management Programs: Relevance For Persons With Dementia, Nina M. Silverstein, Alison S. Gottlieb
Gerontology Institute Publications
The context for this study is the work of the Healthy Brain Initiative. The CDC has established a cooperative agreement with the Alzheimer’s Association to develop and implement a multifaceted approach to look at cognitive health as a public health issue. Late in 2010, the Association commissioned a review of the major chronic disease prevention programs from a systems approach to begin to understand the source of findings that Medicare beneficiaries with Alzheimer’s and related disorders are much higher cost than those simply with a single chronic disease and no AD. This led to the conclusion that Chronic Disease Self‐Management …
Hub City Steps: Methods And Early Findings From A Community-Based Participatory Research Trial To Reduce Blood Pressure Among African Americans, Jamie M. Zoellner, Carol L. Connell, Michael B. Madson, Bo Wang, Vickie Blakely Reed, Elaine F. Molaison, M. Kathleen Yadrick
Hub City Steps: Methods And Early Findings From A Community-Based Participatory Research Trial To Reduce Blood Pressure Among African Americans, Jamie M. Zoellner, Carol L. Connell, Michael B. Madson, Bo Wang, Vickie Blakely Reed, Elaine F. Molaison, M. Kathleen Yadrick
Faculty Publications
Background: Community-based participatory research (CBPR) has been recognized as an important approach to develop and execute health interventions among marginalized populations, and a key strategy to translate research into practice to help reduce health disparities. Despite growing interest in the CBPR approach, CBPR initiatives rarely use experimental or other rigorous research designs to evaluate health outcomes. This behavioral study describes the conceptual frameworks, methods, and early findings related to the reach, adoption, implementation, and effectiveness on primary blood pressure outcomes.
Methods: The CBPR, social support, and motivational interviewing frameworks are applied to test treatment effects of a two-phased CBPR walking …
Smoking During Pregnancy: Its Effects On The Prevalence Of Low Birth Weight Infants, Lynda M. Colussi
Smoking During Pregnancy: Its Effects On The Prevalence Of Low Birth Weight Infants, Lynda M. Colussi
Master of Public Health Program Student Publications
Objective: The purpose of this research was to determine what impact demographic characteristics and the smoking status of mothers had on the prevalence and risk for LBW births. Methods: Birth certificate data from Montgomery County, Ohio from 2006-2009 was analyzed. Among the information collected were the infant's birth weight, the mother's age, marital status, education level, race, payer status at time of delivery, WIC status, and smoking status. The impact demographic characteristics and smoking status had on the prevalence of LBW births was determined by a logistic regression model. The effect of when women smoked during pregnancy had on the …
Commencement Program 2011, Loma Linda University
Commencement Program 2011, Loma Linda University
Commencement Programs
CONTENTS
1 | Message from the President
3 | 2011 Events of Commencement
4 | The Academic Procession
6 | Significance of Academic Regalia
8 | The Good Samaritan
9 | University History Highlights
11 | Loma Linda University Song - "Healing Love"
12 | The Speakers
20 | The University Honorees
32 | The School Honorees
53 | The Programs
- School of Medicine, 54
- School of Pharmacy, 74
- School of Dentistry, 80
- School of Science and Technology and School of Religion, 96
- School of Nursing, 111
- School of Allied Health Professions - Physical Therapy, 121
- School of Allied Health …
Perceived Barriers And Benefits Of Hiv Voluntary Counseling And Testing Among University Students In Nigeria, Clara Egbealele Omogbai
Perceived Barriers And Benefits Of Hiv Voluntary Counseling And Testing Among University Students In Nigeria, Clara Egbealele Omogbai
Loma Linda University Electronic Theses, Dissertations & Projects
Background. Nigeria, the most populous country in Africa is one of the sub- Saharan nations most affected by HIV and AIDS. However, due to stigma most people at risk of infection refuse testing, thereby likely increasing the transmission of HIV. Voluntary counseling and testing (VCT) has been shown to influence behavior change and it is important to explore how to increase rates of VCT in young people who may experiment with sexual activity in this environment that holds increased risks due to nationally elevated rates of HIV.
Purpose. To examine intention to use HIV voluntary counseling and testing (VCT) services …
Child And Family Responses To Weight Management Programs : A Qualitative Investigation, Andra Lynn Fjone
Child And Family Responses To Weight Management Programs : A Qualitative Investigation, Andra Lynn Fjone
Loma Linda University Electronic Theses, Dissertations & Projects
Introduction: The purpose of this study is to explore what happens within families in which a child participates in a pediatric weight management program for the treatment of overweight or obesity and identify strategies and processes for successful weight management.
Method: A qualitative approach was used to collect data from seven families. Individual interviews were conducted with parents, target children, and siblings. Data was analyzed within families and compared between families.
Results: Grounded theory analysis revealed three major essential themes: Shared Burden, Family Congruence, and Collaboration. Descriptive analysis was used to identify recommendations for improving family based weight management programs. …
Obesity And Other Predictors Of Absenteeism In Philadelphia School Children., Elizabeth B Rappaport, Constantine Daskalakis, Jocelyn Andrel
Obesity And Other Predictors Of Absenteeism In Philadelphia School Children., Elizabeth B Rappaport, Constantine Daskalakis, Jocelyn Andrel
Department of Family & Community Medicine Faculty Papers
BACKGROUND: Limited data indicate that obese children are absent from school more than their normal-weight peers. We analyzed administrative data from a large urban school district to investigate the association of obesity and student sociodemographic characteristics with absenteeism.
METHODS: We analyzed 291,040 records, representing 165,056 unique students (grades 1-12). Obesity status was classified according to Centers for Disease Control and Prevention age- and sex-specific percentiles for body mass index (BMI) and analyses were based on negative binomial regression.
RESULTS: Overall rates of overweight and obesity were 17% and 20%, respectively, and the estimated absence rate was 17 absences per 180 …
The Risk Factor Profile Of Women With Secondary Infertility: An Unmatched Case-Control Study In Kigali, Rwanda, Nathalie Dhont, Stanley Luchters, Claude Muvunyi, Joseph Vyankandondera, Ludwig De Naeyer, Marleen Temmerman, Janneke Van De Wijgert
The Risk Factor Profile Of Women With Secondary Infertility: An Unmatched Case-Control Study In Kigali, Rwanda, Nathalie Dhont, Stanley Luchters, Claude Muvunyi, Joseph Vyankandondera, Ludwig De Naeyer, Marleen Temmerman, Janneke Van De Wijgert
Population Health, East Africa
Background: Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis (BV) and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.
Methods: Between November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered …
Screening & Assessment Manual, Institute For Public Health And Justice, Screening And Assessment, John Ryals Jr.
Screening & Assessment Manual, Institute For Public Health And Justice, Screening And Assessment, John Ryals Jr.
Policy & Position Papers
No abstract provided.
Research Methods And Primary Sources: Writing The History Of Your Public Health Laboratory, Kristin Watkins, Anthony R. Sambol, Peter C. Iwen
Research Methods And Primary Sources: Writing The History Of Your Public Health Laboratory, Kristin Watkins, Anthony R. Sambol, Peter C. Iwen
History of the College of Public Health: Papers and Posters
Objective: This study traced the history of the Nebraska Public Health Laboratory (NPHL) since inception in April 1913 to the present time. The significance of knowing the laboratory’s history not only centered around legacy knowledge for the laboratory, but also provided important information on the history of how public health grew and was enforced in Nebraska, especially concerning reportable diseases and specimen collection. Study Design: The historical survey used mostly primary source documents including field notes from public health inspectors, disease reporting databases collected by the state health department and a variety of government documents pertaining to guidelines surrounding reportable …
Maternal And Infant Nutritional Supplementation Practices In Ireland: Implications For Clinicians And Policymakers, Roslyn Tarrant, Margaret Sheridan-Pereira, Roberta Mccarthy, Katherine Younger, John Kearney
Maternal And Infant Nutritional Supplementation Practices In Ireland: Implications For Clinicians And Policymakers, Roslyn Tarrant, Margaret Sheridan-Pereira, Roberta Mccarthy, Katherine Younger, John Kearney
Articles
This prospective Irish observational study examined maternal and infant nutritional supplement use. From an initial sample of 539 mothers recruited from the Coombe Women and Infants University Hospital in Dublin (during 2004-2006), 450 eligible mothers werefollowed up at 6 weeks and 6 months postpartum. Only 200 women (44.4%) complied with peri-conceptional folic acid at therecommended time with strong social patterning associated with its uptake. Almost 10% of the sample (n=44) consumed acombined multivitamin and mineral supplement during pregnancy. A vitamin D-containing supplement was provided to only 5 (1.1%)and 15 (3.3%) infants at 6 weeks and 6 months, respectively. A national …
Control Of Reflexive Saccades Following Hemispherectomy, Patricia A. Reuter-Lorenz, Troy M. Herter, Daniel Guitton
Control Of Reflexive Saccades Following Hemispherectomy, Patricia A. Reuter-Lorenz, Troy M. Herter, Daniel Guitton
Faculty Publications
Individuals who have undergone hemispherectomy for treatment of intractable epilepsy offer a rare and valuable opportunity to examine the ability of a single cortical hemisphere to control oculomotor performance. We used peripheral auditory events to trigger saccades, thereby circumventing dense postsurgical hemianopia. In an antisaccade task, patients generated numerous unintended short-latency saccades toward contralesional auditory events, indicating pronounced limitations in the ability of a single hemicortex to exert normal inhibitory control over ipsilateral (i.e., contralesional) reflexive saccade generation. Despite reflexive errors, patients retained an ability to generate correct antisaccades in both directions. The prosaccade task revealed numerous contralesional express saccades, …
The Believe In All Your Possibilities Campaign: Updating A Social Marketing Campaign On A Shoe String Budget, Moya L. Alfonso, H. Woodcum, Sherri Reynolds, John S. Luque
The Believe In All Your Possibilities Campaign: Updating A Social Marketing Campaign On A Shoe String Budget, Moya L. Alfonso, H. Woodcum, Sherri Reynolds, John S. Luque
Community Health: Faculty Presentations (1993-2018)
The purpose of this presentation is to provide participants with an understanding of how to revamp or refresh a brand on a limited budget using a case study approach. The ‘Believe in All Your Possibilities’ community-based prevention marketing campaign, which was targeted at reducing alcohol and tobacco use among middle school youth, was the result of a long term school-community-university partnership in Southeast Florida. This alcohol campaign has been continuously implemented for eight years. Encouraging evaluation results combined with recently acquired alcohol prevention funding served as the impetus for conducting research to determine if ‘Believe’: a) was still relevant to …
Relationship Of Vitamin D Levels To Blood Pressure In A Biethnic Cohort, Rosario O. Sakamoto
Relationship Of Vitamin D Levels To Blood Pressure In A Biethnic Cohort, Rosario O. Sakamoto
Loma Linda University Electronic Theses, Dissertations & Projects
Background: Serum hydroxyvitamin D [25(OH)D] has been well-accepted as not an ordinary vitamin but a pro-hormone that has many benefits beyond its well-known effects on bone. Cardiovascular risk factors such as hypertension remain a huge health burden and Blacks have been recognized to have higher prevalence of hypertension compared to non-Hispanic Whites. Despite increasing evidence of the benefits of vitamin D on blood pressure control, there is much more to be learned about the relationship of serum 25(OH)D to blood pressure among different ethnicities.
Purpose: The goal of this study was to determine whether vitamin D serum 25(OH)D levels were …
Predicting Mammography Screening And Breast Self-Examination Among Hispanic And Non-Hispanic White Women In Orange County, California, Sanam Kazemi
Loma Linda University Electronic Theses, Dissertations & Projects
Background and Purpose. Breast cancer is the second leading cause of cancer deaths among Hispanic/Latina women who are one of the fastest growing ethnic groups in the United States. Although Hispanic women have a lower incidence of breast cancer when compared to non-Hispanic White women, they are more likely to develop breast cancer at an advanced stage. In California, Hispanic women have the lowest rate of insurance coverage compared to other ethnic groups.
Method. The study was a cross-sectional observational study among Hispanic/Latino and non-Hispanic White women, ages 30-64 years. I examined intention to obtain a mammogram or breast self-exam …
The Relation Of Fitness Assessment Feedback To Intrinsic Motivation And Physical Activity Among College Students, Laura Chandler
The Relation Of Fitness Assessment Feedback To Intrinsic Motivation And Physical Activity Among College Students, Laura Chandler
Loma Linda University Electronic Theses, Dissertations & Projects
Physical inactivity is a major public health concern in the United States and is no less of a concern among college students. According to the 2000 National College Health Assessment, as cited by Kilpatrick, Herbert, and Bartholomew (2005), only 38% of college students participate in regular vigorous activity, and only 20% participate in regular moderate activity. This study focused on how fitness assessment results affect intrinsic motivation for physical activity in college students. The specific mechanism examined was that between the constructs of intrinsic motivation, competence and autonomy from the self determination theory (SDT) and cognitive evaluation theory (CET). Approximately …
The Association Of Religious Coping On Reports Of Low Back Pain And Inflammatory Markers, Jacqueline D. Bougie
The Association Of Religious Coping On Reports Of Low Back Pain And Inflammatory Markers, Jacqueline D. Bougie
Loma Linda University Electronic Theses, Dissertations & Projects
Chronic pain is the most common cause of disability in the United States with depression, anxiety, and stress often occurring co-morbidly. The purpose of the study was to explore how religion may modulate the frequency of back pain, influence inflammatory markers, influence the use of medications, and impact functional ability.
Participants were from the Biological Manifestations of Religion Study (BioMRS; N= 508) and the Psychological Manifestations of Religion Study (PsyMRS; N = 10,988). All participants completed a 20-page questionnaire and BioMRS participants provided blood, salivary, and urine samples, performance tests, and learning tests all collected within 1 week of …
Rocky Mountain Highs And Lows: Efforts To Improve Health And Reduce Costs In Denver, Michele J. Orza, Jessamyn Taylor
Rocky Mountain Highs And Lows: Efforts To Improve Health And Reduce Costs In Denver, Michele J. Orza, Jessamyn Taylor
National Health Policy Forum
In late May–early June 2011, the Forum sponsored a site visit to Denver, Colorado, to observe innovative efforts to improve the health of Coloradans and reduce the cost of health care. The three-day agenda was designed to convey the breadth and interconnectedness of the efforts underway in Denver and to highlight both successes and challenges. The exploration concentrated on how three themes of national interest are unfolding in Denver: building and sustaining a robust and effective safety net in an evolving health care market; improving the health of people and their communities to prevent and reduce the need for health …