Tuberculin skin testing among economically disadvantaged youth in a federally funded job training program.
Low income, medically underserved communities are at increased risk for tuberculosis. Limited population-based national data are available about tuberculous infection in young people from such backgrounds. To determine the prevalence of a positive tuberculin skin test among economically disadvantaged youth in a federally funded job training program during 1995 and 1996, the authors evaluated data from medical records of 22,565 randomly selected students from over 100 job training centers throughout the United States. An estimated 5.6% of students had a documented positive skin test or history of active tuberculosis. Rates were highest among those who were racial/ethnic minorities, foreign born, and (among foreign-born students) older in age (p < 0.001). Weighted rates (adjusting for sampling) were 1.3% for white, 2.2% for Native American, 4.0% for black, 9.6% for Hispanic, and 40.7% for Asian/Pacific Islander students; rates were 2.4% for US-born and 32.7% for foreign-born students. Differences by geographic region of residence were not significant after adjusting for other demographic factors. Tuberculin screening of socioeconomically disadvantaged youth such as evaluated in this study provides important sentinel surveillance data concerning groups at risk for tuberculous infection and allows recommended public health interventions to be offered. (+info)
Philanthropic endowments in general internal medicine.
We performed two surveys to uncover the status of philanthropic endowments in general internal medicine divisions. The initial survey of U.S. medical school departments of medicine found that only 14.1% of general internal medicine divisions hold endowments versus 21.9% of all other divisions, and that endowment sources for general medicine are atypical. The second survey of successfully endowed divisions found that sympathetic administrators and active pursuit of endowments were associated with endowment success. Aggressive pursuit of endowments, publicizing successes of general medicine, and consideration of endowment sources noted in this study are recommended to improve philanthropic contributions to general internal medicine. (+info)
Differences in stakeholder expectations in the outcome of physiotherapy management of acute low back pain.
OBJECTIVE: To compare stakeholder expectations of outcome of physiotherapy management of acute low back pain. DESIGN: Observational design using interviews and questionnaires. SETTING: Practice/workplace. STUDY PARTICIPANTS: The study sample was from South Australia. It comprised 74 physiotherapists randomly selected from professional association listings (49.3% response rate), 121 physiotherapy patients (recruited by participating physiotherapists when attending their first physiotherapy treatment for acute low back pain), 21 general practitioners randomly selected from medical practitioner listings in the metropolitan telephone book (36.2% response rate) and 13 third party payers of a total of 16 available insurers in the metropolitan area (82% response rate). MAIN OUTCOME MEASUREMENTS: Stakeholders reported expectations of outcome at the end of the first treatment session and at the completion of the episode of care. RESULTS: There were differences in expectations between stakeholders, as well as between naive and experienced patients. Overall, patients expected symptom relief at the end of the first treatment. Naive patients decided to return for further treatment based on the relationship established with the therapist, whereas experienced patients also expected some advice on their condition during the first contact. Physiotherapists and referrers expected symptom relief and then long-term management strategies to be provided, and third party payers expected cost-efficient management of the condition and patient satisfaction. CONCLUSION: Physiotherapists need to address potential imbalance of consumer knowledge and foster a quality partnership with their patients on the first visit to physiotherapy. Patients who are in pain may not derive full value from information provided in an untimely manner. (+info)
Lobbying and advocacy for the public's health: what are the limits for nonprofit organizations?
Nonprofit organizations play an important role in advocating for the public's health in the United States. This article describes the rules under US law for lobbying by nonprofit organizations. The 2 most common kinds of non-profits working to improve the public's health are "public charities" and "social welfare organizations." Although social welfare organizations may engage in relatively unlimited lobbying, public charities may not engage in "substantial" lobbying. Lobbying is divided into 2 main categories. Direct lobbying refers to communications with law-makers that take a position on specific legislation, and grassroots lobbying includes attempts to persuade members of the general public to take action regarding legislation. Even public charities may engage in some direct lobbying and a smaller amount of grassroots lobbying. Much public health advocacy, however, is not lobbying, since there are several important exceptions to the lobbying rules. These exceptions include "non-partisan analysis, study, or research" and discussions of broad social problems. Lobbying with federal or earmarked foundation funds is generally prohibited. (+info)
Financing a future for public biological data.
MOTIVATION: The public web-based biological database infrastructure is a source of both wonder and worry. Users delight in the ever increasing amounts of information available; database administrators and curators worry about long-term financial support. An earlier study of 153 biological databases (Ellis and Kalumbi, Nature Biotechnol., 16, 1323-1324, 1998) determined that near future (1-5 year) funding for over two-thirds of them was uncertain. More detailed data are required to determine the magnitude of the problem and offer possible solutions. METHODS: This study examines the finances and use statistics of a few of these organizations in more depth, and reviews several economic models that may help sustain them. RESULTS: Six organizations were studied. Their administrative overhead is fairly low; non-administrative personnel and computer-related costs account for 77% of expenses. One smaller, more specialized US database, in 1997, had 60% of total access from US domains; a majority (56%) of its US accesses came from commercial domains, although only 2% of the 153 databases originally studied received any industrial support. The most popular model used to gain industrial support is asymmetric pricing: preferentially charging the commercial users of a database. At least five biological databases have recently begun using this model. Advertising is another model which may be useful for the more general, more heavily used sites. Microcommerce has promise, especially for databases that do not attract advertisers, but needs further testing. The least income reported for any of the databases studied was $50,000/year; applying this rate to 400 biological databases (a lower limit of the number of such databases, many of which require far larger resources) would mean annual support need of at least $20 million. To obtain this level of support is challenging, yet failure to accept the challenge could be catastrophic. CONTACT: [email protected] edu (+info)
IAIMS: an interview with Dick West. Integrated Advanced Information Management Systems. Interview by Joan S Ash and Frances E Johnson.
Richard T. West, IAIMS (Integrated Advanced Information Management Systems) Program Officer at the National Library of Medicine for 13 years, reflects on the origin, development, effectiveness, and future of IAIMS efforts. He dwells on the changes that have taken place as the concept of IAIMS has evolved from a technology-based to an organization-based level of integration. The role of IAIMS in patient care, education, and research is discussed, along with the role of the librarian in the implementation of IAIMS programs. He sees a need for training for librarians, informaticians, and others in preparation for these efforts and for the development of academic reward systems that encourage them. He expresses a desire for those working in information technology in hospitals to gain a clearer understanding of IAIMS, because the concept fits hospitals as well as academic health science centers. He exhorts informaticians to bring to reality the futuristic fantasies of a new information world. (+info)
Failure to defend a successful state tobacco control program: policy lessons from Florida.
OBJECTIVES: This investigation sought to define policy and political factors related to the undermining of Florida's successful Tobacco Pilot Program in 1999. METHODS: Data were gathered from interviews with public health lobbyists, tobacco control advocates, and state officials; news reports; and public documents. RESULTS: As a result of a recent legal settlement with Florida, the tobacco industry agreed to fund a youth anti-smoking pilot program. The program combined community-based interventions and advertisements. In less than 1 year, the teen smoking prevalence rate dropped from 23.3% to 20.9%. The program also enjoyed high public visibility and strong public support. Nevertheless, in 1999, the state legislature cut the program's funding from $70.5 million to $38.7 million, and the Bush administration dismantled the program's administrative structure. Voluntary health agencies failed to publicly hold specific legislators and the governor responsible for the cuts. CONCLUSIONS: The legislature and administration succeeded in dismantling this highly visible and successful tobacco control program because pro-health forces limited their activities to behind-the-scenes lobbying and were unwilling to confront the politicians who made these decisions in a public forum. (+info)
Health financing changes in the context of health care decentralization: the case of three Latin American countries.
OBJECTIVE: The results of an evaluative longitudinal study, which identified the effects of health care decentralization on health financing in Mexico, Nicaragua and Peru are presented in this article. METHODS: The methodology had two main phases. In the first, secondary sources of data and documents were analyzed with the following variables: type of decentralization implemented, source of financing, funds for financing, providers, final use of resources, mechanisms for resource allocation. In the second phase, primary data were collected by a survey of key personnel in the health sector. RESULTS: Results of the comparative analysis are presented, showing the changes implemented in the three countries, as well as the strengths and weaknesses of each country in matters of financing and decentralization. CONCLUSIONS: The main financing changes implemented and quantitative trends with respect to the five financing indicators are presented as a methodological tool to implement corrections and adjustments in health financing. (+info)