A plague on your city: observations from TOPOFF.
(33/937)
The United States Congress directed the Department of Justice to conduct an exercise engaging key personnel in the management of mock chemical, biological, or cyberterrorist attacks. The resulting exercise was called "TOPOFF," named for its engagement of top officials of the United States government. This article offers a number of medical and public health observations and lessons discovered during the bioterrorism component of the exercise. The TOPOFF exercise illuminated problematic issues of leadership and decision-making; the difficulties of prioritization and distribution of scarce resources; the crisis that contagious epidemics would cause in health care facilities; and the critical need to formulate sound principles of disease containment. These lessons should provoke consideration of future directions for bioterrorism planning and preparedness at all levels of government and among the many communities and practitioners with responsibilities for national security and public health. (+info)
Networking health: learning from others, taking the lead.
(34/937)
The Internet provides one of the most compelling examples of the way in which government research investments can, in time, lead to innovations of broad social and economic impact. This paper reviews the history of the Internet's evolution, emphasizing in particular its relationship to biomedical computing and to the nation's health care system. Here I summarize current national research programs, emphasizing the need for greater involvement by the medical research community and leadership from federal health care agencies. (+info)
Does a third year of emergency medicine training make a difference? Historical cohort study of Queen's University graduates.
(35/937)
OBJECTIVE: To describe outcomes of a third-year residency (PGY-3) program in family medicine/emergency medicine in terms of its graduates' practice characteristics and their self-assessed preparedness for practising emergency medicine. DESIGN: A questionnaire was sent to graduates of Queen's University's family medicine residency programs. SETTING: Recent graduates' practices. PARTICIPANTS: All 30 graduates of Queen's University's Family Medicine/Emergency Medicine Program (PGY-3s) from 1988 to 1997 and 90 matched controls chosen randomly from among the 250 graduates of the 2-year family medicine residency program (PGY-2s) during the same period. Six of the 120 were excluded. Response rate was 89%. MAIN OUTCOME MEASURES: Current practice of family and emergency medicine, leadership activities in emergency medicine, self-assessment of preparedness to practise and to lead others at the end of training, self-report of frequency of emergency care situations in subsequent practice for which physicians felt unprepared by their training, and catchment population and "rurality" of location of current practice. RESULTS: Compared with controls, more PGY-3s practiced and took leadership roles in emergency medicine in their hospitals and communities. At the end of their training, PGY-3s reported higher levels of preparedness for practicing and providing leadership in emergency medicine. Both groups reported the same frequency of encountering emergency situations in subsequent practice for which they felt inadequately prepared. Both groups practised in communities of similar size and location. CONCLUSION: Graduates of Queen's University's third-year emergency medicine program appear to practise in accordance with their extra training. (+info)
Improving the quality of health care in the United Kingdom and the United States: a framework for change.
(36/937)
Fueled by public incidents and growing evidence of deficiencies in care, concern over the quality and outcomes of care has increased in both the United Kingdom and the United States. Both countries have launched a number of initiatives to deal with these issues. These initiatives are unlikely to achieve their objectives without explicit consideration of the multilevel approach to change that includes the individual, group/team, organization, and larger environment/system level. Attention must be given to issues of leadership, culture, team development, and information technology at all levels. A number of contingent factors influence these efforts in both countries, which must each balance a number of tradeoffs between centralization and decentralization in efforts to sustain the impetus for quality improvement over time. The multilevel change framework and associated properties provide a framework for assessing progress along the journey. (+info)
Expanding the research infrastructure for lesbian health.
(37/937)
Interest in research about lesbian health has increased dramatically since the late 1980s and gained national attention in 1999 when the Institute of Medicine published the groundbreaking report Lesbian Health: Current Assessment and Directions for the Future. In March 2000, the Department of Health and Human Services and partner organizations presented the Scientific Workshop on Lesbian Health, during which invited experts on lesbian health worked with federal representatives to develop action steps to implement recommendations in the Institute of Medicine report. National priorities were thus established for the emerging field of lesbian health research. Although researchers of various sexual orientation and gender identities will contribute to this field, lesbian researchers have a unique perspective and an important role to play. This commentary focuses on the preparedness of these individuals to respond to challenges set forth by the Institute of Medicine and Scientific Workshop reports. Despite differences in their academic backgrounds, lesbian researchers have reported common experiences and needs. Substantial proportions have encountered barriers because they were lesbians or conducted lesbian research, and many expressed willingness to mentor others, to help others to conduct research about lesbians, or both. (+info)
Can there be a meaningful participation of Croat expatriates in Croatian science?
(38/937)
The author discusses the possible role for Croat expatriate scientific community in Croatian science. He argues that proper leadership could engage Croatian expatriate scientific community in supporting the foundation of a multidisciplinary science institute in Split, Croatia. The institute could play a key role in regional economic development focused on health, energy, and environment. Establishment and maintenance of a program of such magnitude requires a diminished and more flexible role of the government and introduction of the private sector in a government-private partnership. Development of necessary attitudes and economic base will take time. (+info)
Effectiveness of a community leaders' programme to promote healthy lifestyles in Tokyo, Japan.
(39/937)
The aim of this study was to evaluate a community-based health promotion programme in terms of changing: (i) attitudes with respect to a healthy lifestyle; (ii) behaviour with respect to access to health-related information; and (iii) attitudes and health literacy regardless of socio-economic status. In this programme, 20 people are selected every 2 years in each municipality from the lay people of the community, and they are designated as members of a 'community leaders' committee' by the Mayor. They, as a group, have opportunities to gain knowledge about and skills in healthy lifestyles, and undertake voluntary activities to serve the community. A programme intervention sample (INT group) was selected from programme participants from 13 municipalities in the greater Tokyo area. A questionnaire survey was carried out with the INT group and a general population group (REF group). The data obtained for female respondents, aged 30-59 years, in the two sample populations (n = 662 and 1361, respectively) were analysed using the chi(2) test, the Kruskal-Wallis test and multivariate log-linear methods. Another questionnaire was given to female programme participants (n = 200) to identify any changes since the start of their participation. The results showed that the people in the INT group were pursuing healthier lifestyles than those in the REF group; current non-smokers who performed physical exercise and who ate meals regularly paid more attention to a healthy lifestyle and were more interested in the relationship between food and health. From the INT and REF groups, 22 and 4% of people, respectively, frequently obtained information from health professionals, and 29.8 and 10.8%, respectively, were satisfied with their access to health-related information. Results of multivariate log-linear analysis showed that significantly more people in the INT group were doing exercise, eating meals regularly, paying attention to nutritional balance and to food additives, were interested in health, and were satisfied with access to health information, after excluding the effects of age and socio-economic factors (p < 0.05). The results also showed positive changes after the implementation of the programme. These findings indicated that the people in the INT group were significantly more likely to pursue a healthier lifestyle and to have greater health literacy than those in the REF group, regardless of socio-economic status. In conclusion, this community participation approach, employing a committee style, was effective in improving health-related behaviour and in promoting health literacy while overcoming socio-economic variation. (+info)
A comparative study of peer-led and adult-led school sex education.
(40/937)
There are, and have been, many school-based sex education projects in this country which have used peer leaders (students delivering an educational programme who are of similar, or slightly older, age than the students receiving the programme). Rigorous evaluation of the methodology remains scant. This paper describes a comparative investigation of peer-led and adult-led sex education in National Curriculum Year 9 (aged 13/14 years). The results from this study suggest that peer leaders appear to be more effective in establishing conservative norms and attitudes related to sexual behaviour than the adults. Peer leaders were less effective than adults in imparting factual information and getting students involved in classroom activities. These findings suggest that both adult-led and peer-led methods may have a place in effective sex education--the challenge being to determine which areas are best dealt with by whom. (+info)