The 'wonderfulness' of children's feeding programs

When people involved in children's feeding programs were asked to describe them, without exception they were described using phrases that reflected the perception of 'wonderfulness'. This paper critically analyses the 'wonderfulness' of children's feeding programs by examining the language used to describe these programs, and the features of a 'wonderful' program through an analysis of a multi-site, qualitative case study of nine diverse programs in Atlantic Canada. When participants justified their comments about the 'wonderfulness' of children's feeding programs, they did so based upon five perceptions of program strengths: enhanced family coping; providing good food and nutrition; socializing and making friends; behaving well in school; and volunteerism. We suggest that programs can be designed to be innately 'wonderful' if they are community- and charity-based, support a noble cause such as the elimination of child hunger, engage good people as donors and volunteers, and provide a direct service to children apart from their families. We challenge health promoters to beware of the 'wonderful' program; its 'wonderfulness' may actually be masking unintended negative impacts upon its participants.     

瞄准新定位适应新形势把握提高863计划申报质量的重要环节和建议

针对"十一五"国家科技发展的新形势,结合北京大学组织申报863计划课题(项目)的具体实践,本文分析了"十一五"863计划的新定位和组织管理框架,着重讨论了863计划申报过程的几个重要环节,包括选题、填写申请书、编制经费预算等,并提出了相关建议,以期对科研人员和科研管理人员有所帮助.     

Economic Considerations Related to the Child and Youth Care Professionalization Process: The Risks and the Challenges

This paper deals with a somehow forgotten factor in the discussion about professionalization of the child and youth care field. It is a major and most influential component in every social reality—economic considerations. It is obvious that professionalization costs a lot of money, a fact that is creating strong opposition from various social partners. This factor has not always been taken into consideration, seriously enough, in the discussion about professionalization. Unfortunately, it might become a source for serious problems in the long run. Some examples are already known, like the reduction in the number of children in residential care in many countries. It is argued that instead of debating against or for professionalization of the field, innovative models have to be invented that look at professionalism as a continuum, with minimum and maximum boundaries. These new models have to implement differential levels of professionalism, in the planning of all services for children and youth in need of care, taking economic considerations into account.     

Parameters of Control when Facing Stochastic Demand: A DEA Approach Applied to Bangladeshi Vaccination Sites

An aim of vaccination programs is near-complete coverage. One method for achieving this is for health facilities providing these services to operate frequently and for many hours during each session. However, if vaccine vials are not fully used, the remainder is often discarded, considered as waste. Without an active appointment schedule process, there is no way for facility staff to control the stochastic demand of potential patients, and hence reduce waste. And yet reducing the hours of operation or number of sessions per week could hinder access to vaccination services. In lieu of any formal system of controlling demand, we propose to model the optimal number of hours and sessions in order to maximize outputs, the number and type of vaccines provided given inputs, using Data Envelopment Analysis (DEA). Inputs are defined as the amount of vaccine wastage and the number of full-time equivalent staff, size of the facility, number of hours of operation and the number of sessions. Outputs are defined as the number and type of vaccines aimed at children and pregnant women. This analysis requires two models: one DEA model with possible reallocations between the number of hours and the number of sessions but with the total amount of time fixed and one model without this kind of reallocation in scheduling. Comparing these two scores we can identify the gain that would be possible were the scheduling of hours and sessions modified while controling for all other types of inefficiency. By modeling an output-based model, we maintain the objective of increasing coverage while assisting decision-makers determining optimal operating processes.     

Why girls smoke: a proposed community-based prevention program

OBJECTIVES: To review the literature on reasons teenage girls start smoking and to identify the role and opportunities for nurses to have an impact on this public health problem. In addition, a proposed smoking prevention program targeted to teenage girls is presented. DATA SOURCES: Information was gathered from professional journals and texts and from MEDLINE and PROQUEST. Keywords used in the searches were smoking prevention, tobacco use, smoking and adolescents, teenage girls and smoking, health education and smoking, and smoking prevention programs. DATA SYNTHESIS AND CONCLUSIONS: Smoking initiation in teenage girls is a problem with ramifications for individual health as well as for public health. Although the literature demonstrates the rising incidence of smoking in teenage girls and evidence suggests the reasons girls start smoking differ from those of their male counterparts, a dearth of information on smoking prevention programs exists for this population. It is reasonable to assume that the best practices for adolescent smoking prevention can be applied to programs specifically for girls, along with efforts to address social influences, self-image, and self-esteem, which may be particularly important to teenage girls. The theory of reasoned action provides a framework for prevention strategies that target the behavioral beliefs and attitudes that influence teenage girls to smoke. Nurses can educate themselves about contributing factors that lead teenage girls to start smoking. Implementing this knowledge into nursing practice in a variety of settings could help meet the Healthy People 2010 goals of reducing teenage smoking to 16%.     

瞄准新定位适应新形势把握提高863计划申报质量的重要环节和建议

针对"十一五"国家科技发展的新形势,结合北京大学组织申报863计划课题(项目)的具体实践,本文分析了"十一五"863计划的新定位和组织管理框架,着重讨论了863计划申报过程的几个重要环节,包括选题、填写申请书、编制经费预算等,并提出了相关建议,以期对科研人员和科研管理人员有所帮助.     

PREVENTIVE SOCIAL HEALTH PROGRAMS: ARE THEY AUSTRALIA’S ANSWER TO RISING HEALTH CARE COSTS IN RURAL COMMUNITIES?

ABSTRACT: Although we have good evidence to support the notion that early intervention, prevention and community education programs can mitigate the impact of preventable disease, expanded primary health care is also being promoted by Australian governments as a panacea for reducing growth in demand generally. While preventive programs do reduce acute demand, they may not do so to the extent that resources, currently allocated to the acute sector, can be substituted to provide the additional primary care services necessary to reduce acute demand permanently. These developments have particular relevance for rural and isolated communities where access to acute services is already very limited. What appears to be occurring, in rural South Australia at least, is that traditional acute services are being reduced and replaced with lower level care and social intervention programs. This is well and good, but eventually the acute care being provided in rural health units now will still need to be provided by other units elsewhere and probably at much higher cost to the system and to consumers. Where rural communities have previously managed much of their own acute service demand, they may now be forced to send patients to more distant centres for care but at much greater social and economic cost to individuals and the system.     

Transition programs in cystic fibrosis centers: perceptions of pediatric and adult program directors

There is a growing population of adults with cystic fibrosis (CF) and a need for development of adult CF programs. Recommendations for transfer of patients to an adult program include a transition program. Our goal was to assess the current status of transition programs in US CF centers. In addition, we sought to determine the problems related to the transfer of patients to adult programs as perceived by CF center program directors. A survey was sent in 1998 to 110 pediatric and 44 adult program directors at CF centers approved by the Cystic Fibrosis Foundation (CFF), with a response rate of 65.5% and 72.7%, respectively: 22.2% of pediatric centers reported having a non-CFF-approved adult program, and 38.9% had no specific adult program. About one fifth of pediatric centers cited lack of an adult CF physician as an impediment to establishing an adult program. Age (82% of programs; mean, 18.5 years), but not marriage (17.1%) or pregnancy (24.8%), was used as a criterion for transfer. Criteria precluding transfer included patient/family resistance (51.4%), disease severity (50.5%), and developmental delay (46.7%). The concept of transfer is introduced to the patient and family at the time of diagnosis in a minority (14%) of programs. Over one half of the patients did not meet the adult team until the time of transfer. Pediatricians reported higher perceived parent, patient, pediatric staff, and adult staff concerns about transition issues than did adult program directors. We conclude that there is a lack of standardized programs for transfer of CF patients from a pediatric to an adult care setting, and that there are differences between pediatric and adult program directors' perceptions of concerns that CF patients, their families, and the medical teams have about transfer. These differences may impede the successful transition of patients into an adult program.     

Performance and quality measurement in occupational health services: current status and agenda for further research

BACKGROUND: There is growing interest in evaluating the impact and effectiveness of occupational healthcare services (OHS). Managed care networks, case and disease management, worker health promotion, and utilization review services have proliferated in OHS, usually without scientifically based, objective measures of their impact on the quality of care, outcomes, or costs. Performance and quality improvement (QI) efforts in OHS are different from those in general health care because the population, range of conditions, setting of care, and primary outcomes of interest differ considerably. However, scientific knowledge resulting from the application of QI in general health care can provide a useful framework for the development of measures in OHS. METHODS: We describe the development, selection, and evaluation of OHS performance and quality measures, and propose a research agenda. CONCLUSIONS: Quality and performance measures in OHS should address common work-related conditions with high costs, suboptimal outcomes, or unclear parameters for ideal practices. They should reflect stakeholder priorities. Measures should be precise and quantifiable, clearly specified, reliable, valid, and sensitive to important changes. They should be based upon data that can be collected and analyzed at a reasonable cost and effort. The focus of measurement should be on situations where improvement can be achieved by those directly involved in OHS delivery, through defined approaches. Appropriate severity and case-mix adjustment may be especially problematic in OHS. Confidentiality, regulatory concerns, and appropriate use of results must be considered in the development and use of OHS measures. Research is needed to identify, develop, and validate OHS-specific measures, to establish risk adjustment methods, and to test the utility of this information in improving OHS.