Modernization and Development: Impact on Health Care Decision-Making in Uganda

Abstract

Researchers aim to adapt the breastfeeding motivation scale and to determine the effect of socio-demographic characteristics, obstetric properties and breastfeeding status on type of breastfeeding motivation. The study sample consisted of 250 mothers those who were primiparious. We recorded the telephone numbers of mothers staying in the Postpartum Services of the hospitals and applied data collection tools by home visits at eighth week postnatal. The autonomous motivations of the mothers who were exclusively breastfeeding their babies were higher than those partially breastfeeding. In addition, advanced age, high education level, nonsmoking status and breastfeeding support were factors that positively affected breastfeeding motivation.     

Environmental Interventions to Enhance Student Adjustment: Implications for Prevention

School settings, often the sites for the prevention of adverse outcomes or the promotion of adjustment, are usually not the actual targets of such interventions. However, some interventions focus on modifying the school or classroom environments themselves. This review examines such approaches, and considers how school regularities that might undermine student adjustment are addressed. The environmental interventions are clustered in terms of focus: on student–student interactions, on teacher and peer influences, and on organizational function and structure. Reasons for the paucity of environmental change efforts and the inherent difficulties are discussed, and recommendations for creating ways to undertake future environmental interventions in schools are offered.     

努力提升科技论文的科学性

作者提交的科技文稿中存在各种各样的学术性错误,科技期刊编辑有责任帮助作者发现并改正这些错误,努力提升科技论文的科学性。科技论文中常见的学术性错误有：逻辑错误;公式错误;计算错误;数据错误等。树立强烈的责任感,应用科学的分析方法,建立合理的编校制度,是减少乃至消除论文中学术性错误的有效措施。     

Social Decision-Making and Life Skills Development: A Critical Thinking Approach to Health Promotion in the Middle School

ABSTRACT: This article discusses a classroom-based social decision-making intervention for health promotion and prevention of problem behaviors. The social decision-making approach brings together social-cognitive, affective, behavioral, and social relationship areas with critical thinking skills important for academic achievement. These skills are the same ones needed to promote children's health and prevent substance abuse and related health-compromising behaviors. Key components of this program, its development, and theoretical background are discussed, focusing on implications for school-based health promotion. As such, social decision-making provides an approach to health promotion that enhances coordination among classroom and health education personnel. The middle school years, a time of increasing risk for negative health-related outcomes, are examined as a key period for intervention. Finally, empirical evidence supporting use of social decision-making and related approaches is discussed.     

Responsive Consumerism: Empowerment in Markets for Health Plans

Context: American health policy is increasingly relying on consumerism to improve its performance. This article examines a neglected aspect of medical consumerism: the extent to which consumers respond to problems with their health plans.
Methods: Using a telephone survey of five thousand consumers conducted in 2002, this article assesses how frequently consumers voice formal grievances or exit from their health plan in response to problems of differing severity. This article also examines the potential impact of this responsiveness on both individuals and the market. In addition, using cross-group comparisons of means and regressions, it looks at how the responses of "empowered" consumers compared with those who are "less empowered."
Findings: The vast majority of consumers do not formally voice their complaints or exit health plans, even in response to problems with significant consequences. "Empowered" consumers are only minimally more likely to formally voice and no more likely to leave their plan. Moreover, given the greater prevalence of trivial problems, consumers are much more likely to complain or leave their plans because of problems that are not severe. Greater empowerment does not alleviate this.
Conclusions: While much of the attention on consumerism has focused on prospective choice, understanding how consumers respond to problems is equally, if not more, important. Relying on consumers' responses as a means to protect individual consumers or influence the market for health plans is unlikely to be successful in its current form.     

加大行政干预力度 加强临床用药管理

不合理用药问题被视为医院管理的“顽疾”。由于受到医疗卫生体制、药品流通体制、社会保障体制尚不健全和社会大环境的影响,临床合理用药管理存在相当大的难度。 年 月我院对临床用药中的不合理问题进行专项治理,把行政干预作为加强临床合理用药管理的有效手段,使不合理用药问题得到有效控制,临床用药管理逐步走向制度化、规范化与科学化,推动医院管理再上新台阶。     

Emerging Infections Program Efforts to Address Health Equity

The Emerging Infections Program (EIP), a collaboration between (currently) 10 state health departments, their academic center partners, and the Centers for Disease Control and Prevention, was established in 1995. The EIP performs active, population-based surveillance for important infectious diseases, addresses new problems as they arise, emphasizes projects that lead to prevention, and develops and evaluates public health practices. The EIP has increasingly addressed the health equity challenges posed by Healthy People 2020. These challenges include objectives to increase the proportion of Healthy People–specified conditions for which national data are available by race/ethnicity and socioeconomic status as a step toward first recognizing and subsequently eliminating health inequities. EIP has made substantial progress in moving from an initial focus on monitoring social determinants exclusively through collecting and analyzing data by race/ethnicity to identifying and piloting ways to conduct population-based surveillance by using area-based socioeconomic status measures.     

Consumer and Case Manager Perspectives of Service Empowerment: Relationship to Mental Health Recovery

This study examines the relationship between service empowerment and recovery. Service empowerment is defined as the extent to which consumers participate in service decisions and the level of reciprocity and respect within the relationship with their case managers. Assessments were made from two perspectives: consumers and their case managers. Structural equation models were developed to examine the direct and indirect effects of service empowerment on four recovery outcomes: Quality of Life, Level of Functioning, Consumer-Reported Symptomatology, and Case Manager-Reported Symptomatology. Consumers' perceptions of service empowerment were the most powerful predictor of recovery outcomes across the four models. Consumers' and case managers' perceptions were related but the magnitude of the relationship was small, indicating that considerable differences exist between their perceptions of service empowerment.Wilma J. Lutz, PhD, RN, Office of Program Evaluation & Research, Ohio Department of Mental Health, Columbus, OH, USA.Dee Roth, MA, Office of Program Evaluation & Research, Ohio Department of Mental Health, Coloumbus, OH, USA.     

Transdisciplinary Women's Health: A Call to Action

Various women's health concerns (e.g., hormonal changes, cardiovascular disease, diabetes mellitus, osteoporosis, immune deficiencies, respiratory diseases, eating disorders, substance use/abuse, sexually transmitted infections, stress, poverty, poor nutrition, and early childhood caries) are associated with oral–systemic etiologies that can either cause or form as a result of poor oral health. Nonetheless, the intersections of biological, social–behavioral, and structural factors that impact women's oral–systemic health are rarely examined. We argue for the need for transdisciplinary research, grounded in team science, for incorporating and transcending multiple discipline-specific frameworks and models to examine the complexity of women's health issues holistically across the lifespan.     

Peer Reviewed: Simulating and Evaluating Local Interventions to Improve Cardiovascular Health

Numerous local interventions for cardiovascular disease are available, but resources to deliver them are limited. Identifying the most effective interventions is challenging because cardiovascular risks develop through causal pathways and gradual accumulations that defy simple calculation. We created a simulation model for evaluating multiple approaches to preventing and managing cardiovascular risks. The model incorporates data from many sources to represent all US adults who have never had a cardiovascular event. It simulates trajectories for the leading direct and indirect risk factors from 1990 to 2040 and evaluates 19 interventions. The main outcomes are first-time cardiovascular events and consequent deaths, as well as total consequence costs, which combine medical expenditures and productivity costs associated with cardiovascular events and risk factors. We used sensitivity analyses to examine the significance of uncertain parameters. A base case scenario shows that population turnover and aging strongly influence the future trajectories of several risk factors. At least 15 of 19 interventions are potentially cost saving and could reduce deaths from first cardiovascular events by approximately 20% and total consequence costs by 26%. Some interventions act quickly to reduce deaths, while others more gradually reduce costs related to risk factors. Although the model is still evolving, the simulated experiments reported here can inform policy and spending decisions.     

Occupational Safety and Health Interventions to Reduce Musculoskeletal Symptoms in the Health Care Sector

Introduction Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards. Methods A systematic review of the literature used a best evidence synthesis approach to address the general question “Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?” This was followed by an evaluation of the effectiveness of specific interventions. Results The initial search identified 8,465 articles, for the period 1980–2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006–2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health. Conclusions The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.     

The Health Action Fund: A Community-Based Approach to Enhancing Health

This article is based on a program that was developed by the Center for Healthy Communities (CHC), a community-academic partnership in Dayton, Ohio, that continues to act as a force for change in health professions' education and health delivery, stressing the philosophy of ''doing with'' instead of ''doing for'' or ''doing to''. The Health Action Fund is a grassroots health communications and social marketing program that targets community groups who are involved often in health promotion activities developed by large agencies. However, rather than taking the traditional approach to health promotion and prevention where program develop ment and implementation is left to professionals, a different approach was taken that encourages members of neighborhoods, a community group, or a church to identify a problem and then develop a way to address that problem for their group. The program focuses on neighbors helping neighbors where communities take the lead in health promotion and prevention activities. We discuss in detail the project's innovation, challenges and how they have been addressed, qualitative and quantitative improvements made to the program, and how the program serves as a model for other communities.