U.S. health system performance: a national scorecard

This paper presents the findings of a new scorecard designed to assess and monitor multiple domains of U.S. health system performance. The scorecard uses national and international data to identify performance benchmarks and calculates simple ratio scores comparing U.S averages to benchmarks. Average ratio scores range from 51 to 71 across domains of health outcomes, quality, access, equity, and efficiency. The overall picture that emerges from the scorecard is one of missed opportunities and room for improvement. The findings underscore the importance of policies that take a coherent, whole-system approach to change and address the interaction of access, quality, and cost.     

Nutritional and physiological status of U.S. national figure skaters

This study assessed the nutrient intake, body composition and biochemical indices of National Figure Skating Championship competitors. Four-day diet records, fasting blood samples, and anthropometric measurements were obtained 2 months after the National Championships from 41 figure skaters 11-18 years of age. Energy, carbohydrate, fat, dietary fiber and cholesterol intake were significantly lower compared to the NHANES III averages for adolescents in the U.S. In general, the mean intakes for most vitamins except vitamin D and E were above the recommended intake. But the athletes had lower intakes of vitamin E and B12, and higher intakes of vitamin C, and thiamin (females only) compared with NHANES III. The mean intakes of magnesium, zinc, and iodine by the male skaters were below the recommended levels, as were the mean intakes of calcium, iron, phosphorus, magnesium, and zinc by the female skaters. Also, the number of servings from vegetable, fruit, dairy, and meat groups were below the recommended levels. Biochemical indices of nutritional status were within normal limits for all skaters. But plasma electrolyte concentrations were indicative of potential dehydration status. The results suggest there is a need to develop dietary intervention and educational programs targeted at promoting optimal nutrient and fluid intakes by these athletes to maintain performance and improve long-term health status.     

A national profile of patient safety in U.S. hospitals

Measures based on routinely collected data would be useful to examine the epidemiology of patient safety. Extending previous work, we established the face and consensual validity of twenty Patient Safety Indicators (PSIs). We generated a national profile of patient safety by applying these PSIs to the HCUP Nationwide Inpatient Sample. The incidence of most nonobstetric PSIs increased with age and was higher among African Americans than among whites. The adjusted incidence of most PSIs was highest at urban teaching hospitals. The PSIs may be used in AHRQ's National Quality Report, while providers may use them to screen for preventable complications, target opportunities for improvement, and benchmark performance.     

美国职业健康教育工作者执业资格认证简介

美国国家健康教育认证委员会(national cornmission for health education credentialing，NCHEC)的目标是提高健康教育专业的实践水平，通过认证健康教育工作者，向公众和健康教育专业领域提供服务，以促进健康教育专业的发展，加强健康教育的职业准备和实践能力。NCHEC的职责为：建立一套以能力为基础的考试系统；建立职业准备的标准；通过进修项目使专业能力不断发展。     

Early-response biological dosimetry--recommended countermeasure enhancements for mass-casualty radiological incidents and terrorism

The effective medical management of a suspected acute radiation overexposure incident necessitates recording dynamic medical data, measuring appropriate radiation bioassays, and estimating dose from dosimeters and radioactivity assessments in order to provide diagnostic information to the treating physician and a dose assessment for personnel radiation protection records. The accepted generic multiparameter and early-response approach includes measuring radioactivity and monitoring the exposed individual; observing and recording prodromal signs/symptoms and erythema; obtaining complete blood counts with white blood cell differential; sampling blood for the chromosome-aberration cytogenetic bioassay using the "gold standard" dicentric assay (translocation assay for long times after exposure) for dose assessment; bioassay sampling, if appropriate, to determine radioactivity contamination; and using other available dosimetry approaches. In the event of a radiological mass-casualty incident, current national resources need to be enhanced to provide suitable dose assessment and medical triage and diagnoses. This capability should be broadly based and include stockpiling reagents and devices; establishing deployable (i.e., hematology and biodosimetry) laboratories and reference (i.e., cytogenetic biodosimetry, radiation bioassay) laboratories; networking qualified reference radioactivity-counting bioassay laboratories, cytogenetic biodosimetry, and deployable hematology laboratories with the medical responder community and national radiation protection program; and researching efforts to identify novel radiation biomarkers and develop applied biological dosimetry assays monitored with clinical, deployable, and hand-held analytical systems. These research and applied science efforts should ultimately contribute towards approved, regulated biodosimetry devices or diagnostic tests integrated into a national radioprotection program.     

Historical and comparative reflections on the U.S. national health insurance reforms

The 2010 US reforms addressed forms of public and private insurance designed to reinforce a delivery system that developed to maximize the autonomy of physicians and hospitals. That autonomy emphasizes fees and specialization, which led to for-profit incorporation and overtreatment. Powerful corporate lobbies have defeated previous reforms and diluted the impact of the Obama reform. It barely passed and does little to manage costs or rationalize medicine. US health care does not fit established models of welfare states and contains five different models of health care delivery. Most interesting are forms of democratically run community health centres. Selected features of the reforms are highlighted.     

U.S. Department of Energy policies, directives, and guidance for radiological control and release of property

U.S. Department of Energy (U.S. DOE) regulates its operations with a system of rules, directives, and guidance under the Atomic Energy Act. U.S. DOE's policy is to conduct its radiological operations in a manner that ensures the health and safety of its employees, contractors, and the public. U.S. DOE uses an annual dose limit of 100 mrem (1 mSv) with an "as low as reasonably achievable" (ALARA) process to achieve radiological protection. The primary directive for radiation protection of the public and the environment is DOE Order 5400.5. It contains requirements for the protection of the public and the environment from routine operations, including controlling and releasing property. Since the publication of Order 5400.5 in 1990, U.S. DOE has issued guidance for meeting requirements under it; Guide G 441.1-xx consolidates this guidance. DOE applies a dose constraint of 25 mrem y (0.25 mSy y(-1)), plus ALARA, for the release of real property, and 1 mrem y(-1), plus ALARA, for release of personal property. Models and guidance to develop the needed documentation for release of property are easily available and user-friendly. While achieving protection of human health and the environment, U.S. DOE's dose-based release process has resulted in significant cost savings. U.S. DOE has recently adopted a management systems approach for general environmental and public protection programs. The integration of the radiation protection program into this new approach is a high priority.     

The U.S. government's medical countermeasure portfolio management for nuclear and radiological emergencies: synergy from interagency cooperation

Following the attacks of 11 September 2001, emergency preparedness within the U.S. Department of Health and Human Services, as well as at the Department of Defense and other federal agencies, received higher visibility, new mandates and increased funding. Emergency deployment teams increased the frequency of drills to enable better response to the health consequences of mass-casualty incidents. Interagency coordination has also continued to increase to more efficiently and effectively leverage federal resources toward emergency medical preparedness for both civilian and military populations.     

Emergency medical preparedness for radiological/nuclear incidents in the United States

The Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services develops health and medical response plans for all hazards--natural and human caused. While a nuclear power plant (NPP) incident will take time to evolve, a terrorist incident will have 'no-notice' so that extensive preparation and planning are essential. For radiological/nuclear (rad/nuc) incidents we have developed and continue to refine detailed plans and tools for medical responders for a nuclear detonation and a radiological dispersal device, which also serve for any type of rad/nuc incident. The plans are based on the best available basic science with the goal of providing planners and responders with just-in-time information and tools. There is much in common across the range of hazards, so that the products developed for rad/nuc incidents have helped overall preparedness. A major consideration in the development of new diagnostics, medical treatment and countermeasures for radiation injury is that of 'dual utility' with potential for routine medical use for cancer care. Participation and collaboration among nations helping the Japanese response to the Fukushima earthquake, tsunami and NPP disaster demonstrated the benefit of preparation and ongoing worldwide cooperation among experts.     

Increasing response rates to a smoking survey for U.S. Navy enlisted women

This study examined the effectiveness of several persistent strategies to increase the response to a smoking survey among newly enlisted U.S. Navy women. The stepped approach, which included the use of incentives, repeated mailings, alternative survey administration modes, and reminders, was evaluated in terms of effects on response rates and response bias. Demographic and baseline smoking-related characteristics were compared for those responding on time to the initial mailed follow-up survey, reluctant respondents who did not respond initially but eventually completed a survey after further prompting, and non-respondents. Results showed that incentives and persistent efforts were effective in substantially increasing the response among 2,231 eligible participants, more than doubling the response rate (from 24.9% to 52.7%). The characteristics of on-time, reluctant, and non-respondents did not differ significantly in terms of sociodemographic characteristics. On the other hand, on-time respondents were different from both reluctant respondents and non-respondents in terms of smoking-related behaviors.     

Smoking, cognitive function and mortality in a U.S. national cohort study

Previous studies report that low levels cognitive function and history of smoking are associated with increased mortality risk. Elderly smokers may have increased risk of dementia, but risk in former smokers is unclear. We tested the hypotheses that the harmful effect of impaired cognitive function as related to mortality is greater in persons smoking at baseline than in others. Further, we used serum cotinine levels to assess recall bias of smoking history by cognitive function level. Data were analyzed from a longitudinal mortality follow-up study of 4,916 American men and women aged 60 years and over, examined in 1988-1994 with complete data followed an average 8.5 years. Measurements at baseline included smoking history, a short index of cognitive function (SICF), serum cotinine and socio-demographics. Death during follow-up occurred in 1,919 persons. In proportional hazards regression analysis, a significant interaction of current smoking with cognitive function was not found; but there was a significant age-smoking interaction. After adjusting for confounding by age or multiple variables, current smoking associated with over 2-fold increased mortality (hazards ratio and 95% confidence limits current versus never smoking 2.13, 1.75-2.59) and SICF with 32% reduction in mortality; top versus bottom SICF stratum 0.68, 0.53-0.88). Serum cotinine data revealed substantial recall bias of smoking history in persons with cognitive impairment. However analyses correcting for this bias did not alter the main conclusions: In a nationwide cohort of older Americans, analyses demonstrated a lower risk of death independent of confounders among those with high SICF scores and never smokers, without a significant interaction of the two.