Critical success factors for physical activity promotion through community partnerships

Objectives

To define key factors of effective evidence-based policy implementation for physical activity promotion by use of a partnership approach.

Methods

Using Parent and Harvey’s model for sport and physical activity community-based partnerships, we defined determinants of implementation based on 13 face-to-face interviews with network organisations and 39 telephone interviews with partner organisations. Furthermore, two quantitative data-sets (n = 991 and n = 965) were used to measure implementation.

Results

In total, nine variables were found to influence implementation. Personal contact was the most powerful variable since its presence contributed to success while its absence led to a negative outcome. Four contributed directly to success: political motive, absence of a metropolis, high commitment and more qualified staff. Four others resulted in a less successful implementation: absence of positive merger effects, exposure motive and governance, and dispersed leadership.

Conclusions

Community networks are a promising instrument for the implementation of evidence-based policies. However, determinants of both formation and management of partnerships influence the implementation success. During partnership formation, special attention should be given to partnership motives while social skills are of utmost importance for the management.     

Medical care employment in the United States, 1968 to 1993: The importance of health sector jobs for African Americans and women.

OBJECTIVES: The purpose of this study was to elucidate the social and economic impact of health sector employment. METHODS: US medical care employment was analyzed for each year between 1968 and 1993, with data from the March Current Population Survey. RESULTS: Between 1968 and 1993, medical care employment grew from 4.32 million to 11.40 million persons, accounting for 5.7% of all jobs in 1968 and 8.4% in 1993. Today, one seventh of employed women work in medical care; they hold 78% of medical care jobs. One fifth of all employed African-American women work in medical care. African-Americans hold 15.5% of jobs in the health sector: they hold 24.1% of the jobs in nursing homes, 15.9% of the jobs in hospitals, but only 5.6% of the jobs in practitioners' offices. Hispanics constitute 6.4% of medical care employees. Real wages rose 25% to 50% between 1968 and 1993 for most health occupations. Wages of registered nurses rose 86%; physicians' incomes rose 22%. Wages of nursing home workers were far lower than those of comparable hospital workers, and the gap has widened. In 1993, 11.7% of all medical care workers lacked health insurance and 597 000 lived in poverty. CONCLUSIONS: Hospital cuts and the continuing neglect of long-term care exacerbate unemployment and poverty among women and African Americans.     

Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada.

OBJECTIVES. We compared US and Canadian health administration costs using national medical care employment data for both countries. METHODS. Data from census surveys on hospital, nursing home, and outpatient employment in the United States (1968 to 1993) and Canada (1971 and 1986) were analyzed. RESULTS. Between 1968 and 1993, US medical care employment grew from 3.976 to 10.308 million full-time equivalents. Administration grew from 0.719 to 2.792 million full-time equivalents, or from 18.1% to 27.1% of the total employment. In 1986, the United States deployed 33,666 health care full-time equivalent personnel per million population, and Canada deployed 31,529. The US excess was all administrative; Canada employed more clinical personnel, especially registered nurses. Between 1971 and 1986, hospital employment per capita grew 29% in the United States (mostly because of administrative growth) and fell 14% in Canada. In 1986, Canadian hospitals still employed more clinical staff per million. Outpatient employment was larger and grew faster in the United States. Per capita nursing home employment was substantially higher in Canada. CONCLUSIONS. If US hospitals and outpatient facilities adopted Canada's staffing patterns, 1,407,000 fewer managers and clerks would be necessary. Despite lower medical spending, Canadians receive slightly more nursing and other clinical care than Americans, as measured by labor inputs.     

Lack of health coverage among US veterans from 1987 to 2004

Objectives. Veterans Administration health care enrollment is restricted to veterans with service-connected problems and those who are poor. We sought to determine how many veterans were uninsured, trends in veterans’ coverage, and whether uninsured veterans lacked access to medical care.Methods. We analyzed annual data from 2 federal surveys, the Current Population Survey for the years 1988 to 2005 and the National Health Interview Survey for 2002 to 2004.Results. Nearly 1.8 million veterans were uninsured and not receiving Veterans Administration care in 2004. The proportion of working-age veterans lacking coverage peaked in 1993 at 14.2%, fell to 9.9% in 2000, and rose steadily to 12.7% in 2004. Uninsured veterans had substantial access problems; 51.4% had no usual source of care (vs 8.9% of insured veterans), and 26.5% reported failing to get needed care because of the cost (vs 4.3% of insured veterans).Conclusions. Many US veterans are uninsured and lack adequate access to health care. Expanded funding for veterans’ care is urgently needed; only national health insurance could guarantee coverage to both veterans and their family members.As clinicians at an urban public hospital, we often care for uninsured patients. Recently, we noted that several patients without coverage were combat veterans. We were surprised. We, and most colleagues with whom we conferred, assumed that all veterans qualify for care at Veterans Health Administration (VA) hospitals and clinics.In fact, only a minority of veterans—those disabled by military service—are automatically eligible for VA care. The Veterans Eligibility Reform Act of 1996 opened VA enrollment to all veterans, although non-poor veterans were required to make co-payments of up to $50 per day for outpatient care. (Poor is defined by assets and an income threshold that varies with location and family size. In general, veterans earning more than $30 000 per year are not eligible for free care.) However, a July 18, 2002, memo from the deputy undersecretary for health for operations and management ordered VA regional directors to “ensure that no marketing activities to enroll new veterans occur,” citing “demand for healthcare that exceeds our resources” and “very conservative OMB [Office of Management and Budget] budget guidelines.”1 Subsequently, the secretary of veterans affairs ordered a halt to the enrollment of most nonpoor veterans as of January 17, 2003.2We found scant data on uninsured veterans. Several studies identified the safety net function of VA care,3^,4 looked at uninsured veterans in a single state,5 or offered limited data for a single year.6 An Internet posting by VA analysts offered some data on the number of uninsured veterans.7Our encounters with uninsured veterans led us to explore 3 questions: are many veterans uninsured? Do uninsured veterans suffer problems in access to care similar to others who are uninsured? Is this a new problem?     

Single-payer national health insurance. Physicians' views

BACKGROUND: Forty-one million Americans have no health insurance and, despite the growth of managed care, medical costs are again increasing rapidly. One proposed solution is a single-payer health care financing system with universal coverage. Yet, physicians' views of such a system have not been well studied. METHODS: We surveyed a random sample of physicians (from the American Medical Association Masterfile) in Massachusetts, regarding their views on a single-payer health care financing system and other financing and physician work-life issues that such a system might affect. RESULTS: Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians chose a single-payer system; 10.7%, managed care; and 25.8%, a fee-for-service system. Only 51.9% believed that most physician colleagues would support a single-payer system. Most respondents would give up income to reduce paperwork, agree that it is government's responsibility to ensure the provision of medical care, believe that insurance firms should not play a major role in health care delivery, and would prefer to work under a salary system. CONCLUSIONS: Most physicians in Massachusetts, a state with a high managed care penetration, believe that single-payer financing of health care with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system. Physicians' advocacy of single-payer national health insurance could catalyze a renewed push for its adoption.     

Resting state functional MRI reveals abnormal network connectivity in neurofibromatosis 1

Neurofibromatosis type I (NF1) is a genetic disorder caused by mutations in the neurofibromin 1 gene at locus 17q11.2. Individuals with NF1 have an increased incidence of learning disabilities, attention deficits, and autism spectrum disorders. As a single‐gene disorder, NF1 represents a valuable model for understanding gene–brain–behavior relationships. While mouse models have elucidated molecular and cellular mechanisms underlying learning deficits associated with this mutation, little is known about functional brain architecture in human subjects with NF1. To address this question, we used resting state functional connectivity magnetic resonance imaging (rs‐fcMRI) to elucidate the intrinsic network structure of 30 NF1 participants compared with 30 healthy demographically matched controls during an eyes‐open rs‐fcMRI scan. Novel statistical methods were employed to quantify differences in local connectivity (edge strength) and modularity structure, in combination with traditional global graph theory applications. Our findings suggest that individuals with NF1 have reduced anterior–posterior connectivity, weaker bilateral edges, and altered modularity clustering relative to healthy controls. Further, edge strength and modular clustering indices were correlated with IQ and internalizing symptoms. These findings suggest that Ras signaling disruption may lead to abnormal functional brain connectivity; further investigation into the functional consequences of these alterations in both humans and in animal models is warranted. Hum Brain Mapp 36:4566–4581, 2015. © 2015 Wiley Periodicals, Inc.