Healthy Iowans 2010 Mid-Course Revision, July 2005

In the past century, public health has been credited with adding 25 years to life expectancy by contributing to the decline in illness and injury. Progress has been made, for example, in smoking reduction, infectious disease, and motor vehicle and workplace injuries. Besides its focus on traditional concerns such as clean water and safe food, public health is adapting to meet emerging health problems. Particular troublesome are health threats to youth: teenage pregnancies, violence, substance abuse, sexually transmitted diseases, and other conditions associated with high-risk behaviors. These threats add to burgeoning health care costs. A conservative estimate of $69 billion in medical spending could be averted through the impact of public health strategies aimed at heart disease, stroke, fatal and nonfatal occupational injuries, motor vehicle-related injuries, low birth weight, and violence. These strategies require the collaboration of many groups in the public and private sectors. Collaboration is the bedrock of public health and Healthy Iowans planning. At the core of Healthy Iowans 2000 and its successor, Healthy Iowans 2010, is the idea that all Iowans benefit when stakeholders decide on disease prevention and health promotion strategies and agree to work together on them. These strategies can improve the quality of life and hold down health care costs. The payoff for health promotion and disease prevention is not immediate, but it has long-lasting benefits. The Iowa plan is a companion to the national plan, Healthy People 2010. An initiative to improve the health of Americans, the national plan is the driving force for federal resource allocation for disease prevention and health promotion. The state plan is used in the same way. Both plans have received broad support from Republican and Democratic administrations. Community planners are using the state plan to help assess health needs and craft health improvement plans. Healthy Iowans 2010 was written at an unusual point in history – a new decade, a new century, a new millennium. The introduction was optimistic. “The 21st century,” it says, “promises to add life as well as years through improved health habits coupled with medical advances. Scientists have suggested that if these changes occur, the definition of adulthood will also change. An extraordinary number of people will live fuller, more active lives beyond that expected in the late 20th century.” At the same time, the country has spawned a new generation of health hazards. According to Dr. William Dietz of the Centers for Disease Control and Prevention (CDC), it has replaced “the diseases of deficiency with diseases of excess” (Newsweek, August 2, 1999). New threats, such as childhood overweight, can reverse progress made in the last century. This demands concerted action.

Nursing Supervision: Studying the “Case” of the phenomenon of interorganizational articulation Nursing School and Hospital

The history of this research found a suitable ethos not only by the route of the researcher, but also by the current public policies of modernization and reform that are capable of regulating and transforming the educational and health systems, as well as their professional groups. The reflection meantime developed had raised a clear perception of the organizational change processes by which they interfered with the interorganizational coordination between School of Nursing and Hospital, where internship supervision would be the main protagonist, supported by the meanings that intervening actors have assigned to them. In this context, the search for explicit epistemological and methodological choices leads to look more attentively at the problem, ascertaining it, taking into account the organizational dimensions. In this regard, the choice of a case study was related to the fact that the method allowed to answer the purpose of knowing and understanding the interorganizational coordination phenomenon between School of Nursing and Hospital, namely through the supervision of internships.

L'expérience de la ménopause : étude ethnographique en Suisse Romande et au Centre-Cameroun

Aujourd'hui, la construction sociale de la ménopause intéresse de nombreux chercheurs en sciences sociales. Cependant, la façon dont les femmes vivent ou se représentent cet événement reste peu documentée. L'objectif de cette thèse est donc d'approfondir la compréhension de l'expérience de la ménopause en accordant une place primordiale aux discours et aux pratiques des femmes elles-mêmes. En s'appuyant sur une recherche ethnographique en Suisse romande et au Centre-Cameroun, cette étude parcourt différentes dimensions de l'expérience de la ménopause (représentations, vécus, pratiques de gestion) qui, corrélées les unes aux autres, forment un tout. Au-delà des divergences que l'on peut observer au niveau culturel, de la situation économique et sociale des femmes, des systèmes de santé et du statut occupé par la ménopause dans les deux pays, les résultats de ce travail montrent que les expériences de la ménopause chez les Suissesses et les Camerounaises interviewées ne peuvent pas simplement être classifiées de manière binaire ou dichotomique. Dans chacun des contextes, ces expériences sont plurielles et dépendent de plusieurs facteurs. D'une part, elles découlent d'une observation empirique de la part de ces femmes elles-mêmes et de leurs interactions avec différents acteurs dont les médias (particulièrement en Suisse), les pairs, les proches et les professionnels de la santé. D'autre part, elles sont influencées par de nombreuses variables parmi lesquelles le contexte économique, socioculturel, familial et conjugal, le statut professionnel, la prévalence des troubles ressentis et le statut ménopausique de ces femmes. Mais, ces facteurs ne sont pas hiérarchisés puisqu'ils agissent différemment pour chacune d'entre elles. Dès lors, s'il apparaît que les expériences ménopausiques n'échappent point aux déterminations sociales, il n'en demeure pas moins qu'elles relèvent aussi des capacités réflexives des femmes, les conduites sociales n'étant pas réductibles à des applications des codes intériorisés. Au fil du travail, la médicalisation de la ménopause, bien qu'existant à des degrés variables entre la Suisse et le Cameroun, a émergé comme une problématique transversale. Interrogeant les logiques qui la sous-tendent, cette étude se propose d'analyser le rôle que jouent les femmes elles-mêmes dans ce processus. - Today, the social construction of the menopause is of great interest for many researchers in social sciences. Neverthless, the way of living or of representing this event is still little documented. The aim of this thesis is to study thoroughly the understanding of menopausal experience through the discourses and practices of women themselves. Based on an ethnograph ic research, in French-speaking Switzerland and in Centre-Cameroon, this study looks at different dimensions of menopausal experience (representations, real-life experiences, pratices) that, connected to each other, form a whole. Inspite of the cultural, economic, social, health systems and menopausal status differences between these two countries, the results of this thesis show that menopausal experiences among the Swiss and the Cameroonians interviewee can not simply be classified in two dichotomous groups. In each context, those experiences are plural and depend on several factors. On the one hand, they arise from women's own empirical observations and from their interactions with several actors like the media (especially in Switzerland), the peers, the people closest to them and health professionals. On the other hand, they are influenced by many elements such as the economical, sociocultural, family and marital context, the professional status, the prevalence of felt disorders and the menopausal status of those women. But, these factors are not hierarchical beacause they operate differently for each person. Accordingly, if menopausal experiences don't escape from social determinism, nonetheless they also depend on the reflexive capacities of women beacause social conducts can not be reduced to the application of interiorised codes. Through this work, the médicalisation of the menopause, even though varying between Switzerland and Cameroon, comes to light as a cross-cutting problematic. Questioning its underlying logic, this study proposes to analyse the role that women themselves play in this process.

Population based resource allocation: The use of hybrid risk adjustment

The emphasis on integrated care implies new incentives that promote coordinationbetween levels of care. Considering a population as a whole, the resource allocation systemhas to adapt to this environment. This research is aimed to design a model that allows formorbidity related prospective and concurrent capitation payment. The model can be applied inpublicly funded health systems and managed competition settings.Methods: We analyze the application of hybrid risk adjustment versus either prospective orconcurrent risk adjustment formulae in the context of funding total health expenditures for thepopulation of an integrated healthcare delivery organization in Catalonia during years 2004 and2005.Results: The hybrid model reimburses integrated care organizations avoiding excessive risktransfer and maximizing incentives for efficiency in the provision. At the same time, it eliminatesincentives for risk selection for a specific set of high risk individuals through the use ofconcurrent reimbursement in order to assure a proper classification of patients.Conclusion: Prospective Risk Adjustment is used to transfer the financial risk to the healthprovider and therefore provide incentives for efficiency. Within the context of a National HealthSystem, such transfer of financial risk is illusory, and the government has to cover the deficits.Hybrid risk adjustment is useful to provide the right combination of incentive for efficiency andappropriate level of risk transfer for integrated care organizations.

Comportamentos de saúde e doença numa comunidade Cabo-Verdiana em Lisboa

O objetivo foi compreender como os indivíduos se comportam em termos de saúde e o que fazem em caso de doença. Análise comparativa realçou semelhanças e divergências de práticas de saúde ou em caso de doença. O estudo foi efetuado numa amostra de 40 cabo-verdianos da primeira geração residentes na região de Lisboa, dividida em subgrupos: grupo social, geração e genero. Baseou-se em metodologia qualitativa com entrevistas semi-estruturadas. As práticas analisadas foram agrupadas em preventivas e de saúde, práticas utilizadas em episódios de doença, recursos para prevenção e tratamento, utilização de remédios caseiros e outros recursos ou terapeutas. Indivíduos experimentaram, ao nível das práticas, três sistemas de saúde que coexistiam em Cabo Verde, oficial, popular e tradicional e o recurso à religião. O discurso acerca das práticas de saúde e de doença demonstrou existirem diferenças, em alguns aspectos, entre grupos sociais e entre generos e gerações. Práticas de saúde destes imigrantes são idênticas às dos portugueses em contextos socioeconomicos semelhantes. Resultados sugerem existência de diferenças entre grupos sociais relativamente às práticas, na esfera da saúde e da doença. Mais que cultura e etnicidade, que se moldam às condições materiais de existência, neste estudo, o nível socioeconomico determinou as maiores diferenças a interferir nas práticas de saúde e doença, de grupo com cultura de base comum. Em geral, os indivíduos sobrevalorizaram sua identidade étnica e cultura de origem. Pertencimento a grupos sociais diferentes dá origem a partilha do sentimento de pertença cultural, mas não a comportamentos e práticas idênticos.

Comportamentos de saúde e doença numa comunidade Cabo-Verdiana em Lisboa

This study aims at analysing, through personal reports, the way individuals behave in terms of health and illness. A comparative analysis of the collected data was performed, with the purpose of highlighting divergences in the health and illness practices. The study was undertaken with a sample of 40 «first generation» Cape Verdeans living in the Metropolitan area of Lisbon, divided into distinct groups: social (popular and elite), generation (younger and older) and gender (men and women). A qualitative methodology was employed, by conducting semi-structured interviews for the collection of information. The health and illness practices were grouped into preventive and health care practices, practices used in episodes of illness, resources used for prevention and treatment, use of home remedies, and other alternative resources. Individuals who are part of our study experimented, at the level of practices, with the three health systems that existed in Cape Verde, namely, the official, popular and traditional, and recourse to religion. The discourse analysis concerning health and disease practices showed there are differences, in some respects, between social groups. There were also slight differences between genders and generations. These immigrants’ health practices are identical to those of the Portuguese who are in similar socioeconomic contexts, with no significant effects of immigration itself on these practices. The analysis of the results confirms the existence of differences between social groups concerning the health and illness practices. They were more determined by the socioeconomic factors than by the cultural and ethnic aspects. Those differences also highlighted the existence of a unifying aspect, resulting from their cultural heritage. Although belonging to different social groups, the existence of a common culture and ethnic identity originates a shared feeling of cultural belonging, but not identical behaviours and practices.

Comportamentos de saúde e doença numa comunidade Cabo-Verdiana em Lisboa

O objetivo foi compreender como os indivíduos se comportam em termos de saúde e o que fazem em caso de doença. Análise comparativa realçou semelhanças e divergências de práticas de saúde ou em caso de doença. O estudo foi efetuado numa amostra de 40 cabo-verdianos da primeira geração residentes na região de Lisboa, dividida em subgrupos: grupo social, geração e genero. Baseou-se em metodologia qualitativa com entrevistas semi-estruturadas. As práticas analisadas foram agrupadas em preventivas e de saúde, práticas utilizadas em episódios de doença, recursos para prevenção e tratamento, utilização de remédios caseiros e outros recursos ou terapeutas. Indivíduos experimentaram, ao nível das práticas, três sistemas de saúde que coexistiam em Cabo Verde, oficial, popular e tradicional e o recurso à religião. O discurso acerca das práticas de saúde e de doença demonstrou existirem diferenças, em alguns aspectos, entre grupos sociais e entre generos e gerações. Práticas de saúde destes imigrantes são idênticas às dos portugueses em contextos socioeconomicos semelhantes. Resultados sugerem existência de diferenças entre grupos sociais relativamente às práticas, na esfera da saúde e da doença. Mais que cultura e etnicidade, que se moldam às condições materiais de existência, neste estudo, o nível socioeconomico determinou as maiores diferenças a interferir nas práticas de saúde e doença, de grupo com cultura de base comum. Em geral, os indivíduos sobrevalorizaram sua identidade étnica e cultura de origem. Pertencimento a grupos sociais diferentes dá origem a partilha do sentimento de pertença cultural, mas não a comportamentos e práticas idênticos.

La gestión sanitaria: orientaciones a futuro para el cambio organizativo, del control y la financiación

This paper offers a general view of changes in health care management in theSpanish Health System. We focus on the organisational, financing andaccountability aspects of health care provision. We do this by encompassingmanagerial changes and social change and well-grounded in theory health economicsliterature. In this way we try to link applied economics and management issues,as we did in a former paper, ten years ago on the same basis(López-Casasnovas, 2002). We emphasise mistakes and milestones in the wayforward to improve health systems by better understanding the public natureof health policies. Key aspects of this are to achieve a better allocation ofresponsibilities to providers on patients health, to incentive the organisationof medical self-managed health care institutions and to build global budgets onrisk-adjusting capitation and better integrated health care providers on acommunity basis.

Factors de creixement autòlegs aplicats a les ferides cròniques amb evolució tòrpida

Les ferides cròniques, especialment les de lenta curació, suposen una carga important pels pacients i pels sistemes de salut. És imprescindible investigar en nous tractaments que redueixin el temps de curació d‟aquestes ferides. L‟objectiu d‟aquest projecte, és avaluar l‟eficàcia dels factors de creixement, obtinguts de plasma ric en plaquetes, en la curació o millora de les ferides cròniques. El projecte s‟ha dissenyat com un estudi d‟una sèrie de casos que compara el tractament convencional amb el tractament amb factors de creixement. La variable resultats és la curació o la disminució del àrea de l‟úlcera. El projecte pretén avaluar uns quants pacients consecutius atesos en l‟ unitat de ferides cròniques del nostre hospital. Els subjectes del estudi han de presentar una ferida de més de 3 mesos d‟evolució nul·la o escassa resposta als tractaments habituals. La tècnica de obtenció dels factors de creixement plaquetar no és complexa i es pot realitzar en l‟entorn d‟un hospital de dia. No s‟han comunicat en la literatura efectes secundaris majors de l‟aplicació dels factors de creixement en ferides cròniques.

Offender Assessments Help Guide Use of Treatment Resources, Data Download, Iowa Department of Corrections, December 2009

The Department of Corrections contracts with Spectrum Health Systems to conduct front-end substance abuse assessments at the inmate reception center – Iowa Medical and Classification Center. Such assessments are considered vital in so far as 80-85% of offenders in DOC institutions list alcohol/drug problems as one of their top three need areas.

Outpatient Quick Diagnosis Units for the evaluation of suspected severe diseases: an observational, descriptive study

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal. AIMS: Our goal was to describe the functioning of a Quick Diagnosis Unit in a Spanish public university hospital after evaluating 1,000 consecutive patients. We also aimed to ascertain the degree of satisfaction among Quick Diagnosis Unit patients and the costs of the model compared to conventional hospitalization practices. DESIGN: Observational, descriptive study. METHODS: Our sample comprised 1,000 patients evaluated between November 2008 and January 2010 in the Quick Diagnosis Unit of a tertiary university public hospital in Barcelona. Included patients were those who had potentially severe diseases and would normally require hospital admission for diagnosis but whose general condition allowed outpatient treatment. We analyzed several variables, including time to diagnosis, final diagnoses and hospitalizations avoided, and we also investigated the mean cost (as compared to conventional hospitalization) and the patients' satisfaction. RESULTS: In 88% of cases, the reasons for consultation were anemia, anorexia-cachexia syndrome, febrile syndrome, adenopathies, abdominal pain, chronic diarrhea and lung abnormalities. The most frequent diagnoses were cancer (18.8%; mainly colon cancer and lymphoma) and Iron-deficiency anemia (18%). The mean time to diagnosis was 9.2 days (range 1 to 19 days). An estimated 12.5 admissions/day in a one-year period (in the internal medicine department) were avoided. In a subgroup analysis, the mean cost per process (admission-discharge) for a conventional hospitalization was 3,416.13 Euros, while it was 735.65 Euros in the Quick Diagnosis Unit. Patients expressed a high degree of satisfaction with Quick Diagnosis Unit care. CONCLUSIONS: Quick Diagnosis Units represent a useful and cost-saving model for the diagnostic study of patients with potentially severe diseases. Future randomized study designs involving comparisons between controls and intervention groups would help elucidate the usefulness of Quick Diagnosis Units as an alternative to conventional hospitalization.

Chagas Disease among the Latin American Adult population attending in a primary care center in Barcelona, Spain

Background/Aims: The epidemiology of Chagas disease, until recently confined to areas of continental Latin America, has undergone considerable changes in recent decades due to migration to other parts of the world, including Spain. We studied the prevalence of Chagas disease in Latin American patients treated at a health center in Barcelona and evaluated its clinical phase. We make some recommendations for screening for the disease. Methodology/Principal Findings: We performed an observational, cross-sectional prevalence study by means of an immunochromatographic test screening of all continental Latin American patients over the age of 14 years visiting the health centre from October 2007 to October 2009. The diagnosis was confirmed by serological methods: conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA). Of 766 patients studied, 22 were diagnosed with T. cruzi infection, showing a prevalence of 2.87% (95% CI, 1.6-4.12%). Of the infected patients, 45.45% men and 54.55% women, 21 were from Bolivia, showing a prevalence in the Bolivian subgroup (n = 127) of 16.53% (95% CI, 9.6-23.39%). All the infected patients were in a chronic phase of Chagas disease: 81% with the indeterminate form, 9.5% with the cardiac form and 9.5% with the cardiodigestive form. All patients infected with T. cruzi had heard of Chagas disease in their country of origin, 82% knew someone affected, and 77% had a significant history of living in adobe houses in rural areas. Conclusions: We found a high prevalence of T. cruzi infection in immigrants from Bolivia. Detection of T. cruzi¿infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems.

Chronic Disease Connections, September 2013

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.

Chronic Disease Connections, October 2013

IDPH has a new grant-funded program, the Health Promotion and Chronic Disease Control Partnership. This publication, Chronic Disease Connections, will be part of the communication strategy between IDPH staff and healthcare system providers throughout the state as we partner to help patients control their diabetes and high blood pressure. This is just one of the major objectives for the funding. The CDC would like to see that more patients are aware that they have pre-diabetes, diabetes or high blood pressure and that health systems are maximizing evidence-based strategies to assist patients with achieving control. Over the coming months you will hear more about the new program and how you can become involved.