State of Iowa Employee Benefits Handbook, November 2010

Examples of the information available include: • Links to health and dental plans • Health plan comparisons • Health and Dependent Care Flexible Spending Account information • Deferred Compensation information • Life and Long Term Disability insurance information • Link to Employee Assistance Program (EAP) Web site • Link to Employee Discount Program • Link to Wellness Web site which includes information about - Smoking Cessation Program - Prescription Drug information - Wellness activities

State of Iowa Employee Benefits Handbook, December 2002

Examples of the information available include: • Links to health and dental plans • Health plan comparisons • Health and Dependent Care Flexible Spending Account information • Deferred Compensation information • Life and Long Term Disability insurance information • Link to Employee Assistance Program (EAP) Web site • Link to Employee Discount Program • Link to Wellness Web site which includes information about - Smoking Cessation Program - Prescription Drug information - Wellness activities

State of Iowa Employee Benefits Handbook, December 2002

Examples of the information available include: • Links to health and dental plans • Health plan comparisons • Health and Dependent Care Flexible Spending Account information • Deferred Compensation information • Life and Long Term Disability insurance information • Link to Employee Assistance Program (EAP) Web site • Link to Employee Discount Program • Link to Wellness Web site which includes information about - Smoking Cessation Program - Prescription Drug information - Wellness activities

Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes.

BACKGROUND: Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting the doctor to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. OBJECTIVES: To evaluate the effects of reminders automatically generated through a computerized system and delivered on paper to healthcare professionals on processes of care (related to healthcare professionals' practice) and outcomes of care (related to patients' health condition). SEARCH METHODS: For this update the EPOC Trials Search Co-ordinator searched the following databases between June 11-19, 2012: The Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Library (Economics, Methods, and Health Technology Assessment sections), Issue 6, 2012; MEDLINE, OVID (1946- ), Daily Update, and In-process; EMBASE, Ovid (1947- ); CINAHL, EbscoHost (1980- ); EPOC Specialised Register, Reference Manager, and INSPEC, Engineering Village. The authors reviewed reference lists of related reviews and studies.  SELECTION CRITERIA: We included individual or cluster-randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals on processes and/or outcomes of care. DATA COLLECTION AND ANALYSIS: Review authors working in pairs independently screened studies for eligibility and abstracted data. We contacted authors to obtain important missing information for studies that were published within the last 10 years. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median absolute improvement and interquartile range (IQR) in process adherence across included studies using the primary outcome or median outcome as representative outcome. MAIN RESULTS: In the 32 included studies, computer-generated reminders delivered on paper to healthcare professionals achieved moderate improvement in professional practices, with a median improvement of processes of care of 7.0% (IQR: 3.9% to 16.4%). Implementing reminders alone improved care by 11.2% (IQR 6.5% to 19.6%) compared with usual care, while implementing reminders in addition to another intervention improved care by 4.0% only (IQR 3.0% to 6.0%) compared with the other intervention. The quality of evidence for these comparisons was rated as moderate according to the GRADE approach. Two reminder features were associated with larger effect sizes: providing space on the reminder for provider to enter a response (median 13.7% versus 4.3% for no response, P value = 0.01) and providing an explanation of the content or advice on the reminder (median 12.0% versus 4.2% for no explanation, P value = 0.02). Median improvement in processes of care also differed according to the behaviour the reminder targeted: for instance, reminders to vaccinate improved processes of care by 13.1% (IQR 12.2% to 20.7%) compared with other targeted behaviours. In the only study that had sufficient power to detect a clinically significant effect on outcomes of care, reminders were not associated with significant improvements. AUTHORS' CONCLUSIONS: There is moderate quality evidence that computer-generated reminders delivered on paper to healthcare professionals achieve moderate improvement in process of care. Two characteristics emerged as significant predictors of improvement: providing space on the reminder for a response from the clinician and providing an explanation of the reminder's content or advice. The heterogeneity of the reminder interventions included in this review also suggests that reminders can improve care in various settings under various conditions.

Investigation of Earlham Community School District Employee’s Personal Use of a School Vehicle, July 6, 2012

We received a complaint in late September 2011 that an Earlham School District employee had borrowed a school vehicle for her personal use for one month, with the Superintendent’s permission. The school board had discussed the circumstances of the borrowed district vehicle in closed session. The complainant believed this was contrary to Iowa law and also believed no action had been taken against the school employee who borrowed the vehicle or the superintendent who allowed the personal use of the vehicle. He was aware the school district’s attorney reviewed the matter and determined the employee and superintendent violated no law or district policies. Since the school board discussed the matter only in closed session, it was unknown what, if any, discipline was taken against the employees and whether such actions were condoned by the district. We agreed to investigate to determine if the actions of school officials or employees violated Iowa law and if the response from the school board was appropriate.

Aplicación de una técnica operativa con carácter discriminatorio en los procesos de selección de personal

Existen técnicas clásicas cuya función es seleccionar aquellas personas que son idóneas para un determinado puesto de trabajo. El punto fundamental consiste en adaptar una persona a un perfíl de tareas que esa persona debe desarrollar y al mismo tiempo esa persona debe sentirse parte integrante de la empresa, para conseguirlo, en el presente trabajo expondremos una nueva técnica para la selección de personal ejecutivo y basada en la teoría de los subconjuntos borrosos dentro de las nuevas técnicas operativas de gestión.

Se former à l'entretien motivationnel pour aider ses patients à changer: Les étudiants en médecine le confirment [Learning motivational interviewing to help patients change their health-related behaviors: medical students confirm it].

At the Lausanne University, 5th year medical students were trained in Motivational interviewing (MI). Eight hours of training improved their competence in the use of this approach. This experience supports the implementation of MI training in medical schools. Motivational interviewing allows the health professional to actively involve the patient in this behavior change process (drinking, smoking, diet, exercise, medication adherence, etc.), by encouraging reflection and reinforcing personal motivation and resources.

Health care renunciation for economic reasons in Switzerland.

BACKGROUND: Most societies elaborate ways to contain increasing health care expenditures. In Switzerland out of pocket payments and cuts in the catalogue of reimbursed services are used as cost-containment measures. The aims of the study were to estimate the extent of health care renunciation for economic reasons and to identify associated factors. METHODS: A population-based cross-sectional survey (2008-2009) of a representative sample in the Canton of Geneva, Switzerland. Health care underuse, income level categories (<CHF 3000/month, 3000-4999, 5000-6999, 7000-9499, 9500-13 000, >13 000), education, occupation, insurance status and cardiovascular comorbidities were collected using self-rated questionnaires. RESULTS: 765 men and 814 women aged 35-74 years participated. 14.5% (229/1579) (95%CI 12.7-16.2) renounced health care for economic reasons. Among those who renounced (N = 229), 74% renounced dental care, 37% physician consultation (22% specialist, 15% general practitioner), 26% health devices, 13% medication, and 5% surgery. Income was negatively correlated with renouncement (r = -0.18, p <.0001). Each decrease in income level category provided a 48% increased risk of renouncing health care for economic reasons (OR 1.48, 1.31-1.65). This association remained when dental care was excluded from the definition of health care renunciation. CONCLUSIONS: In a region of Switzerland with a high cost of living, such as Geneva, socioeconomic status may influence the use of the health care system, and renunciation for economic reasons was not uncommon. More than 30% of the lowest income group renounced health care for economical reasons in the previous year. Health care underuse and renunciation may worsen the health status of a substantial part of society.

El secreto profesional y la protección de datos de carácter personal

El secreto profesional es un elemento de obligado cumplimiento para los profesionales de la salud, entre ellos la matrona. El deber de guardar secreto permite a las mujeres y a sus familias mantener la intimidad personal, y a los profesionales conocer datos, situaciones y sucesos imprescindibles para la asistencia sanitaria. A las matronas, por nuestro ámbito profesional, se nos confían datos referentes a la salud y a la sexualidad de la mujer, entre otros. La protección de estos datos, su custodia, la elaboración de la historia clínica como elemento fundamental para la asistencia continuada y como justificador del buen hacer profesional de la matrona están regulados jurídicamente y tienen, en la actualidad, gran repercusión legal.

Shorter time since inflammatory bowel disease diagnosis in children is associated with lower mental health in parents.

AIM: This study assessed the mental health of parents of children with inflammatory bowel disease (IBD), compared their mental health with age-matched and gender-matched references and examined parental and child predictors for mental health problems. METHODS: A total of 125 mothers and 106 fathers of 125 children with active and inactive IBD from the Swiss IBD multicentre cohort study were included. Parental mental health was assessed by the Symptom Checklist 27 and child behaviour problems by the Strengths and Difficulties Questionnaire. Child medical data were extracted from hospital records. RESULTS: While the mothers reported lower mental health, the fathers' mental health was similar, or even better, than in age-matched and gender-matched community controls. In both parents, shorter time since the child's diagnosis was associated with poorer mental health. In addition, the presence of their own IBD diagnosis and child behaviour problems predicted maternal mental health problems. CONCLUSIONS: Parents of children with IBD may need professional support when their child is diagnosed, to mitigate distress. This, in turn, may help the child to adjust better to IBD. Particular attention should be paid to mothers who have their own IBD diagnosis and whose children display behaviour problems.

El secreto profesional y la protección de datos de carácter personal

El secreto profesional es un elemento de obligado cumplimiento para los profesionales de la salud, entre ellos la matrona. El deber de guardar secreto permite a las mujeres y a sus familias mantener la intimidad personal, y a los profesionales conocer datos, situaciones y sucesos imprescindibles para la asistencia sanitaria. A las matronas, por nuestro ámbito profesional, se nos confían datos referentes a la salud y a la sexualidad de la mujer, entre otros. La protección de estos datos, su custodia, la elaboración de la historia clínica como elemento fundamental para la asistencia continuada y como justificador del buen hacer profesional de la matrona están regulados jurídicamente y tienen, en la actualidad, gran repercusión legal.

Is diagnosis enough to guide interventions in mental health? Using case formulation in clinical practice.

ABSTRACT: While diagnosis has traditionally been viewed as an essential concept in medicine, particularly when selecting treatments, we suggest that the use of diagnosis alone may be limited, particularly within mental health. The concept of clinical case formulation advocates for collaboratively working with patients to identify idiosyncratic aspects of their presentation and select interventions on this basis. Identifying individualized contributing factors, and how these could influence the person's presentation, in addition to attending to personal strengths, may allow the clinician a deeper understanding of a patient, result in a more personalized treatment approach, and potentially provide a better clinical outcome.

An epidemiological study of dental agenesis in a primary health area in Spain: estimated prevalence and associated factors

Objectives: To evaluate the prevalence of dental agenesis and its possible association with other developmental dental anomalies and systemic entities. Setting and Sample Population: Descriptive transversal study, for which 1518 clinical records, of patients visited by the Odontological Service of the Primary Health Centre of Cassà de la Selva (Girona-Spain) between December 2002 and February 2006 were reviewed. The data were recorded in relation to the oral and dental anomalies and the associated systemic entities, between the ones referred as concomitant in literature. Results: Values of 9.48% (7.25% excluding the third molars) for dental agenesis and 0.39% for oligodontia were obtained. The presence of dental agenesis concomitant with some other forms of oral and dental anomalies was observed. Attention must be drawn to the fact that a greater number of concomitant systemic entities were observed in those patients that presented a severe phenotypical pattern of dental agenesis. Conclusions: The results of the present study do not differ from the ones reported in studies of similar characteristics among Occidental and Spanish populations. The relationship observed between certain systemic entities and developmental dental anomalies suggest a possible common genetic etiology