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The article presents news briefs regarding community health nursing. A report which has been released by the Centers for Disease Control and Prevention (CDC) regarding the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) is discussed. Guidelines which have been provided by the American Nurses Association (ANA) regarding the way in which health care workers should respond to emergencies and disasters are mentioned.

The context for contemporary research and policy is set through a theoretically informed history of the modern American health care system that draws on the concept of countervailing powers and Fligstein's theory of control In this context, the papers of this special issue are then introduced. [ABSTRACT FROM AUTHOR]

The creation of the National Centers of Excellence in Women's Health (CoE) program in 1996 by the Office on Women's Health, Department of Health and Human Services, included the stipulation that each institution awarded a CoE contribute at least a 25% match for the federal funds. Even the combination of these two sources of monies was insufficient for each CoE to accomplish its goals, however, so leveraging funds became necessary for each CoE to function effectively. The forms of leveraging varied from CoE to CoE, in part as a result of the institutional environment and the unique possibilities each permitted and in part as a result of the creativity of the leaders of the CoEs. This paper describes the concepts and some applications of leveraging in the setting of the CoEs, which might be applicable to other settings as well. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to empirically explore issue of differential use of health services by men and women. For this, a 1977 data set from the National Medical Care Expenditure Survey was used. The question addressed in this paper is whether it is possible to establish specific factors which explain some of the higher use of health services. Whether the theft use higher because their time and time price, theft preferences, or their need for medical services differ, or whether they are more sensitive at the margin to one or more of these factors. Empirical approach suggested that: women are sicker or at least report more conditions; women respond somewhat differently to the factors that influence use, but the differences are not usually large. They are not always in the direction that would suggest greater use. For illness-specific visits, men and women respond more similarly than for all visits; and as more women join or remain in the labor force, and as their time costs increase, the differential use of physician services between men and women may well decline.

This paper describes changes in the population for which General Motors provides health benefits using data from domestic personnel records. Total population size grew from 2.01 million in 1983 to 2.14 million in 1987, twice as fast as the US populations. Dependents, particularly spouses, fueled the population growth. Trends suggest that nonworker eligibility for employer-provided health benefits may receive more attention in health care cost containment efforts. [ABSTRACT FROM AUTHOR]

This paper proposes a national program to restructure local public health services in the United States which are still characterized by an excessive number of very small health units. It reviews past proposals to correct this situation, and recommends specific programmatic, organizational and financial measures to strengthen the public health infrastructure and achieve an effective national network of federal, state and local public health agencies. [ABSTRACT FROM AUTHOR]

The article offers information on the challenges faced by the American Public Health Association on the development of the association's Medical Care Section in the U.S. On November 10, 1948, the American Public Health Association's Governing Council voted to approve the petition requesting the establishment of a Medical Care Section. In 1972, the association expanded their health services because of the changes on their needs and demands. In 1920, the association created a committee to study the municipal health departments and determine the extent of variation on the health services and procedures offered in a specific community.

Editorial. Offers a look at how personal feelings affect an individual's reading of a medical journal. Discussion of a paper by Jack Wennberg in the March 13, 2004 issue regarding death in highly respected American hospitals; Use of healthcare resources in the best hospitals in America; Reference to a paper in the same issue by Chibuzo Odigwe that claims children in Great Britain often feel ignored by the British National Health Service; Communication between children patients and physicians.

The article reports on the American Public Health Association's announcement of the schedule for the annual process of considering proposed policy statements for 1990. These public policy statements form the basis of the association's position on legislative, regulatory, legal and health matters of interest to the public health community. They also provide a record of the association's stand on a variety of health issues, reflecting the diverse interest of its membership. Deadline for receipt of proposed resolutions is on February 26, 1990.

While many Americans grouse about the high cost of medical care in the United States, their willingness to pay is strong evidence of the value they place on having ready access to these services. But little research has documented why Americans pay so much more than citizens in other industrialized countries and how U.S. medical prices compare with the growth of other personal consumption spending in this country. The first of these papers, published in this issue of the journal "Public Health," discuss the controversy over patents and access to drugs in developing countries and how the General Agreement on Trade in Services may influence the shape of domestic health care systems.

With its primary focus on community health, the public health system focuses on intervention and prevention of disease and injury to protect entire populations. As a federation of city, county and state entities operating independently under a complicated array of local, state and federal laws, public health can best be understood as a complex adaptive system. The dynamic nature of this system and the need for public health agencies to relate and respond to numerous stimuli in terms of new regulations, changing health status, emerging threats and shifting policy, can mask the commonality of underlying business processes performed within the public health sector. Heightened demand for interoperable, adaptive information systems across the broader US health system necessitates the recognition of this commonality and highlights the need for comprehensive analysis and understanding of these core business processes. In turn, this analysis paves the way for public health to apply proven systems engineering techniques to streamline, automate and facilitate those processes. Here, we look at the nature of the public health system and the evolution of a purpose-built methodology for process engineering within public health. We also present a case study based on the application of the methodology to develop requirements for public health laboratory information management systems. [ABSTRACT FROM AUTHOR]

Latinos are the largest minority group in the U.S. For Latino immigrants, a shift in migration from larger to smaller cities has recently occurred; the Latino immigrant population in Charlotte, North Carolina, has increased by 634% since 1990. The extent to which immigrants can achieve health and well-being is often related to employment, healthcare access, and social support. This study explored the human, social, and financial capital circumstances of Latino immigrants new to Charlotte and examined the effects of different aspects of capital on health outcomes. Findings indicate that capital is significantly associated with functional status and depression. Implications for social work are discussed. [ABSTRACT FROM AUTHOR]

The article relates the author's interest as a public scholar in improving the health of the U.S. population. According to the author, his scholarly efforts over the last decade and more have been related to new understandings he has gained about population health. Through medical practice, the author learned that medical care was not what made populations healthy, but, social, economic and political factors were far more important. He admits that his academic work is directed at encouraging students and citizens to develop critical thinking skills, coupled with the types of awareness that they can use as lifelong scholars and activists in improving societal outcomes.

Aim To test a priori hypotheses concerning client–treatment matching in the treatment of alcohol problems and to evaluate the more general hypothesis that client–treatment matching adds to the overall effectiveness of treatment. Design Pragmatic, multi-centre, randomized controlled trial (the UK Alcohol Treatment Trial: UKATT) with open follow-up at 3 months after entry and blind follow-up at 12 months. Setting Five treatment centres, comprising seven treatment sites, including National Health Service (NHS), social services and joint NHS/non-statutory facilities. Treatments Motivational enhancement therapy and social behaviour and network therapy. Measurements Matching hypotheses were tested by examining interactions between client attributes and treatment types at both 3 and 12 months follow-up using the outcome variables of percentage days abstinent, drinks per drinking day and scores on the Alcohol Problems Questionnaire and Leeds Dependence Questionnaire. Findings None of five matching hypotheses was confirmed at either follow-up point on any outcome variable. Conclusion The findings strongly support the conclusion reached in Project MATCH in the United States that client–treatment matching, at least of the kind examined, is unlikely to result in substantial improvements to the effectiveness of treatment for alcohol problems. Possible reasons for this failure to support the general matching hypothesis are discussed, as are the implications of UKATT findings for the provision of treatment for alcohol problems in the United Kingdom. [ABSTRACT FROM AUTHOR]

The widespread development of comprehensive community initiatives that aim to improve community health is driven by the need to change the systems charged with delivering the services and creating the policies related to a variety of health outcomes. Georgia’s Family Connection initiative is the nation’s largest statewide network of community collaboratives for health, with collaboratives operating in 159 counties. Data on community context, collaborative processes, engagement in systems change, and changes in programs and activities implemented, gathered consistently at the collaborative level over 3 years, will be used to answer the following questions. How do community contexts and the structure and processes of collaboratives affect implementation of systems change? How do systems changes affect intermediate outcomes such as the type of programs offered in a community? Longitudinal change in systems change and program implementation is described and significant predictors of between-collaborative variation in longitudinal change for each outcome are identified. [ABSTRACT FROM AUTHOR]

Details the evolution of personal health services in the United States. Recognition of need to organized personal health services; Bases for organization of personal health services; Parameters for surveillance as a basis for health maintenance; Model for the organization of personal health services; Steps toward improved organization of personal health services.

The Health Resources and Services Administration and All Kids Count (a national technical assistance center fostering development of integrated child health information systems) have been working together to foster development of integrated child health information systems. Activities have included: identification of key elements for successful integration of systems; development of principles and core functions for the systems; a survey of state and local integration efforts; and a conference to develop a common vision for child health information systems to meet medical care and public health needs. We provide 1 state (Utah) as an example that is well on the way to development of integrated child health information systems. [ABSTRACT FROM AUTHOR]

This article discusses several strategies for diffusing public health innovations through older adults' health communication networks. Individuals across the world are living longer, mostly because of basic advances in public health such as sanitation and clean drinking water. In the U.S., changes in lifestyle that include more health-promoting behavior are among the factors helping individuals to live longer. Two major developments in the twentieth century are important in a consideration of population health and aging. In health, the causes of population mortality shifted from acute, infectious diseases to chronic, noninfectious diseases. Thus, the basic public health notions of prevention have required revision. The range of preventive health behaviors includes lifestyle practices such as exercise and eating habits as well as undergoing medically recommended procedures such as screening. Fifty percent of premature mortality' is directly related to individual lifestyle factors and behaviors; a much lower percentage of premature mortality is related to genetic profiles or inadequate access to medical care.

This article discusses public health issues among older American Indians and Alaska Natives. Provision of services to specific populations, particularly those groups who face barriers to equity in healthcare, has always been an important focus of public health. The public health perspective outlines a societal approach to protecting and promoting health, which emphasizes prevention, macro-level interventions, and the reshaping of public policy. Given that health behavior and health outcomes are known to differ by ethnicity, researchers must understand diverse populations without assuming that all diverse populations are the same. When universal models and norms of health are applied across groups, differences can be misinterpreted as "deficits." The purpose of this article is to illustrate how differences make it necessary to reject the notion of universality when applying a public health approach. Tremendous variation exists across ethnic groups, reflecting differences in socioeconomic status, histories, and cultural norms. Within-group diversity is also dynamic individuals of an ethnic identity may differ from the group as they reject or adapt to the mainstream culture.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) needs to evaluate appropriate nutrition education for its at risk audience, including Five-A-Day for Better Health educational material that promotes consumption of five servings a day of fruits and vegetables. An evaluation was conducted of a Five-A-Day recipe booklet for use with mothers having a child or children enrolled in WIC. Three clinic sites in eastern Washington State tested the booklet using a pretest (n = 225)/post-test (n = 167) design and an intervention protocol based on preliminary focus group data. The booklet featured information on fresh produce and was accordingly tested over the summer months. Participants were on average 28 years of age and mostly White (77%). After receiving the booklet, many WIC mothers reported feeling more confident about choosing good quality fresh produce (70%) and storing fruits and vegetables appropriately (68%), and also felt that it was easier to include fruits and vegetables in their family's meals (74%). Many mothers reportedly served more fruits and vegetables to their families after receiving the booklet. Notably, this occurred at numerous meals and snack times with both fruits and vegetables, and was independent of a reported trend to consume more fruits and vegetables in the summer. Mothers also favorably evaluated the format and content of the booklet. However, mothers' barriers related to fruits and vegetables did not change, and their estimated intake of fruits and vegetables decreased slightly over the intervention period. Adjustments to the protocol are suggested that may enhance the booklet's effect on WIC mothers' attitudes and behaviors. KEY WORDS: Five-A-Day evaluation; WIC nutrition education. [ABSTRACT FROM AUTHOR]

An improperly healed fracture was the most common reason for the medical malpractice crisis between the 1830s and 1860s in the United States. As a practicing lawyer in Illinois, Abraham Lincoln defended physicians in medical malpractice law suits. One of these was Dr. Powers Ritchey, who was sued for malpractice in 1855. Lincoln agreed to represent Dr. Ritchey in 1858 as the case was appealed to the supreme court of Illinois. In the interim, Lincoln defended two indicted murderers and won acquittals for both. Between the two murder trials, Lincoln debated Stephen A. Douglas while running for U.S. Senator from Illinois. Lincoln believed that Ritchey's case was poorly represented in the lower court. Ritchey's prior attorneys did not file a bill of exceptions to the testimony of the plaintiffs expert medical witnesses. Lincoln attempted to rebut the allegation of a lack of reasonable medical care and diligence by Ritchey, and he sought to secure a new trial for his client. In its decision, the supreme court of Illinois did not find any error and affirmed the lower court's judgment. KEY WORDS: Abraham Lincoln; lawyer; medical malpractice; bone fracture; improper healing. [ABSTRACT FROM AUTHOR]

Epidemiological trends in HIV infection in the United States suggest existing primary and secondary prevention efforts are inadequate. Healthcare providers may be missing valuable opportunities to engage in necessary public health services, such as prevention education, risk assessment, and case finding. This study examined the HIVrelated practice behaviors and training needs of physicians and nurses in the Midwest. A cross-sectional survey method was employed. A questionnaire was mailed to a probability sample of 1,500 physicians and registered nurses licensed as of August 1999 in one of six Midwestern states. A total of 534 physicians and nurses replied to the survey, and over half had received prior HIV-related continuing medical education and training. One third of nurses and 26.8 percent of physicians reported that they did not engage in any HIV-related public health role in their practice. Physicians with prior HIV continuing medical education and training were 3.1 times more likely to report HIV-related public health services in their practice than providers without prior training (p = .004). Nurses with prior experience serving HIV-infected patients were 2.0 times more likely to identify a public health role (p = .012). These findings reflect the need for greater awareness among medical providers of the importance of assuming a public health role with the HIV epidemic. KEY WORDS: HIV/AIDS; education; public health; prevention; training. [ABSTRACT FROM AUTHOR]

The September 11, 2001, attack on the World Trade Center had profound effects on the well-being of New York City. The authors describe and assess the strengths and weaknesses of the city's response to the public health, environmental/occupational health, and mental health dimensions of the attack in the first 6 months after the event. They also examine the impact on the city's health care and social service system. The authors suggest lessons that can inform the development of a post-September 11th agenda for strengthening urban health infrastructures. (Am J Public Health. 2003;93:400-406) [ABSTRACT FROM AUTHOR]

This article presents information on the Cooperative Agreement Projects launched by the U.S. Department of Health and Human Services' (DHHS) Special Projects of National Significance program to fund 27 innovative models of HIV care. The organizations involved in HIV care aim to improve access to care, health and quality of life for traditionally underserved populations living with HIV/AIDS. It explains that the population being served by the projects have the following characteristics: 88.9% lacked private insurance, 72.5% were people of color and 85.7% were unemployed or unable to work due to a disability. It added that 22.1% had a history of sex work.

The approach of a millennial passage invites public health to a review of past performance and a preview of future prospects toward assuring a healthy public. Since the 1974 Canadian Lalonde report, the best national plans for health progress have emphasized disease prevention and health promotion. WHO'S multinational Health for All by the Year 2000 promotes basic health services essential to leading a socially and economically productive life. Healthy People 2000, the latest US guide, establishes three goals: increase healthy life span, reduce health disparities, and achieve universal access to preventive services. Its objectives can be used to excite public understanding, equip program development, evaluate progress, and encourage public accountability for health initiatives. Needed is federal leadership in defining requisite action and securing necessary resources. Elsewhere a "new public health" emphasizes community life-style and multisectoral "healthy public policy." In the United States, a national health program is needed to achieve equity in access to personal health care. Even more essential is equitable sharing in basic health determinants in society—nutritious food, basic education, safe water, decent housing, secure employment, adequate income, and peace. Vital to such a future is able and active leadership now from governments and public health professionals. [ABSTRACT FROM AUTHOR]

The article presents the APHA recommended program guide for abortion services for 1979. It enumerates the specific principles established by the Court regarding abortion prior to fetal viability. It also mentions special statutory provisions that require accredited hospitals, hospital abortion committees and residency in the state are invalid. It also talks about publication about procedures and services, referrals, counseling and medical care. It also specifies the items of information recommended for inclusion in a system for the reporting of legal abortions.

The change in recent times from acute to chronic patterns of morbidity necessitates a corresponding restructuring of the medical profession to eliminate the anachronistic division of medicine into curative and preventive branches. [ABSTRACT FROM AUTHOR]

This article looks at the history and evolution of human service corporations and their contributions to welfare state in the U.S. Fifty years after its inception, the U.S. welfare state is undergoing a fundamental reorganization. The primary manifestation of this is the proliferation of for-profit human service corporations. The corporate sector has begun to exploit the post-industrial human services market, making substantial inroads in, if not dominating, several areas: nursing homes, hospital management, health maintenance organizations, and home care. While the initial corporate incursions into social welfare have been chiefly in health care, firms have aggressively moved into the child-care, life-care, and corrections markets as well. Between the bureaucratic behemoths of the governmental and corporate sectors, nonprofit agencies of the voluntary sector struggle to maintain their standing in an increasingly competitive welfare market. Diminishing revenues in relation to service demand have led some voluntary-sector agencies into income-generating ventures that allow them to transfer profits from commercial activities to their welfare programs.

This article focuses on the primary care policy in the U.S. The definition of "primary care" has been the subject of some debate, but it will be defined here as health services that are provided on an ambulatory or outpatient basis, and basic or general health care which emphasizes the point when the patient first seeks assistance from the medical care system and the care of the simpler and more common illnesses. The role of the public sector was limited to one that would not be "competitive" with private medicine. Local public health departments provided services that private physicians were unable or un-interested in providing. The federal government remained largely uninvolved until the 1930's.

Quite a few people in public health have been thinking what Dr. Freedman says, and are wondering where we are really going. The fragmentation and the attitudes to which he addresses himself must be seen in terms of the need for development of comprehensive health services for all Americans. [ABSTRACT FROM AUTHOR]

This is a review of programs in the New York City Health Department that have to do with responsibilities relating to the provision of health care services. It is believed that such activities will be regular functions of many municipal health departments during the 1970s. [ABSTRACT FROM AUTHOR]

We surveyed 1196 Black health and political leaders on their perceptions about the US Department of Health and Human Services' Healthy People 2000 public health goals. Respondents identified reducing the incidence of acquired immunodeficiency syndrome, improving maternal and infant health, and controlling sexually transmitted diseases as the three most important public health goals for Black Americans that are amenable to intervention. The leaders assigned nearly all responsibility for prevention efforts to the federal government and the individual. With the American health care system now in flux, Black leaders need to organize to see that these priority issues are addressed. [ABSTRACT FROM AUTHOR]

In epidemiologic and public health studies of disease incidence in geographic subpopulations, attention is properly directed toward the ascertainment of accurate numerators. Population or person-years denominators are generally given less consideration, under the assumption that estimates produced by sources other than the state health department are sufficiently accurate. Here, we report our experience in estimating person-years denominators in the highly urbanized, rapidly expanding population of Maricopa County, Arizona. The usual sources of population estimates were found to be of little use for public health purposes, and so we report on a method for obtaining smoothed person-years figures that can accurately reflect population acceleration which varies from one time period to another. Our method is to regress the logarithm of census enumerations on quadratic or tertic polynomials in time. We describe how differential reliability of census figures can be incorporated into our procedure, and how the problem of missing census data can he handled by an iterated regression method. Our evidence suggests that the logarithmic regression model works well, even in the face of rapid and erratic population growth or decline. [ABSTRACT FROM AUTHOR]

This article presents a citation from the report of the National Commission on Community Health Services, a private corporation sponsored by the American Public Health Association and the National Health Council. The group carried out a four-year nationwide study of community health needs, resources, and practices, with the aid of six task-force explorations in 21 communities across the U.S. Government grants and contributions from foundations and business firms subsidized the study. Where health services are concerned, the Commission suggests that the boundaries of each community are those practical ones within which a health problem can be defined, dealt with, and solved.

The article presents a policy statement of The American Public Health Association concerning the introduction of registered care technologists in patient care as a temporary solution to the severe shortage of professional nurses in the U.S. The association objects to the proposal and instead encourages the National League for Nursing, American Nurses Association, and other professional nursing associations to address the nursing shortage in partnership with the federal government and health-related organizations to guarantee quality patient care.

The article explores some practical difficulties that have emerged concerning the status of paraprofessionals or lay mental workers in the U.S. These difficulties include their utilization and selection, job roles, identification problems and troubles concerning research and evaluation. In practice, most paraprofessionals are potential consumers of community mental health services like the poor and the black. There do not seem to be very many middle and upper class paraprofessionals. The article also proposes a greater emphasis to be placed on middle class volunteer workers.

A reprint of the article "Lay Movements for the Improvement of the Public Health" which appeared in the July 3, 1909 issue is presented. It deals with lay movements in the U.S. aimed at improving public health. The Committee of One Hundred on National Health is considered an influential organization, which is made more extensive through its publication "American Health." Two resolutions have been passed by the House of Delegates during the Atlantic City Session of the American Medical Association in New Jersey on June 10, focusing on medical societies.

Reports on the multimillion dollar contribution of the U.S. to help in the reduction of morbidity and mortality among children under five years of age. Grant agreement of the U.S. Agency for International Development with the World Health Organization's Regional Office of Africa; Concentration of the primary health care programme on three areas; Usage of the multimillion dollar contribution.