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Objective: The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches. Methods: Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests. Results: Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant (P <.05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health (P =.057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services. Conclusion: Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system. [ABSTRACT FROM AUTHOR]

In integrated health care systems, techniques that identify successes and opportunities for targeted improvement are needed. The authors propose a new method for estimating population health that provides a more accurate and dynamic assessment of performance and priority setting. Member data from a large integrated health system (n = 96,246, 73.8% female, mean age = 44 ± 0.01 years) were used to develop a mechanistic mathematical simulation, representing the top causes of US mortality in 2014 and their associated risk factors. An age- and sex-matched US cohort served as comparator group. The simulation was recalibrated and retested for validity employing the outcome measure of 5-year mortality. The authors sought to estimate potential population health that could be gained by improving health risk factors in the study population. Potential gains were assessed using both average life years (LY) gained and average quality-adjusted life years (QALYs) gained. The simulation validated well compared to integrated health system data, producing an AUC (area under the curve) of 0.88 for 5-year mortality. Current population health was estimated as a life expectancy of 84.7 years or 69.2 QALYs. Comparing potential health gain in the US cohort to the Kaiser Permanente cohort, eliminating physical inactivity, unhealthy diet, smoking, and uncontrolled diabetes resulted in an increase of 1.5 vs. 1.3 LY, 1.1 vs. 0.8 LY, 0.5 vs. 0.2 LY, and 0.5 vs. 0.5 LY on average per person, respectively. Using mathematical simulations may inform efforts by integrated health systems to target resources most effectively, and may facilitate goal setting. [ABSTRACT FROM AUTHOR]

This special issue of the California Management Review contains a selection of the best papers presented at the Ninth Annual Meeting of the Strategic Management Society, which was held in San Francisco in on October 11-14, 1989. Guest editors Robert Harris and David Mowery provide an overview of the topic of "Strategies for Innovation" (the theme of the conference) and discuss its critical importance to management practice. They provide an introduction to the articles in this special issue and conclude with an exploration of other dimensions of strategy and innovation. [ABSTRACT FROM AUTHOR]

Type 2 diabetes affects Chinese Americans at an alarming rate. To address this health disparity, research in the area of cultural sensitivity and health literacy provides useful guidelines for creating culturally appropriate health education. In this article, we use discourse analysis to examine a group of locally available, Chinese- and English-language diabetes print documents from a surface level and deep structure level of culture. First, we compared these documents to research findings about printed health information to determine whether and how these documents apply current best practices for health literacy and culturally appropriate health communication. Second, we examined how diabetes as a disease and diabetes management is being constructed. The printed materials addressed surface level culture through the use of Chinese language, pictures, foods, and exercises. From a deeper cultural level, the materials constructed diabetes management as a matter of measurement and control that contrasted with previous research suggesting an alternative construction of balance. A nuanced assessment of both surface and deeper levels of culture is essential for creating health education materials that are more culturally appropriate and can lead to increased health literacy and improved health outcomes. [ABSTRACT FROM PUBLISHER]

Objectives. Over a 31/2-year period, 4 California counties implemented one of SAMHSA's evidence-based practices, integrated dual disorders treatment (IDDT). The project was a test of the SAMHSA implementation resource kit, which provides a clear statement of the intervention for a variety of stakeholders and prescribes implementation strategies. An additional dissemination strategy was also tested. Method. An IDDT fidelity scale, other scales measuring organizational functioning, and semistructured interviews with stakeholders were used to evaluate the implementation. Results. Six of the 8 sites sustained implementation of the model, 1 to a very high degree of fidelity and 3 others to an adequate level of fidelity. Successful implementation was predicted by the Organizational Readiness for Change scale. The long time required by most programs to achieve high fidelity caused vulnerability to staff turnover, which occurred at each administrative level. However, one program developed an implementation strategy that achieved very high fidelity within a year. In 2 of the 4 counties, IDDT is being further disseminated. [ABSTRACT FROM AUTHOR]

Much of the scholarship on initiatives emphasizes the link between voting behavior and initiative election outcomes or the strategies employed during the policy enactment phase. Little research has considered implementation or whether initiatives ultimately achieve their intended goals. Although the initiative process provides a direct link between the people and policy, it cannot be assumed that upon voter approval, an initiative will simply be implemented in a meaningful and uniform manner within the scope of the initiative's original intent. Using a case study of California's Substance Abuse and Crime Prevention Act (SACPA/Proposition 36) I ask how local politics and other contextual factors influence the implementation of a statewide voter initiative. Using aggregate data drawn from each of California's 58 counties, results indicate that politics at the county-level, measured via counties’ general ideological dispositions and more specific policy preferences toward drug abuse and drug offenders affect how they implement the initiative. Contrary to popular conceptions, results here confirm that initiatives are not uniformly implemented, but in fact, will be manifested in quite different ways due to local contextual differences. [ABSTRACT FROM AUTHOR]

Five nineteenth-century policies for alienating the federal public domain only partially fulfilled their objectives when applied in the arid setting of Owens Valley, California. The Homestead Law was most successful in advancing the family farm ideal, to judge by the persistence of small holdings several decades after land entry. Preemption claims, coincident in time and space with homesteading, were more often consolidated into larger farm units. The Desert Land Act, though designed to encourage irrigated farming in the arid West, tended to attract nonresident speculative entries on marginal lands, most of which were eventually consolidated into large grazing units. State Land Grants also contributed to large-scale holdings, whereas the Timber Culture Act, though used for entry in the 1880s, had little relevance to final settlement. Public land policies were generally adequate for settling the well-watered north end of Owens Valley, hut they were unsuccessful in reclaiming most of the irrigable lands of the vast arid stretches of the valley's southern townships. Federal land measures failed to account for the environmental diversity which prevails in the arid West and made no provision for the cooperative reclamation of desert lands. Unsound land alienation policies for the and public domain resulted in the urban use of Owens Valley's water resources. [ABSTRACT FROM AUTHOR]

The article analyses the salient variables that lead to delinquency and discusses past research on the issue. It also focuses on two different types of goal discrepancy, long range and more immediate goal discrepancy. The article concludes that long-range goal discrepancy is untenable as a cause for delinquency. The population used for this study consisted of the total male population of eight high schools in California, a total of 1,338 boys. The present is more important than future to these students. Peer pressure and academic failures also lead to delinquency. Frustration in itself was not a sufficient indicator of delinquent behavior. The pressure resulting from a discrepancy between high aspirations and limited legitimate opportunities, forces lower-class adolescents to seek alternative-often deviant-means to realize these aspirations. The pressure resulting from the discrepancy between cultural goals, that fuels the aspirations for higher goals, and socially sanctioned means, is then the cause for most delinquency in the society.

Focuses on the agenda of the 1974 Convention of the American Nurses Association in San Francisco, California. Advancement on the common goals of the nurses; Application of knowledge to nursing practices; Improvement on the quality of care.