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Objectives: Infant mortality remains a significant public health problem in the U.S. The Collaborative Improvement & Innovation Network (CoIIN) model is an innovative approach, using the science of quality improvement and collaborative learning, which was applied across 13 Southern states in Public Health Regions IV and VI to reduce infant mortality and improve birth outcomes. We provide an in-depth discussion of the history, development, implementation, and adaptation of the model based on the experience of the original CoIIN organizers and participants. In addition to the political genesis and functional components of the initiative, 8 key lessons related to staffing, planning, and implementing future CoIINs are described in detail. Methods: This paper reports the findings from a process evaluation of the model. Data on the states' progress toward reducing infant mortality and improving birth outcomes were collected through a survey in the final months of a 24-month implementation period, as well as through ongoing team communications. Results: The peer-to-peer exchange and platform for collaborative learning, as well as the sharing of data across the states, were major strengths and form the foundation for future CoIIN efforts. A lasting legacy of the initiative is the unique application and sharing of provisional 'real time' data to inform 'real time' decision-making. Conclusion: The CoIIN model of collaborative learning, QI, and innovation offers a promising approach to strengthening partnerships within and across states, bolstering data systems to inform and track progress more rapidly, and ultimately accelerating improvement toward healthier communities, States, and the Nation as a whole. [ABSTRACT FROM AUTHOR]

The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel to reduce influenza-related morbidity and mortality among both health care personnel and their patients (1-4). To estimate influenza vaccination coverage among U.S. health care personnel for the 2015-16 influenza season, CDC conducted an opt-in Internet panel survey of 2,258 health care personnel during March 28-April 14, 2016. Overall, 79.0% of survey participants reported receiving an influenza vaccination during the 2015-16 season, similar to the 77.3% coverage reported for the 2014-15 season (5). Coverage in long-term care settings increased by 5.3 percentage points compared with the previous season. Vaccination coverage continued to be higher among health care personnel working in hospitals (91.2%) and lower among health care personnel working in ambulatory (79.8%) and long-term care settings (69.2%). Coverage continued to be highest among physicians (95.6%) and lowest among assistants and aides (64.1%), and highest overall among health care personnel who were required by their employer to be vaccinated (96.5%). Among health care personnel working in settings where vaccination was neither required, promoted, nor offered onsite, vaccination coverage continued to be low (44.9%). An increased percentage of health care personnel reporting a vaccination requirement or onsite vaccination availability compared with earlier influenza seasons might have contributed to the overall increase in vaccination coverage during the past 6 influenza seasons. [ABSTRACT FROM AUTHOR]

The article discusses methods to identify pregnant women who consume alcohol in order to prevent fetal alcohol spectrum disorders (FASD), and tackles interventions for infants and children with FASD. Topics include the etiology and pathophysiology of FASD, the recommendation to collaborate with the nurse midwife or obstetrician of the patient to prevent FASD, and the role of advanced practice registered nurses (APRNs) in dealing with FASD.

Initiated in 1991, the Federal Healthy Start Program includes 105 community-based projects in 39 states, the District of Columbia and Puerto Rico. Healthy Start projects work collaboratively with stakeholders to ensure participants' continuity of care during pregnancy through 2 years postpartum. This evaluation of Healthy Start projects examined relationships between implementation of nine core service and system program components and improvements in birth and project outcomes. Program components and outcomes were examined using data from a 2010 Healthy Start project director (PD) survey (N = 104 projects) and 2009 performance measure data from the Maternal and Child Health Bureau Discretionary Grant Information System (N = 98 projects). We explored bivariate relationships between the nine core program components and (a) intermediate and long-term project outcomes and (b) birth outcomes. We assessed independent associations of implementation of all core program components with birth outcomes, adjusting for project characteristics and activities. In 2010, 57 projects implemented all nine core program components: 104 implemented all five core service components and 69 implemented all four core systems components. Implementation of all core program components was significantly associated with several PD-reported intermediate and long-term project outcomes, but was not associated with singleton low birth weight or infant mortality among participants' infants. This evaluation revealed a mixed set of relationships between Healthy Start projects' implementation of the core program components and achievement of project outcomes. Although the findings demonstrated a positive impact of Healthy Start projects on birth outcomes, only a few associations were statistically significant. [ABSTRACT FROM AUTHOR]

This article discusses the findings of an online survey conducted by the U.S. Centers for Disease Control and Prevention (CDC) to determine influenza vaccination coverage among health-care personnel (HCP) during the 2012-2013 season. Overall, 72% of HCP reported having vaccination for the said season, an increase during the 2011-2012 season. By occupation, coverage was 92.3% among physicians, 89.1% among pharmacists, 88.5% among nurse practitioners/physician assistants and 84.8% among nurses.

The article discusses the influenza vaccination of health-care personnel (HCP) in the U.S. during the 2011-2012 influenza season. The Advisory Committee on Immunization has recommended their vaccination. Data showed that vaccination was effective in minimizing the risk for medical care-acquired influenza illnesses among physicians and nurses. The Centers for Medicare & Medicaid Services (CMS) plans to require hospitals to report HCP influenza vaccination levels beginning in January 2013.

The article discusses the influenza vaccination of pregnant women in the U.S. during the 2011-2012 influenza season. The Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) have recommended their vaccination. Data showed that vaccination was effective in minimizing the risk for influenza among pregnant women. Some women expressed concern over vaccination's safety risk to their baby.

The article reports on the influenza vaccination coverage among pregnant women in the U.S. from 2010-2011, based on a survey conducted by the U.S. Centers for Disease Control and Prevention (CDC). Data show the percentage of pregnant women aged 18-49 years who received influenza vaccination before, during, or after pregnancy baby month of delivery or expected month of delivery. The top reasons of the respondents for not receiving influenza vaccination were concerns about the possible safety risks to the baby if vaccinated, the risk to influenza to the mother if vaccinated, and doubt over the effectiveness of the vaccine to prevent flu. INSET: What is already known on this topic?.

Site visits were conducted for the evaluation of the national Healthy Start program to gain an understanding of how projects design and implement five service components (outreach, case management, health education, depression screening and interconceptional care) and four system components (consortium, coordination/collaboration, local health system action plan and sustainability) as well as program staff’s perceptions of these components’ influence on intermediate outcomes. Interviews with project directors, case managers, local evaluators, clinicians, consortium members, outreach/lay workers and other stakeholders were conducted during 3-day in-depth site visits with eight Healthy Start grantees. Grantees reported that both services and systems components were related to self-reported service achievements (e.g. earlier entry into prenatal care) and systems achievements (e.g. consumer involvement). Outreach, case management, and health education were perceived as the service components that contributed most to their achievements while consortia was perceived as the most influential systems component in reaching their goals. Furthermore, cultural competence and community voice were overarching project components that addressed racial/ethnic disparities. Finally, there was great variability across sites regarding the challenges they faced, with poor service availability and limited funding the two most frequently reported. Service provision and systems development are both critical for successful Healthy Start projects to achieve intermediate program outcomes. Unique contextual and community issues influence Healthy Start project design, implementation and reported accomplishments. All eight projects implement the required program components yet outreach, case management, and health education are cited most frequently for contributing to their perceived achievements. [ABSTRACT FROM AUTHOR]

To describe the characteristics, access, utilization, satisfaction, and outcomes of Healthy Start participants in eight selected sites, a survey of Healthy Start participants with infants ages 6–12-months-old at time of interview was conducted between October 2006 and January 2007. The response rate was 66% ( n = 646), ranging from 37% in one site to >70% in seven sites. Healthy Start participants’ outcomes were compared to two national benchmarks. Healthy Start participants reported that they were satisfied with the program (>90% on five measures). Level of unmet need was 6% or less for most services, except for dental appointments (11%), housing (13%), and child care (11%). Infants had significantly better access to medical care than did their mothers, with higher rates of insurance coverage, medical homes, and checkups, and fewer unmet needs for health care. Healthy Start participants’ rates of ever breastfeeding (72%) and putting infants to sleep on their backs (70%) were at or near the Healthy People 2010 objectives, and considerably higher than rates among low-income mothers in the ECLS. The high rate of health education (>90%) may have contributed to these outcomes. Elimination of smoking among Healthy Start participants (46%) fell short of the Healthy People 2010 objective (99%). The low-birth weight (LBW) rate among Black Healthy Start participants (14%) was three times higher than the rate for Whites and Hispanics (5% each). Overall, the LBW rate in the eight sites (7.5%) was similar to the rate for low-income mothers in the ECLS, but both rates were above the Healthy People 2010 objective (5%). Challenges remain in reducing disparities in maternal and child health outcomes. Further attention to risk factors associated with LBW (especially smoking) may help close the gaps. The life course theory suggests that improved outcomes may require longer-term investments. Healthy Start’s emerging focus on interconception care has the potential to address longer-term needs of participants. [ABSTRACT FROM AUTHOR]

The article considers the potential of the nursing profession to influence the public conversation on health care ahead of the 2016 U.S. presidential election. Issues and concerns discussed are the concern of Americans over healthcare costs and insurance, health care issues in the platforms of the Republican and Democratic parties including the Affordable Care Act (ACA), and the respective stance of presidential candidates Hillary Clinton and Donald Trump on health care issues.

The Partnership for Reform in Science and Mathematics is a National Science Foundation-funded program administered by the Board of Regents of the University System of Georgia (USG). Georgia Southern University is a participant, and has partnerships with seven public school systems. University faculty and public school teachers clearly have very different teaching responsibilities, yet everyone wants students to succeed nationally and abroad. Georgia Southern faculty and their colleagues from the schools have developed a poster and a brochure that are designed to provide students, teachers, and parents with information concerning the kinds of knowledge, behaviors, and attitudes that university faculty expect students to possess when they enroll for their first semester. Recently gathered data suggest that larger numbers of high school students take more demanding science and math courses in PRESM-affiliated systems than in other school systems, and that larger numbers of students at PRISM institutions in the USG take math courses than is the case at non-PRISM institutions. Maintaining constructive relationships among USG science and math faculty and public schools should enhance these early trends. [ABSTRACT FROM AUTHOR]

To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2–3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income <$25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600–70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event. [ABSTRACT FROM AUTHOR]

The article offers information on the Guardian Ad Litem (GAL) program in the U.S., an institutional structure that has achieved an acceptable volunteer retention rate. The article addresses research questions involving the advantages of the program, motivations of the GAL volunteers and recruitment, among others. It also discusses four practices of the GAL program including adherence to rules, flexibility and fluidity and effective techniques of interpersonal communication which provides volunteers with a feeling of empowerment and a chance to build community.

Discusses effects of preferred provider organizations (PPO) on costs and utilization of hysterectomy in the United States. Conflicting anecdotal evidence of PPO success in reducing health care costs and utilization; Appropriateness of hysterectomy; Comparison with traditional plans with utilization review.

Public health researchers and practitioners have begun to recognize the dynamic nature of disability, promote the health of people with disabilities, and develop strategies to prevent secondary conditions among them. To understand the epidemiology of secondary conditions, the authors developed the Massachusetts Survey of Secondary Conditions, a longitudinal study of adults with major disabilities ( n =656) based on a conceptual framework linking disability, mediating factors, and health outcomes. This paper reports baseline data on the number of secondary conditions experienced by survey respondents. Respondents experienced a mean of 5.3 of 17 secondary conditions. More numerous secondary conditions were associated with fair or poor general health and number of days unable to do routine activities. Factors amenable to public health interventions included difficulty with weight and exercise maintenance, tobacco and marijuana use, and experiencing assault. Disability should be a focus in all public health research, policy, and programs. [ABSTRACT FROM AUTHOR]

Objectives : The purpose of the study was to examine the effect of language proficiency on enrollment in a state-sponsored child health insurance program. Methods : 1055 parents of Medicaid-eligible children, who were enrolled in a state-sponsored child health insurance program, were surveyed about how they learned about the state program, how they enrolled their children in the program, and perceived barriers to Medicaid enrollment. We performed weighted χ[sup 2] tests to identify statistically significant differences in outcomes based on language. We conducted multivariate analyses to evaluate the independent effect of language controlling for demographic characteristics. Results : Almost a third of families did not speak English in the home. These families, referred to as limited English proficiency families, were significantly more likely than English-proficient families to learn of the program from medical providers, to receive assistance with enrollment, and to receive this assistance from staff at medical sites as compared to the toll-free telephone information line. They were also more likely to identify barriers to Medicaid enrollment related to “know-how”—that is, knowing about the Medicaid program, if their child was eligible, and how to enroll. Differences based on language proficiency persisted after controlling for marital status, family composition, place of residence, length of enrollment, and employment status for almost all study outcomes. Conclusions : This study demonstrates the significant impact of English language proficiency on enrollment of Medicaid-eligible children in publicly funded health insurance programs. Strong state-level leadership is needed to develop an approach to outreach and enrollment that specifically addresses the needs of those with less English proficiency. [ABSTRACT FROM AUTHOR]

Community health nurse practitioners are often the major contraceptive counselors who may use anticipatory guidance to help clients' use behaviors. Because pregnancy rates during typical use are much higher than during "perfect" use, more effective anticipatory guidance could help improve use behaviors. Principles of cognitive theory were used to explore the implications of specific words and approaches associated with discussing young adults' contraceptive use. Qualitative results are reported here, and potential implications are made for nurse practitioners' anticipatory guidance related to contraceptive use. [ABSTRACT FROM AUTHOR]

Focuses on the Brookline early education project of the public schools in Brookline, Massachusetts. Rationale for the project; Description of the programs for parents and children; Evaluation procedure for the project; Characteristics of the children involved in the project.

Abstract. In April 1987, a census of children dependent on medical technology was carried out in Massachusetts to determine the one-month point prevalence. All medical and educational providers in the state who were likely to interact with such children were contacted and asked to complete a two-sided data form on youngsters (aged 3 months to 18 years) with tracheostomies, supplementary oxygen, respirators, auctioning, gastric feeding, central venous lines, ostomies, ureteral diversion, urethral catheterization and dialysis. Nearly 1250 children were found meeting these criteria. Capture-recapture analysis set the lower bound for technology dependence at 0.08% of the state's children. An analysis of the organ systems involved showed that 57% of the children had neurologic involvement--13% multisystem, 7% gastrointestinal-metabolic, 4% renal-genitourinary, and 3% musculoskeletal. Less than 1% of the children were reported as having immunologic or "other" disorders. Review of putative etiologies indicated that 45% of the children had congenital anomalies, 33% chronic medical diseases, 9% perinatal conditions, 7% hereditary-genetic disorders, 5% injuries, 2% infections, and 3% "other." The substantial prevalence of technology dependency among children creates challenges at the social, economic, and policymaking levels. It will be important to carry out systematic reporting and monitoring activities throughout time and across sites. This census is an example of one such statewide effort. [ABSTRACT FROM AUTHOR]

Describes the available educational options and placement patterns for chronically ill children in the U.S. Education legislation provided for chronically ill children; Problems faced by chronically ill children in schools; Overview of the special programming arrangements and modifications considered for chronically ill children in schools.

An editorial is presented on maternal mortality in the U.S. Topics include considered that maternal safety bundles implemented by the Alliance for Innovation on Maternal Health and Safety Initiative; efforts to reduce maternal mortality as there is not meaningful population‐level change; and reported that the American Academy of Nursing (AAN) calls for increased action to reduce maternal mortality.

The article presents the author's comments on the challenges facing public health programs in the U.S. on local, national and global levels. The author suggests that with a change in the country's administration the focus should be on developing a political will to improve the public health system. A major investment in the public health services is needed to counter the high cost of health care so that the services reach a larger part of the population, the author says.

Deals with the implications of the passage of the Education for All Handicapped Children Act by the United States Congress on pediatricians. Medical issues addressed by the law; Significance of the law on the pediatricians' relationship with handicapped children; Overview of the formulation of the law.