Tuberculosis and Local Health Department Expenditures on Tuberculosis Services

Background: Although tuberculosis (TB) morbidity and mortality have decreased in recent decades, challenges exist regarding disproportionate distributions of TB among specific populations and geographic areas. Inconsistent local health department (LHD) funding for TB programs poses difficulties for LHDs to sustain resources and personnel that predisposes communities to risks of future outbreaks of TB and drug-resistant TB diseases. Purpose: This study examined relationships between annual TB incidence rates and LHD expenditures on TB-related services to elucidate potential impacts of TB incidence on LHD TB spending. Methods: This dataset included county-level TB incidence data with comparable, annual (2000–2010) TB-related service expenditures for each of the 160 LHDs in Florida, New York, and Washington States. A panel study design was adopted to estimate relationships between county-specific TB incidence and LHD TB service expenditures, while accounting for demographic, geographic, and TB service provision factors. Results: Following declines in TB incidence, funding for LHD TB programs in Florida, New York, and Washington State has similarly declined. This study demonstrated significant, positive association between TB incidence rate and per capita TB expenditures. Jurisdictions with higher percentages of foreign-born and black populations had significantly higher TB service spending. Micropolitan jurisdictions had significantly lower TB service spending than metropolitan jurisdictions. Implications: Effective TB control and prevention requires sustainable resources and strategies to assure local public health capacity for timely and thorough responsiveness to TB outbreaks. This capacity may need to be in the forms of cross jurisdiction sharing, state-level support, and partnerships with alternative providers in communities

Measuring Population Care Performance: Development of the Population-Patient Satisfaction Survey for Use with Community Groups

Background: Assessing the satisfaction of the “population-patient” requires conceptualizing the dimensions of satisfaction differently from that of individual patients. Purpose: The focus of this study was to develop and pilot test a short questionnaire that can reliably assess satisfaction with the care provided by public health nurses (PHNs) carrying out population-level activities in their communities. Methods: An instrument-development approach was used. With input from five experts, items were developed to assess seven dimensions of population-patient satisfaction, and then refined before use in the community with a convenience sample of community participants recruited by PHNs in six counties across two states. The pilot yielded 134 surveys collected on 28 different dates over 5 years. Analysis included calculating the means and alpha reliability of each satisfaction dimension and the overall satisfaction. Results: All dimensions except communication (alpha 0.68) had an alpha reliability above 0.80. The enthusiasm dimension received the highest rating (mean=4.6, SD=0.60). The respect dimension had the lowest rating (mean=4.3, SD=0.80). Significant differences between the two states (n=32, n=97) were found for values (p=0.02) and communication (p=0.03). Analysis of variance showed significant differences by local health departments (LHDs) on values (p=0.001), enthusiasm (p=0.002), and communication (p=0.02). Although the enthusiasm subscale seemed to be the highest for most LHDs, no clear pattern of strengths and weaknesses per LHD emerged. Implications: Data from using the Population Patient Satisfaction Survey can be used to identify perceptions of the community regarding the quality of population-focused activities and thus areas for improvement which would then enhance community health

Mandated activities and limited decision-making authority among local public health officials

Local public health department leaders face difficult decisions regarding the allocation of increasingly scarce resources, yet existing evidence for public health decision making, while still limited, is underutilized by public health officials. Participants in this study described processes regarding resource allocation in response to local budget cuts as based largely on legally mandated activities and categorical funding and perceived these factors as limiting much of their agency-level decision making to a relatively small portion of flexible funding. In the limited areas in which they perceived themselves to have flexibility, they generally considered their agencies to have very little capacity for accessing or using data-driven processes in their decision making. Given the apparent large role that mandated practices and categorical funding parameters have as factors in local public health decision making, policy making and practice-based research is urgently needed to narrow the divide between what is known regarding the effectiveness of mandated and categorical public health practices and how local public health leaders feel they can approach local decision making

A Method for Identifying Positive Deviant Local Health Departments in Maternal and Child Health

Local health departments (LHDs) are under increasing pressure to improve performance with limited resources. While research has found that financial resources may be associated with better health outcomes, there are some LHDs that maintain exceptional performance, even with limited budgets. Our interest was identifying LHDs that positively deviate in MCH outcomes compared to their peers while taking into account local context including geography and finances. We found that our method for identifying positive deviants was effective, and that LHD expenditures may not be linked to MCH outcomes. The next step in our work is to conduct in-depth analysis with positive deviants to understand the practices they use to achieve exceptional health outcomes

Local Health Department Provision of WIC Services Relative to Local “Need”— Examining 3 States and 5 Years

Great variation exists in the nature of LHD service delivery and it varies, in part, relative to jurisdiction population size. Larger LHD jurisdictions may achieve an economy of scale in WIC service delivery that is not matched in smaller areas. Overall, we found that WIC service provision appears relatively consistent across study states and in the presence of increasing need, with greater responsiveness to need in urban areas. As demand for some preventive services increases LHDs in rural areas may need greater support than LHDs in large jurisdictions for meeting local demand. Unlike WIC, LHD-provided services that have less consistently maintained service-delivery guidelines may have a harder time responding to increasing need. The relative consistency of a federally-funded program such as WIC may serve as a good baseline for further study of less consistently delivered programs among LHDs. LHD service statistics can serve as useful data sources in measuring volume of service delivery relative to need

What Does a Hand-Over Tell?—Individuality of Short Motion Sequences

Bekemeier H, Maycock J, Ritter H. What Does a Hand-Over Tell?—Individuality of Short Motion Sequences. Biomimetics. 2019;4(3): 55.How much information with regard to identity and further individual participant characteristics are revealed by relatively short spatio-temporal motion trajectories of a person? We study this question by selecting a set of individual participant characteristics and analysing motion captured trajectories of an exemplary class of familiar movements, namely handover of anobject to another person. The experiment is performed with different participants under different, predefined conditions. A selection of participant characteristics, such as the Big Five personality traits, gender, weight, or sportiness, are assessed and we analyse the impact of the three factor groups “participant identity”, “participant characteristics”, and “experimental conditions” on the observed hand trajectories. The participants’ movements are recorded via optical marker-based hand motion capture. One participant, the giver, hands over an object to the receiver. The resulting time courses of three-dimensional positions of markers are analysed. Multidimensional scaling is used to project trajectories to points in a dimension-reduced feature space. Supervised learning is also applied. We find that “participant identity” seems to have the highest correlation with the trajectories, with factor group “experimental conditions” ranking second. On the other hand, it is not possible to find a correlation between the “participant characteristics” and the hand trajectory features

A Bi-Functional Anti-Thrombosis Protein Containing Both Direct-Acting Fibrin(ogen)olytic and Plasminogen-Activating Activities

Direct-acting fibrin(ogen)olytic agents such as plasmin have been proved to contain effective and safety thrombolytic potential. Unfortunately, plasmin is ineffective when administered by the intravenous route because it was neutralized by plasma antiplasmin. Direct-acting fibrin(ogen)olytic agents with resistance against antiplasmin will brighten the prospect of anti-thrombosis. As reported in ‘Compendium of Materia Medica’, the insect of Eupolyphaga sinensis Walker has been used as traditional anti-thrombosis medicine without bleeding risk for several hundreds years. Currently, we have identified a fibrin(ogen)olytic protein (Eupolytin1) containing both fibrin(ogen)olytic and plasminogen-activating (PA) activities from the beetle, E. sinensis. Objectives: To investigate the role of native and recombinant eupolytin1 in fibrin(ogen)olytic and plasminogen-activating processes. Methods and Results: Using thrombus animal model, eupolytin1 was proved to contain strong and rapid thrombolytic ability and safety in vivo, which are better than that of urokinase. Most importantly, no bleeding complications were appeared even the intravenous dose up to 0.12 µmol/kg body weight (3 times of tested dose which could completely lyse experimental thrombi) in rabbits. It is the first report of thrombolytic agents containing both direct-acting fibrin(ogen)olytic and plasminogen-activating activities. Conclusions: The study identified novel thrombolytic agent with prospecting clinical potential because of its bi-functional merits containing both plasmin- and PA-like activities and unique pharmacological kinetics in vivo

Development of a nurse home visitation intervention for intimate partner violence

<p>Abstract</p> <p>Background</p> <p>Despite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships.</p> <p>Methods</p> <p>Following a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented.</p> <p>Results</p> <p>Based on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a client's level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a woman's specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component.</p> <p>Conclusions</p> <p>NFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed.</p

Emancipatory practices of nurses in primary health care: the home visit as an instrument of health needs assessment

Objective Identify nurses’ emancipatory practices in primary care, to contribute to the improvement of health care. Method A case study type social research of qualitative nature, in which nurses of a primary health care service unit in São Paulo were interviewed. Results The home visit was identified as a nursing practice possible to be expanded in order to identify social determinants of health, triggering emancipatory practices in the service. This expansion occurred because the design of health care labour intended by the service team changed its focus from the traditional object of health services, the disease. Conclusion First, it is advocated that social policies lead projects with the purpose of improving health needs. On the other hand, the daily labour needs to provide opportunities for reflection and discussion of healthcare projects, leading workers to propose labour-processes targeted to both the social determinants of health and people’s illness