9 research outputs found
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Child welfare reform in the United States: findings from a local agency survey.
Efforts to improve the public welfare and child welfare system sparked an unprecedented amount of federal legislation in the 1990s, including the Adoption and Safe Families Act of 1997 (ASFA), the Multiethnic Placement Act of 1994 and Interethnic Adoption Provisions of 1996 (MEPA-IEP), and welfare reform. Such reforms allow an unprecedented degree of flexibility, but little is known about their implementation. Researchers administered the Local Agency Survey to the first national probability sample of public child welfare agencies from 1999 to 2000. Findings indicate that ASFA has had the most effect on child welfare service delivery. Welfare reform has had less effect, and MEPA-IEP seems to have had little effect at all
A design thinking approach to primary ovarian insufficiency.
Most clinicians are not prepared to provide integrated personal care to address all the clinical needs of women with primary ovarian insufficiency. Design thinking is an engineering methodology used to develop and evaluate novel concepts for systems operation. Here we articulate the need for a seamlessly integrated mobile health system to support genomic research as well as patient care. We also review the pathophysiology and management of primary ovarian insufficiency. Molecular understanding regarding the pathogenesis is essential to developing strategies for prevention, earlier diagnosis, and appropriate management of the disorder. The syndrome is a chronic disorder characterized by oligo/amenorrhea and hypergonadotropic hypogonadism before age 40 years. There may be significant morbidity due to: 1) depression and anxiety related to the loss of reproductive hormones and infertility; 2) associated autoimmune adrenal insufficiency or hypothyroidism; and 3) reduced bone mineral density and increased risk of cardiovascular disease related to estrogen deficiency. Approximately 5% to 10% of women with primary ovarian insufficiency conceive and have a child. Women who develop primary ovarian insufficiency related to a premutation in FMR1 are at risk of having a child with fragile X syndrome, the most common cause of inherited intellectual disability. In most cases of spontaneous primary ovarian insufficiency no environmental exposure or genetic mechanism can be identified. As a rare disease, the diagnosis of primary ovarian insufficiency presents special challenges. Connecting patients and community health providers in real time with investigators who have the requisite knowledge and expertise would help solve this dilemma