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Early Childhood Education to Promote Health Equity: A Community Guide Systematic Review. 幼儿教育促进健康公平:社区指南系统综述。
Pub Date : 2016-09-01 DOI: 10.1097/PHH.0000000000000378
Robert A. Hahn, W. Steven Barnett, John A. Knopf, B. Truman, Robert L. Johnson, Jonathan E. Fielding, Carles Muntaner, Camara Phyllis Jones, M. T. Fullilove, Pete C. Hunt
CONTEXTChildren in low-income and racial and ethnic minority families often experience delays in development by 3 years of age and may benefit from center-based early childhood education.DESIGNA meta-analysis on the effects of early childhood education by Kay and Pennucci best met Community Guide criteria and forms the basis of this review.RESULTSThere were increases in intervention compared with control children in standardized test scores (median = 0.29 SD) and high school graduation (median = 0.20 SD) and decreases in grade retention (median = 0.23 SD) and special education assignment (median = 0.28 SD). There were decreases in crime (median = 0.23 SD) and teen births (median = 0.46 SD) and increases in emotional self-regulation (median = 0.21 SD) and emotional development (median = 0.04 SD). All effects were favorable, but not all were statistically significant. Effects were also long-lasting.CONCLUSIONSBecause many programs are designed to increase enrollment for high-risk students and communities, they are likely to advance health equity.
背景低收入家庭和少数种族和族裔家庭的儿童通常会经历3岁以上的发育迟缓,并可能受益于以中心为基础的幼儿教育。Kay和Pennucci对早期儿童教育效果的荟萃分析最符合社区指南的标准,并构成了本综述的基础。结果干预组在标准化考试成绩(中位数= 0.29 SD)和高中毕业率(中位数= 0.20 SD)上均高于对照组,在成绩保持(中位数= 0.23 SD)和特殊教育任务(中位数= 0.28 SD)上均低于对照组。犯罪率(中位数= 0.23 SD)和青少年生育率(中位数= 0.46 SD)有所下降,情绪自我调节(中位数= 0.21 SD)和情绪发展(中位数= 0.04 SD)有所增加。所有的效果都是有利的,但并非所有的效果都具有统计学意义。效果也是持久的。结论:由于许多项目旨在增加高危学生和社区的入学率,它们可能会促进健康公平。
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引用次数: 33
Using Evidence-Based Interventions to Improve Cancer Screening in the National Breast and Cervical Cancer Early Detection Program. 在国家乳腺癌和宫颈癌早期检测项目中使用循证干预措施改善癌症筛查。
Pub Date : 2016-09-01 DOI: 10.1097/PHH.0000000000000369
A. Degroff, Aundrea D. Carter, K. Kenney, Z. Myles, S. Melillo, J. Royalty, Ketra L. Rice, Lindsay Gressard, Jacqueline W. Miller
CONTEXTThe National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening to low-income, un-, and underinsured women through more than 11 000 primary care clinics. The program is well-positioned to work with health systems to implement evidence-based interventions (EBIs) to increase screening among all women.OBJECTIVETo collect baseline data on EBI use, evaluation of EBIs, and related training needs among NBCCEDP grantees.DESIGNThe Centers for Disease Control and Prevention conducted a Web-based survey in late 2013 among NBCCEDP grantees for the period July 2012 to June 2013. This was the first systematic assessment of EBIs among NBCCEDP grantees.SETTINGThe Centers for Disease Control and Prevention's NBCCEDP.PARTICIPANTSPrimarily program directors/coordinators for all 67 NBCCEDP grantees.MAIN OUTCOME MEASURESData captured were used to assess implementation of 5 EBIs, their evaluation, and related training needs. Frequencies and proportions were determined. Cluster analysis identified grantees with similar patterns of EBI use for NBCCEDP clients and providers.RESULTSOn average, 4.1 of 5 EBIs were implemented per grantee for NBCCEDP clients and providers. Four clusters were identified including "high overall EBI users," "high provider EBI users," "high EBI users with no provider assessment and feedback," and "high client EBI users." Only 1.8 EBIs were implemented, on average, with non-NBCCEDP clients and providers. Fewer than half (n = 32, 47.8%) of grantees conducted process or outcome evaluation of 1 or more EBIs. Overall, 47.6% of grantees reported high or medium training needs for client-oriented EBIs and 54.3% for provider-oriented EBIs.CONCLUSIONSThe NBCCEDP grantees are implementing EBIs extensively with clients and providers. Increased EBI use among non-NBCCEDP clients/providers is needed to extend the NBCCEDP's reach and impact. Grantee training and technical assistance is necessary across EBIs. In addition, grantees' use of process and outcome evaluation of EBI implementation must be increased to inform effective program implementation.
背景:国家乳腺癌和宫颈癌早期检测计划(NBCCEDP)通过11000多家初级保健诊所为低收入、无保险和保险不足的妇女提供癌症筛查。该规划有能力与卫生系统合作,实施循证干预措施(ebi),以增加对所有妇女的筛查。目的收集NBCCEDP受助者EBI使用、EBI评估和相关培训需求的基线数据。疾病控制和预防中心于2013年底在2012年7月至2013年6月期间对NBCCEDP受助人进行了一项基于网络的调查。这是第一次对NBCCEDP受助人的ebi进行系统评估。美国疾病控制与预防中心的NBCCEDP。参与者主要是67个NBCCEDP受助人的项目主管/协调员。主要结果测量收集的数据用于评估5个ebi的实施、评估和相关培训需求。频率和比例被确定。聚类分析确定了NBCCEDP客户和提供者使用EBI模式相似的受助人。结果平均而言,每个受助人对NBCCEDP客户和提供者实施了5个ebi中的4.1个。确定了四个集群,包括“高整体EBI用户”、“高提供商EBI用户”、“没有提供商评估和反馈的高EBI用户”和“高客户EBI用户”。在非nbccedp客户和提供者中,平均只有1.8个ebi被实施。不到一半(n = 32, 47.8%)的受助人对1个或更多ebi进行了过程或结果评估。总体而言,47.6%的受助人报告了面向客户的ebi的高或中等培训需求,而面向提供者的ebi的培训需求为54.3%。结论:NBCCEDP受助机构正在与客户和供应商广泛实施ebi。需要在非NBCCEDP客户/供应商中增加EBI的使用,以扩大NBCCEDP的覆盖范围和影响。受资助者培训和技术援助是整个ebi的必要条件。此外,必须增加受助人对EBI实施过程和结果评估的使用,以便为有效的项目实施提供信息。
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引用次数: 9
A Strategy for Addressing Population Health Management. 人口健康管理战略。
Pub Date : 2016-09-01 DOI: 10.1097/PHH.0000000000000383
J. Kapp, D. Oliver, E. Simões
CONTEXTPopulation health management in the era of the Affordable Care Act focuses on identifying needs of health care service areas for targeted strategies. The United States has a "health disadvantage" compared with peer countries, particularly regarding obesity and women's life expectancy, while having high rates of mammography screening. Emphasizing lifestyle factors is a strategy to reduce one's risk of obesity and heart disease, as well as some breast cancers.OBJECTIVEWe explored perceptions of the risk of female population-based breast cancer mortality compared with heart disease mortality; perceived likelihood of developing breast cancer; and recognition of the association between modifiable lifestyle factors and breast cancer risk.DESIGNCross-sectional online survey.SETTINGService area of one mid-Missouri health care system.PARTICIPANTSFemale US residents ages 35 to 49 years who did not have a personal history of any cancer.RESULTSMinority women and women with a college education or less had greater odds of reporting that breast cancer, rather than heart disease, would cause more deaths in women this year. Women who had ever had a mammogram had greater odds of reporting a moderate/high compared with low likelihood of developing breast cancer. Women with less than a college education had greater odds of not knowing of any lifestyle behaviors or reporting only clinical behaviors related to reducing one's risk of breast cancer.CONCLUSIONSThe present study illuminates areas of lagging information dissemination that may be used for targeted strategies for population health management in the era of the Affordable Care Act, that of bridging healthy lifestyle strategies for heart health with messages for breast health.
背景《平价医疗法案》时代的人口健康管理侧重于确定医疗保健服务领域的需求,以制定有针对性的战略。与同龄国家相比,美国在“健康方面处于劣势”,尤其是在肥胖和女性预期寿命方面,而乳房x光检查的比例很高。强调生活方式因素是降低肥胖、心脏病和某些乳腺癌风险的一种策略。目的:探讨以女性人群为基础的乳腺癌死亡率与心脏病死亡率的风险认知;患乳腺癌的可能性;认识到可改变的生活方式因素与乳腺癌风险之间的联系。横断面在线调查。设置密苏里州中部医疗保健系统的服务区域。参与者:年龄在35 - 49岁之间,没有任何癌症病史的美国女性居民。结果:少数族裔女性和受过大学或更低教育的女性报告说,今年乳腺癌而不是心脏病将导致更多的女性死亡。曾经做过乳房x光检查的女性报告患乳腺癌的可能性为中度/高度的几率大于低水平的几率。未受过大学教育的女性更有可能不知道任何生活方式行为,或者只报告与降低乳腺癌风险有关的临床行为。结论本研究揭示了信息传播滞后的领域,可用于《平价医疗法案》时代人口健康管理的针对性策略,即将促进心脏健康的健康生活方式策略与促进乳房健康的信息联系起来。
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引用次数: 2
Recommendation for Center-Based Early Childhood Education to Promote Health Equity. 关于以中心为基础的幼儿教育促进健康公平的建议。
Pub Date : 2016-09-01 DOI: 10.1097/PHH.0000000000000354
C. T. Force
The Community Preventive Services Task Force recommends early childhood education programs based on strong evidence of effectiveness in improving educational outcomes associated with long-term health and sufficient evidence of effectiveness in improving social- and health-related outcomes. When provided to low-income or racial and ethnic minority communities, early childhood education programs are likely to reduce educational achievement gaps, improve the health of low-income student populations, and promote health equity.
社区预防服务特别工作组建议儿童早期教育方案的基础是,有强有力的证据表明,在改善与长期健康相关的教育成果方面有效,并有充分的证据表明,在改善与社会和健康相关的结果方面有效。当提供给低收入或种族和少数民族社区时,幼儿教育项目可能会缩小教育成就差距,改善低收入学生群体的健康状况,并促进健康公平。
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引用次数: 4
Profile of Public Health Leadership. 公共卫生领导简介。
Pub Date : 2016-09-01 DOI: 10.1097/PHH.0000000000000399
R. Little, A. Greer, M. Clay, C. McFadden
CONTEXTPublic health leaders play pivotal roles in ensuring the population health for our nation. Since 2000, the number of schools of public health has almost doubled. The scholarly credentials for leaders of public health in academic and practice are important, as they make decisions that shape the future public health workforce and important public health policies.OBJECTIVEThis research brief describes the educational degrees of deans of schools of public health and state health directors, as well as their demographic profiles, providing important information for future public health leadership planning.DESIGNData were extracted from a database containing information obtained from multiple Web sites including academic institution Web sites and state government Web sites. Variables describe 2 sets of public health leaders: academic deans of schools of public health and state health directors.RESULTSDeans of schools of public health were 73% males and 27% females; the PhD degree was held by 40% deans, and the MD degree by 33% deans. Seventy percent of deans obtained their terminal degree more than 35 years ago. State health directors were 60% males and 40% females. Sixty percent of state health directors had an MD degree, 4% a PhD degree, and 26% no terminal degree at all. Sixty-four percent of state health directors received their terminal degree more than 25 years ago. In addition to terminal degrees, 56% of deans and 40% of state health directors held MPH degrees.CONCLUSIONThe findings call into question competencies needed by future public health professionals and leadership and the need to clarify further the level of public health training and degree type that should be required for leadership qualifications in public health.
背景公共卫生领导者在确保我国人口健康方面发挥着关键作用。自2000年以来,公共卫生学院的数量几乎翻了一番。公共卫生领导人在学术和实践方面的学术证书很重要,因为他们做出决定,影响未来的公共卫生工作人员和重要的公共卫生政策。目的本研究概述了公共卫生学院院长和州卫生主任的教育程度,以及他们的人口统计资料,为未来公共卫生领导规划提供重要信息。DESIGNData是从一个包含多个网站信息的数据库中提取出来的,这些网站包括学术机构网站和州政府网站。变量描述了两组公共卫生领导者:公共卫生学院的学术院长和州卫生主任。结果公共卫生学院院长中男性占73%,女性占27%;持有博士学位的院长占40%,持有医学博士学位的院长占33%。70%的院长在35年前就获得了最终学位。州卫生主任中男性占60%,女性占40%。60%的州卫生主管拥有医学博士学位,4%拥有博士学位,26%根本没有最终学位。64%的州卫生主管在25年前就获得了他们的终末学位。除了最终学位外,56%的院长和40%的州卫生主任拥有公共卫生硕士学位。结论研究结果对未来公共卫生专业人员和领导所需的能力提出了质疑,需要进一步明确公共卫生领导资格所需的公共卫生培训水平和学位类型。
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引用次数: 2
Criteria-Based Resource Allocation: A Tool to Improve Public Health Impact. 基于标准的资源分配:改善公共卫生影响的工具。
Pub Date : 2016-07-01 DOI: 10.1097/PHH.0000000000000319
J. Ross Graham, C. Mackie
OBJECTIVEResource allocation in local public health (LPH) has been reported as a significant challenge for practitioners and a Public Health Services and Systems Research priority. Ensuring available resources have maximum impact on community health and maintaining public confidence in the resource allocation process are key challenges. A popular strategy in health care settings to address these challenges is Program Budgeting and Marginal Analysis (PBMA). This case study used PBMA in an LPH setting to examine its appropriateness and utility.DESIGNThe criteria-based resource allocation process PBMA was implemented to guide the development of annual organizational budget in an attempt to maximize the impact of agency resources. Senior leaders and managers were surveyed postimplementation regarding process facilitators, challenges, and successes.SETTINGCanada's largest autonomous LPH agency.RESULTSPBMA was used to shift 3.4% of the agency budget from lower-impact areas (through 34 specific disinvestments) to higher-impact areas (26 specific reinvestments). Senior leaders and managers validated the process as a useful approach for improving the public health impact of agency resources. However, they also reported the process may have decreased frontline staff confidence in senior leadership.CONCLUSIONSIn this case study, PBMA was used successfully to reallocate a sizable portion of an LPH agency's budget toward higher-impact activities. PBMA warrants further study as a tool to support optimal resource allocation in LPH settings.
目的据报道,地方公共卫生(LPH)的资源分配是从业人员面临的重大挑战,也是公共卫生服务和系统研究的重点。确保现有资源对社区卫生产生最大影响和保持公众对资源分配过程的信心是主要挑战。在卫生保健机构应对这些挑战的一个流行策略是项目预算和边际分析(PBMA)。本案例研究在LPH环境中使用PBMA来检查其适用性和实用性。设计采用基于标准的资源分配过程PBMA来指导年度组织预算的制定,以最大化机构资源的影响。在实施后,对高级领导和管理人员进行了关于流程促进因素、挑战和成功的调查。加拿大最大的自主LPH机构。结果spbma将3.4%的机构预算从低影响领域(通过34项具体的撤资)转移到高影响领域(26项具体的再投资)。高级领导和管理人员确认这一进程是改善机构资源对公共卫生影响的有用方法。然而,他们也报告说,这一过程可能会降低一线员工对高层领导的信心。结论:在本案例研究中,PBMA成功地将LPH机构的相当一部分预算重新分配给影响更大的活动。PBMA作为支持LPH环境下资源优化配置的工具值得进一步研究。
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引用次数: 15
Active Communities, Active Economies. 活跃的社区,活跃的经济。
Pub Date : 2016-05-01 DOI: 10.1097/PHH.0000000000000361
Chip Johnson, J. Moore
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引用次数: 0
Experiences Supporting Local Health Departments to Increase Human Papillomavirus Vaccination Rates. 支持地方卫生部门提高人乳头瘤病毒疫苗接种率的经验。
Pub Date : 2016-05-01 DOI: 10.1097/PHH.0000000000000405
K. Drezner, K. Heyer, Lisa McKeown, Lilly Kan
I n the fall of 2014, the National Association of County & City Health Officials (NACCHO) launched a project to support a subset of local health departments to engage and collaborate with health care providers and other key stakeholders to increase human papillomavirus (HPV) vaccination rates in their communities. This project, supported by the Centers for Disease Control and Prevention, is one component of NACCHO’s immunization program. NACCHO’s immunization program is dedicated to strengthening local health departments’ immunization infrastructure by working to increase their capacity to implement evidence-based public health programs, policies, and services to meet national standards for preventing and controlling vaccine-preventable diseases. NACCHO is the voice of the 2800 local health departments in the United States that work every day to protect and promote health and well-being for all people in their communities. NACCHO provides resources to help local health departments develop public health policies and programs to ensure that communities have access to the vital services people need to keep them protected from disease and disaster. Local health departments play a pivotal role in maintaining high levels of community immunization rates, acting as leaders in their communities and strengthening their networks through partnerships with state immunization programs, coalitions, and the immunization neighborhood. According to the 2013 National Profile of Local Health Departments, 90% of local health departments provide direct immunization services. In addition, local health department immunization programs deliver provider education, outreach campaigns, and vaccine-preventable disease outbreak
2014年秋季,全国县和市卫生官员协会(NACCHO)启动了一个项目,支持部分地方卫生部门参与并与卫生保健提供者和其他主要利益攸关方合作,以提高其社区的人乳头瘤病毒(HPV)疫苗接种率。该项目由疾病控制和预防中心支持,是全国儿童健康中心免疫规划的一个组成部分。NACCHO的免疫计划致力于加强地方卫生部门的免疫基础设施,努力提高其实施循证公共卫生计划、政策和服务的能力,以达到预防和控制疫苗可预防疾病的国家标准。NACCHO是美国2800个地方卫生部门的代言人,这些部门每天都在努力保护和促进社区中所有人的健康和福祉。NACCHO提供资源,帮助地方卫生部门制定公共卫生政策和计划,以确保社区能够获得人们需要的重要服务,使他们免受疾病和灾害的侵害。地方卫生部门在维持高水平的社区免疫接种率方面发挥关键作用,在其社区中发挥领导作用,并通过与州免疫规划、联盟和免疫社区建立伙伴关系加强其网络。根据2013年全国地方卫生部门概况,90%的地方卫生部门提供直接免疫服务。此外,地方卫生部门的免疫计划提供提供者教育、外展活动和疫苗可预防的疾病爆发
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引用次数: 3
Advocacy for Leaders: Crafting Richer Stories for Public Health. 倡导领导者:为公共卫生制作更丰富的故事。
Pub Date : 2016-04-13 DOI: 10.1097/PHH.0000000000000413
G. Matthews, S. Burris, S. Ledford, E. Baker
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引用次数: 10
Charting a New Path: Helping Local Health Departments Navigate Emerging Issues in Public Health. 绘制新路径:帮助地方卫生部门应对公共卫生中的新问题。
Pub Date : 2016-03-01 DOI: 10.1097/PHH.0000000000000393
L. Hasbrouck
In communities across the United States, public health and health care systems are changing due to a number of forces. Health care reform spurs innovation in payment and service delivery. Economic instability leads to federal, state, and local budget cuts. Accreditation and community benefit requirements encourage collaborative assessment and improvement planning. The list goes on. Despite facing these often challenging forces of change, local health departments (LHDs) are seizing emerging opportunities, exploring new partnerships, and continuing to minimize—and prevent—threats to the health and well-being of their communities. The National Association of County & City Health Officials (NACCHO) helps LHDs find their footing in this changing landscape. We strive to understand their needs and challenges, highlight innovation, disseminate evidence-based practices, provide training and continuing education, and advocate for policies that support health and equity.
在美国各地的社区,公共卫生和卫生保健系统正在发生变化,由于一些力量。医疗改革刺激了支付和服务提供方面的创新。经济不稳定导致联邦、州和地方预算削减。认证和社区利益要求鼓励协作评估和改进计划。这样的例子不胜枚举。尽管面临这些往往具有挑战性的变革力量,地方卫生部门正在抓住新出现的机会,探索新的伙伴关系,并继续尽量减少和预防对其社区健康和福祉的威胁。全国县和市卫生官员协会(NACCHO)帮助lhd在这种不断变化的环境中找到自己的立足点。我们努力了解他们的需求和挑战,强调创新,传播循证实践,提供培训和继续教育,并倡导支持健康和公平的政策。
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引用次数: 0
期刊
Journal of public health management and practice : JPHMP
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