Frontiers in public health services & systems research最新文献_第2页

Diffusion theory and knowledge dissemination, utilization and integration. 扩散理论与知识的传播、利用与整合。

Frontiers in public health services & systems research

Pub Date : 2014-01-01 DOI: 10.13023/FPHSSR.0301.03

L. Green, J. Ottoson, César García, R. Hiatt, Maria L Roditis

Part of the Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, Health Policy Commons, Health Services Administration Commons, Health Services Research Commons, and the Public Health Education and Promotion Commons. Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners in decision making, conducting sound evaluation, and disseminating what is learned. The usual application of these principles has overemphasized the scientific evidence as the starting point, whereas this review suggests engaging the community and practitioners as an equally important starting point to assess their needs, assets and circumstances, which can be facilitated with program planning frameworks and use of local assessment and surveillance data.

是社区卫生和预防医学共享区、卫生和医疗管理共享区、卫生政策共享区、卫生服务管理共享区、卫生服务研究共享区和公共卫生教育和促进共享区的一部分。公共卫生的许多成就在人群中分布不均。本文回顾了在这些不同人群的不同文化和实践情况下，在公共卫生中应用循证实践的概念。EBPH的关键组成部分包括:根据现有的最佳科学证据做出决策，系统地使用数据和信息系统，应用规划框架，让社区和从业人员参与决策，进行合理的评估，并传播所学知识。这些原则的通常应用过分强调将科学证据作为起点，而本综述建议将社区和从业者作为评估其需求、资产和环境的同等重要的起点，这可以通过项目规划框架和使用当地评估和监测数据来促进。

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引用次数: 41

The effect of race and chronic obstructive pulmonary disease on long-term survival after coronary artery bypass grafting. 种族和慢性阻塞性肺疾病对冠状动脉旁路移植术后长期生存的影响。

Frontiers in public health services & systems research

Pub Date : 2013-04-03 DOI: 10.3389/fpubh.2013.00004

Jimmy T Efird, Wesley T O'Neal, Curtis A Anderson, Jason B O'Neal, Linda C Kindell, T Bruce Ferguson, W Randolph Chitwood, Alan P Kypson

Background: Chronic obstructive pulmonary disease (COPD) is a known predictor of decreased long-term survival after coronary artery bypass grafting (CABG). Differences in survival by race have not been examined. Methods: A retrospective cohort study was conducted of CABG patients between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. Results: A total of 984 (20%) patients had COPD (black n = 182; white n = 802) at the time of CABG (N = 4,801). The median follow-up for study participants was 4.4 years. COPD was observed to be a statistically significant predictor of decreased survival independent of race following CABG (no COPD: HR = 1.0; white COPD: adjusted HR = 1.9, 95% CI = 1.7–2.3; black COPD: adjusted HR = 1.6, 95% CI = 1.1–2.2). Conclusion: Contrary to the expected increased risk of mortality among black COPD patients in the general population, a similar survival disadvantage was not observed in our CABG population.

背景:慢性阻塞性肺疾病(COPD)是冠状动脉旁路移植术(CABG)后长期生存率降低的已知预测因子。种族间的生存差异尚未被研究过。方法:对2002 ~ 2011年CABG患者进行回顾性队列研究。比较COPD患者和非COPD患者的长期生存率，并按种族分层。采用Cox回归模型计算风险比(HR)和95%置信区间(CI)。结果:共有984例(20%)患者患有COPD(黑色n = 182;白色n = 802)， CABG时(n = 4801)。研究参与者的中位随访时间为4.4年。观察到COPD是CABG后独立于种族的生存率下降的统计学显著预测因子(无COPD: HR = 1.0;白色COPD:调整后HR = 1.9, 95% CI = 1.7-2.3;黑色COPD:调整后HR = 1.6, 95% CI = 1.1-2.2)。结论:与一般人群中黑人COPD患者死亡风险增加的预期相反，在我们的CABG人群中没有观察到类似的生存劣势。

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引用次数: 22

Carrots, Sticks and False Carrots: How high should weight control wellness incentives be? Findings from a population-level experiment. 胡萝卜，大棒和假胡萝卜:控制体重的健康激励应该有多高?一项人口水平实验的结果。

Frontiers in public health services & systems research

Pub Date : 2013-01-01

Harald Schmidt

Employers are increasingly using wellness incentives, including penalties for unhealthy behavior. Survey data suggests that people are willing to accept the principle of penalizing those perceived to take health risks, but the equally relevant question of the magnitude of acceptable penalties is unclear. While the principle of penalizing overweight and obese people has some support, findings from a population-level experiment (n=1,000) suggest that the acceptable size of penalties is comparatively small, around $50: more than 10-fold below levels favored by advocates. Reward-based incentives are favored over penalty-based ones by a factor of 4. Of two different ways of framing penalty programs, poorer and higher weight groups appear to find the one that is more overtly penalizing less acceptable. Levels of incentives matter on effectiveness as well as on ethical grounds, as it cannot be assumed that it is equally easy for all to meet health targets to secure a benefit or avoid a penalty. Programs should be designed to engage, not to frustrate those most in need of health improvement. Employee involvement in determining incentive types and levels, and explicit justification for program design can help both employees and employers to reap benefits.

雇主们越来越多地采用健康激励措施，包括对不健康行为的处罚。调查数据表明，人们愿意接受惩罚那些被认为冒健康风险的人的原则，但同样相关的可接受惩罚的程度问题尚不清楚。虽然惩罚超重和肥胖者的原则得到了一些支持，但一项人口水平实验(n= 1000)的结果表明，可接受的罚款金额相对较小，约为50美元，比倡导者所赞成的水平低10倍以上。以奖励为基础的激励比以惩罚为基础的激励受欢迎的程度是前者的4倍。在制定惩罚计划的两种不同方式中，较贫穷和体重较高的群体似乎觉得更公开的惩罚方式更难以接受。激励措施的水平既关系到有效性，也关系到道德原因，因为不能假设所有人都同样容易实现健康目标，从而获得利益或避免惩罚。项目的设计应该是为了吸引那些最需要健康改善的人，而不是为了挫败他们。员工参与决定激励类型和水平，以及明确的计划设计理由，可以帮助员工和雇主都获得利益。

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引用次数: 0

Carrots, Sticks and False Carrots: How high should weight control wellness incentives be? Findings from a population-level experiment. 胡萝卜，大棒和假胡萝卜:控制体重的健康激励应该有多高?一项人口水平实验的结果。

Frontiers in public health services & systems research

Pub Date : 2013-01-01 DOI: 10.13023/FPHSSR.0201.02

H. Schmidt

Employers are increasingly using wellness incentives, including penalties for unhealthy behavior. Survey data suggests that people are willing to accept the principle of penalizing those perceived to take health risks, but the equally relevant question of the magnitude of acceptable penalties is unclear. While the principle of penalizing overweight and obese people has some support, findings from a population-level experiment (n=1,000) suggest that the acceptable size of penalties is comparatively small, around $50: more than 10-fold below levels favored by advocates. Reward-based incentives are favored over penalty-based ones by a factor of 4. Of two different ways of framing penalty programs, poorer and higher weight groups appear to find the one that is more overtly penalizing less acceptable. Levels of incentives matter on effectiveness as well as on ethical grounds, as it cannot be assumed that it is equally easy for all to meet health targets to secure a benefit or avoid a penalty. Programs should be designed to engage, not to frustrate those most in need of health improvement. Employee involvement in determining incentive types and levels, and explicit justification for program design can help both employees and employers to reap benefits.

雇主们越来越多地采用健康激励措施，包括对不健康行为的处罚。调查数据表明，人们愿意接受惩罚那些被认为冒健康风险的人的原则，但同样相关的可接受惩罚的程度问题尚不清楚。虽然惩罚超重和肥胖者的原则得到了一些支持，但一项人口水平实验(n= 1000)的结果表明，可接受的罚款金额相对较小，约为50美元，比倡导者所赞成的水平低10倍以上。以奖励为基础的激励比以惩罚为基础的激励受欢迎的程度是前者的4倍。在制定惩罚计划的两种不同方式中，较贫穷和体重较高的群体似乎觉得更公开的惩罚方式更难以接受。激励措施的水平既关系到有效性，也关系到道德原因，因为不能假设所有人都同样容易实现健康目标，从而获得利益或避免惩罚。项目的设计应该是为了吸引那些最需要健康改善的人，而不是为了挫败他们。员工参与决定激励类型和水平，以及明确的计划设计理由，可以帮助员工和雇主都获得利益。

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引用次数: 10

Local Health Department Provision of WIC Services Relative to Local "Need"- Examining 3 States and 5 Years. 地方卫生部门提供的与当地"需要"相关的WIC服务——考察3个州和5年。

Frontiers in public health services & systems research

Pub Date : 2012-04-01 DOI: 10.13023/FPHSSR.0101.02

B. Bekemeier, M. Bryan, M. Dunbar, Christina I. Fowler

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.

社会福利署提供服务的性质千差万别，部分取决于司法管辖区的人口规模。较大的LHD管辖区可能在WIC服务提供方面实现规模经济，这在较小的地区是无法比拟的。总体而言，我们发现WIC服务的提供在各个研究州和需求增加的情况下相对一致，在城市地区对需求的响应更大。随着对某些预防服务需求的增加，农村地区的卫生保健机构可能比大辖区的卫生保健机构需要更多的支持，以满足当地的需求。与WIC不同的是，lhd提供的服务缺乏一贯的服务交付指南，可能难以应对日益增长的需求。联邦政府资助的项目(如WIC)的相对一致性可以作为一个良好的基线，用于进一步研究低卫生保健地区中不太一致的项目。LHD服务统计数据可作为衡量相对于需求的服务交付量的有用数据源。

引用次数: 5

Local Health Department Provision of WIC Services Relative to Local "Need"- Examining 3 States and 5 Years. 地方卫生部门提供的与当地"需要"相关的WIC服务——考察3个州和5年。

Frontiers in public health services & systems research

Pub Date : 2012-04-01

Betty Bekemeier, Matthew Bryan, Matthew D Dunbar, Chris Fowler

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.

社会福利署提供服务的性质千差万别，部分取决于司法管辖区的人口规模。较大的LHD管辖区可能在WIC服务提供方面实现规模经济，这在较小的地区是无法比拟的。总体而言，我们发现WIC服务的提供在各个研究州和需求增加的情况下相对一致，在城市地区对需求的响应更大。随着对某些预防服务需求的增加，农村地区的卫生保健机构可能比大辖区的卫生保健机构需要更多的支持，以满足当地的需求。与WIC不同的是，lhd提供的服务缺乏一贯的服务交付指南，可能难以应对日益增长的需求。联邦政府资助的项目(如WIC)的相对一致性可以作为一个良好的基线，用于进一步研究低卫生保健地区中不太一致的项目。LHD服务统计数据可作为衡量相对于需求的服务交付量的有用数据源。

引用次数: 0