Health Assurance Research Articles

NYSCHAP Johne’s Disease Module, A Program to Change Management of Dairy Farms to Reduce Johne’s Disease Prevalence

characteristics of farms (herd size, objectives to join, etc.) which participated in the core and Johne’s disease (JD) modules of the New York State Cattle Health Assurance Program (NYSCHAP). In addition, we evaluated whether the NYSCHAP JD module was successful in motivating farmers to adopt recommended management practices that limit transmission of enteric diseases, including JD. First, descriptive parameters of farms engaged in the NYSCHAP were determined. Second, adoption of recommended management practices was evaluated in a sub-group of farms.The average NYSCHAP herd was larger than the average dairy herd in New York state and had higher milk production. Goals for participation in the JD module mentioned most frequently by participants were 1) limit transmission of the disease, 2) become a JD negative herd and 3) gain information and have knowledge to change management on the farm. Most farms (94%) intended to do some kind of herd testing for JD and 83% intended to test 75-100% of their herd. The large number of laboratory tests conducted for each farm showed that completed testing corresponded with intended plans. The average percentage of advised management practices implemented by a sub-group of NYSCHAP herds was 74%. This indicates that the average farm appeared to implement 13 of 17 advised measures. An educational, process-oriented program, such as NYSCHAP, may be a successful way to encourage producers to improve herd health management on farms.

L'avenir de notre politique de santé

This paper opens with the statement that the Belgian health care system finds itself nowadays in a paradoxical position as the favourable appreciation of its performance and high quality level resulting from both international comparisons and recent national enquiries among the Belgian population on the one hand, and the significant growth of the compulsory health assurance budgets over the past few years on the other hand, strikingly contrast with far less positive aspects of the actual situa- tion mainly reflected by the ever increasing burden of health care costs to be supported by patients, by serious accessibility problems for some categories of the population and by an overall feeling of dissatisfaction among health care providers. Pointing out the main issues the system has to cope with in four different key areas (financing, health care structures, administrative structures, institutional structures), the paper formulates a series of reflections and proposals in order to stimulate the debate.

NYSCHAP

The New York State Cattle Health Assurance Program (NYSCHAP) is a voluntary program of the Division of Animal Industry of the New York State Department of Agriculture and Markets that creates a team including the producer, herd veterinarian, government veterinarians, universities, extension and agricultural related businesses. The team gathers history, current facts, goals, and concerns as well as performs a risk assessment of the animal production unit. From this information a mutually discussed and agreed upon herd plan is developed incorporating "best management practices" to minimize risk, enhance production and performance as well as address environmental issues. The herd becomes a NYSCHAP Herd and the plan is reviewed regularly by the herd veterinarian and annually by the team.

Survey of infection control training program graduates: Long-term care facility and small hospital practitioners

Graduates of a 2-day basic training course in infection control were surveyed. Respondents were generally from Midwestern long-term care facilities and small hospitals. These infection control practitioners had multiple roles in addition to infection control, most notably employee health and quality assurance. Infection control practitioners demonstrated significant job stability. The vast majority of institutions where survey respondents were employed followed recommended infection control practices. (Am J Infect Control 2002;30:311-3.)

The health assurance coaching model for chronic renal disease management.

This article presents a coach-player approach to the care of patients with chronic renal disease (CRD) that evokes patients’ motivation toward self-maintaining behaviors and informed, competent, and confident selfcare. In operation, it is superior to our conventional directive and prescriptive styles of patient caregiving because self-evidently it assures each patient’s continuous access to consistent high-quality care at lower cost because of predictably reduced use of health care resources. Grounded on evidence-based disease management and generically applicable to virtually all chronic medical disease, health assurance coaching should specifically focus on reducing both the morbidity risks among pre– end stage CRD patients and, as a consequence, cause a significant reduction in the current, unacceptable rates of morbidity and mortality of end-stage renal disease (ESRD) patients. It is generally agreed that our dialyzed ESRD patients’ current rates of morbidity and mortality, and therefore their health care costs, are too high. The principal, alleged causes, including late referral to a nephrologist of already uremic patients, late initiation of dialysis, underdialysis, and undernutrition, are being addressed, respectively, by educational countermeasures in the literature; increasing amounts of dialysis; and use of biocompatible membranes, erythropoietin, intradialytic alimentation, and dietetic coun

Assessing the financial health of the endoscopy center.

Just as a trend of a patient's physiologic vital signs is more informative than a single assessment, the most reliable measure of EASC financial health is achieved over a continuum of time. The earliest estimate of prognosis is accomplished with a business plan that is based on an analysis of practice history, strategic planning, and carefully derived assumptions. Periodic assessments of financial performance with benchmarking data provide a current assessment of health and allow trending of performance improvements or decline. Assurance of future financial health is derived from focusing on customer needs, developing EASC core competence, and creating value through innovation. Following these guidelines helps to ensure a strong, productive, and long-lasting EASC.

The privatization of environmental health services: a national survey of practices and perspectives in local health departments.

This article presents nationally representative data on environmental health (EH) services privatized by local public health departments, enforcement and assurance mechanisms for privatized services, and administrators' views about EH services that should not be privatized. A national sample of 380 local public health departments, stratified by jurisdiction size, was drawn from a universe of 2,488 departments. Telephone interviews were conducted with 347 administrators of departments. Results were weighted to be nationally representative. Approximately one-quarter of departments had privatized at least one EH service, almost always to for-profit organizations. The two most common reasons given for privatizing EH services were cost savings or increased efficiency and lack of capacity or expertise to carry out the service. The most rigorous, although infrequent, technique of enforcement and assurance of EH standards when services were privatized was double-testing of samples. Departments more commonly relied on state licensing and certification of contractors. When asked what services should not be privatized, 27% of respondents cited EH services. Many respondents argued against privatizing environmental services that have inherent regulatory functions. They expressed concern that privatization would fragment the public health infrastructure by impairing communication, diminishing control over performance, or weakening health departments' capacity to respond to environmental and other health crises. These findings raise serious concerns about the privatization of EH.

Animal Health Assurance

A program to assure the health of laboratory animals and to provide a stable environment for their maintenance is necessary to reduce unwanted variables or complicating factors in experimentation. To assure animal health throughout a research study, the animals involved should be procured in good health, monitored for continued health status, and protected from pathogenic organisms through testing of any biological materials. This unit addresses all three of these health management practices. Essential in support of these practices is a diagnostic laboratory capable of testing for rodent and rabbit pathogens.

An Approach to the Support of the Fault-Tolerance of the Double Redundant Computer Control Systems

Faults in computer control systems cause great economic losses and endanger human beings. In order to ensure control and monitoring tasks, the availability and safety of computer control systems in areas such as military, manufacturing plants, traffic, public health service, environment protection, banking and assurances have to be improved. The fault-tolerance of the computer control system is achieved by using the hardware and software redundancy and redundancy of processor time. In this paper, the structure of real time double redundant computer control system is updated. The highly efficient methods and device are designed for supporting of the fault-tolerance of the double redundant computer control system by using the hardware redundancy. The fault-tolerant system software enables identical application programs to work parallel on two reserved computers. The computational process executed in a computer control system is periodically interrupted at checkpoints by execution of the fault-tolerant procedure, which recognizes and eliminates the faulty computers. The recovery of computer control system is automatically without interruption of the control services.

Determinants of counseling in primary care pediatric practice: physician attitudes about time, money, and health issues.

To assess pediatrician goals and practice in preventive counseling, and to use social learning theory to examine physician attitudes about preventive health issues, time, and reimbursement to explain physician counseling behavior. Random sample survey of American Academy of Pediatrics fellows. A total of 1620 pediatricians were surveyed with a return rate of 72%. The 556 pediatricians who had finished training and who currently performed child health supervision were included. Pediatricians were asked about their goals in 6 areas of health supervision: biomedical issues, development, behavior, family functioning, safety education, and supportive interpersonal interaction. They were also asked about the prevalence of counseling, importance of specific topics, their self-efficacy, outcome expectation in these areas, and their concerns about time and reimbursement for preventive counseling. Assurance of physical health and normal development were the most important goals of child health supervision among the pediatricians surveyed. Goals involving behavioral, family, and safety issues were less important and less likely to be addressed in practice. Most did not regularly discuss family stress, substance abuse, gun safety, and television. In these areas, physicians had less confidence they could provide guidance and lower expectation that they could prevent problems. Only 17% felt that they receive adequate reimbursement for preventive counseling. Most have adequate time (53%) and receive adequate respect (57%) for their preventive efforts. Physicians who were more concerned about time for preventive counseling reported less overall counseling (r = -0.28, P<.001). Concern about reimbursement was not associated with reported counseling. Multiple regression analysis found that the primary predictors of physician counseling were an issue's importance, a physician's perceived self-efficacy, and perceived effectiveness of counseling, while concerns about time and reimbursement were secondary. Physician goals in child health supervision were primarily biomedical, with psychosocial and safety issues of lesser importance. Concern about time for preventive counseling was associated with less reported counseling. Physician attitudes regarding the importance of a health issue and their confidence and effectiveness in counseling were more predictive of physician practice than their attitudes about time and reimbursement for preventive care.

Immunization registries in the United States: implications for the practice of public health in a changing health care system.

Although immunization rates among children are rising across the country, rates in inner-city areas have remained at approximately 50%-60%, < or = 30% lower than corresponding suburban or state immunization levels. The failure to raise immunization levels in poor, underserved populations is caused in part by the lack of timely and accurate child-specific immunization information for providers and parents. Immunization registries are a new tool in health care that can be used to address these and other barriers to effective immunization delivery. Moreover, immunization registries have the potential to help health care officials track and improve delivery for a broad range of important child health services. An immunization registry is a computerized database of information on children (usually preschool-age children) in a defined population (e.g. those enrolled in a health maintenance organization or living in a specific geographic area), which is used to record and track all immunizations received by each child. The registry receives the information primarily from public and private providers that administer immunizations, as well as from parents, schools, and other agencies. A fully functioning immunization registry can be used to identify individual children in need of immunizations and to report on immunization rates by population characteristics such as child age, assigned provider, or geographic area (e.g. neighborhood, city). Today, > 250 local public health departments have immunization registries that are in various stages of planning or development. Only a small number of these registries meet the minimum functional criteria of maintaining records on 95% of all eligible 2-year-old children in the target population and providing an electronic immunization record that is accessible to providers. Nascent immunization registries represent innovative technologic solutions to the challenge of monitoring health problems and health care access on a population basis. This is a fundamental activity of public health agencies, but one that is increasingly shared by large health maintenance organizations. The study of the development of immunization registries across the United States provides an important case study for how public health agencies will use the rapidly developing health information infrastructure to perform health assessment and health assurance activities in a managed care environment.

Primate Conservation: The Prevention of Disease Transmission

We address the strategies to prevent disease transmission from human to non-human primates in natural settings. Some field research methods, such as gaining close proximity for observation, provisioning for habituation, or reintroducing for repopulation, may place primate subjects at risk for acquiring human-carried diseases. Additional risks arise through inadequate waste disposal or nonhygienic conditions of humans residing at the study site. We describe several disease outbreaks at primate field sites, emphasizing the need for proper protocols to diagnose, to treat, and to prevent recurrence. Finding solutions to the disease transmission problem requires effecting change in the behavior and policies of many individuals, including field researchers, veterinarians, human health care providers, park personnel, government officials, local villagers, and tourists. The prevention of exposure to infectious disease is an important, fundamental aspect of primate conservation; the assurance of good health and longevity in wild primate populations is paramount to the more traditional conservation issues of poaching control and forest protection.

Swine and Beef Producer Evaluation of Handling, Transportation, and Other Management Factors

Questionnaires requesting producers to identify management changes were mailed or handed out to 370 swine and 2050 beef producers. The survey response rate was 71 (19%) and 410 (20%) swine and beef, respectively. Respondents evaluated the amount and importance of changes (codes; 0=no change, 1=little change, 2=moderate change, 3=large change, and 4=not sure or not applicable) made to their enterprises in the past 10 yr, and changes intended in the near future. The questions included facilities, nutrition, handling, transport, herd health, biosecurity, and other management factors. In addition, respondents were requested to indicate the effects of these practices on animal stress, causing or preventing injury or mortality, and improving management of the enterprise. The most important changes identified by swine producers in the past were nutrition, herd health, and quality assurance and in the near future, ventilation, herd health, and quality assurance. Beef producers identified breeding management, nutrition, and herd health as most important changes in the past and in the near future breeding management, quality assurance, and nutrition. Loading and trucking ranked low (9th, 7th) for swine and beef, respectively, which indicates producer satisfaction or a lack of information on transportation and the frequency of associated negative factors (dark cutters, porcine stress syndrome, bruising, shrink, death loss). Waste management also ranked low (swine 7th, beef 9th), which was unanticipated, especially when considering Pennsylvania’s new nutrient management laws. Over all, producers expressed concern with animal well-being and contemporary animal issues. This is indicated by past and intended future changes and the importance producers place on critical management factors.

The public health primer

PART ONE: THE DEFINITION, DEVELOPMENT AND ORGANIZATION OF PUBLIC HEALTH History and Development The Current US Public Health System Public Health Practice Assessment, Assurance and Public Development PART TWO: BASIC CONCEPTS AND ANALYTIC TOOLS IN PUBLIC HEALTH Epidemiology and Determinants of Disease Basic Measurements and Statistics Makng Inferences from Observations Surveillance and Monitoring the Health of Populations PART THREE: PUBLIC HEALTH INTERVENTIONS AND APPLICATIONS Health Promotion and Health Protection Personal Health Care Services Health Planning Global Health

AI in pigs: the production of quality-assured, healthy semen

THE use of artificial insemination (Al) in pigs as a means of widespread dissemination of genetic superiority at a reduced risk to health, and as a valuable aid to service...

Milk pasteurisation and safety: a brief history and update.

A brief history of the development of milk pasteurisation is presented and updated. Concerns about the margin of safety provided by current pasteurisation standards in terms of milk-borne pathogens such as mycobacteria (in particular Mycobacterium paratuberculosis) and other emerging pathogens such as Listeria monocytogenes and Escherichia coli O157:H7 are discussed. With the exception of the endospores of Bacillus cereus, current standards appear to be adequate for public health assurance of milk safety provided good manufacturing practices are followed.

Prospects for childhood immunization registries in public health assessment and assurance: initial observations from the All Kids Count initiative projects.

This article offers an overview of selected evaluation findings from the initial implementation year of the Robert Wood Johnson Foundation's All Kids Count childhood immunization initiative in which demonstration projects were funded to develop community-based immunization registry and follow-up systems in 14 sites throughout the United States. The basic components of these systems, the process through which these registries were developed, efforts to secure the participation of private sector providers, the prospects for system success at the community level, and the potential for these immunization programs to influence other aspects of primary health care for children are addressed.

Suitability of Fetal Tissue for Transplantation-Reply

In Reply. —Dr Michejda's letter raises several issues related to our study on the suitability of fetal tissue from SAbs and EPs for human transplantation therapy. First, the objective of the study posed a straightforward scientific question: to ascertain how much fetal tissue that would be useful for human transplantation therapy could be obtained from SAbs and EPs. The study was conducted under the auspices, oversight, and direction of the National Institutes of Health. It was reviewed, funded, and monitored in accordance with standard National Institutes of Health procedures, assurances, and certifications. The answer to the question posed was obtained under the best practical working conditions in five geographically different areas by people expert in tissue procurement and processing. As such, it provided a clinically realistic approach to evaluating the availability of useful fetal tissue from SAbs and EPs. Second, the study was conducted to collect hard data on the

Animal Health Assurance

AbstractA program to assure the health of laboratory animals and to provide a stable environment for their maintenance is necessary to reduce unwanted variables or complicating factors in experimentation. To assure animal health throughout a research study, the animals involved should be procured in good health, monitored for continued health status, and protected from pathogenic organisms through testing of any biological materials. This unit addresses all three of these health management practices. Essential in support of these practices is a diagnostic laboratory capable of testing for rodent and rabbit pathogens.

The space life sciences strategy for the 21st century

In the past, space life sciences has focused on gaining an understanding of physiological tolerance to spaceflight, but, for the last 10 years, the focus has evolved to include issues relevant to extended duration missions. In the 21st century, NASA's long-term strategy for the exploration of the solar system will combine the assurance of human health and performance for long periods in space with investigations aimed at searching for traces of life on other planets and acquiring fundamental scientific knowledge of life processes. Implementation of this strategy will involve a variety of disciplines including radiation health, life support, human factors, space physiology and countermeasures, medical care, environmental health, and exobiology. It will use both ground-based and flight research opportunities such as those found in current on-going programs, on Spacelab and unmanned biosatellite flights, and during Space Station Freedom missions.