bluuebunny/crossref_metadata_2025_split huggingface dataset:
Helping Public Sector Health Systems Innovate: The Strategic Approach to Strengthening Reproductive Health Policies and Programs
Authors: Fajans Peter , Simmons Ruth , Ghiron Laura 
Published: February 2006

Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already-strained institutions with fewer resources and insufficient capacity to relieve health burdens. The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much-needed change. We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach’s dissemination and sustainability.
Vulnerability, Human Rights, and Comprehensive Health Care Needs of Young People Living With HIV/AIDS
Authors: Ayres José Ricardo de Carvalho Mesquita , Paiva Vera , França Ivan , Gravato Neide , Lacerda Regina , Della Negra Marinella , Marques Heloisa Helena de Sousa , Galano Eliana , Lecussan Pilar , Segurado Aluísio Cotrim , Silva Mariliza Henrique 
Published: February 2006

We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs. Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs.
Systems Analysis of Real-World Obstacles to Successful Cervical Cancer Prevention in Developing Countries
Authors: Suba Eric J. , Murphy Sean K. , Donnelly Amber D. , Furia Lisa M. , Huynh My Linh D. , Raab Stephen S. 
Published: February 2006

Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grassroots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies. We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.
System Dynamics Modeling for Public Health: Background and Opportunities
Authors: Homer Jack B. , Hirsch Gary B. 
Published: February 2006

The systems modeling methodology of system dynamics is well suited to address the dynamic complexity that characterizes many public health issues. The system dynamics approach involves the development of computer simulation models that portray processes of accumulation and feedback and that may be tested systematically to find effective policies for overcoming policy resistance. System dynamics modeling of chronic disease prevention should seek to incorporate all the basic elements of a modern ecological approach, including disease outcomes, health and risk behaviors, environmental factors, and health-related resources and delivery systems. System dynamics shows promise as a means of modeling multiple interacting diseases and risks, the interaction of delivery systems and diseased populations, and matters of national and state policy.
A System for Rapidly and Accurately Collecting Patients’ Race and Ethnicity
Authors: Baker David W. , Cameron Kenzie A. , Feinglass Joseph , Thompson Jason A. , Georgas Patricia , Foster Shawn , Pierce Deborah , Hasnain-Wynia Romana 
Published: February 2006

Objectives. We assessed the feasibility of collecting race/ethnicity data from patients using their own preferred racial/ethnic terms. Methods. The 424 patients described their race/ethnicity using their own categories, and we compared their descriptions with their responses to the questions (1) “Do you consider yourself Latino or Hispanic?” and (2) “Which category best describes your race?” (7 response options in our computer interview). We also determined patients’ preferences between the 2 approaches. Results.seconds. Rates of missing values and categorization as “other” race were lower than with the closed questions. Agreement between racial/ethnic categorization with open-ended and closed responses was 93% (κ =0.88). Latino/Hispanic and multiracial/multiethnic individuals were more likely to prefer using their own categories to describe their race/ethnicity. Conclusions. Collecting race/ethnicity data using patients’ own racial/ethnic categories is feasible with the use of computerized systems to capture verbatim responses and results in lower rates of missing and unusable data than do standard questions.
A Societal Outcomes Map for Health Research and Policy
Authors: Garfinkel Michele S. , Sarewitz Daniel , Porter Alan L. 
Published: February 2006

The linkages between decisions about health research and policy and actual health outcomes may be extraordinarily difficult to specify. We performed a pilot application of a “road mapping” and technology assessment technique to perinatal health to illustrate how this technique can clarify the relations between available options and improved health outcomes. We used a combination of data-mining techniques and qualitative analyses to set up the underlying structure of a societal health outcomes road map. Societal health outcomes road mapping may be a useful tool for enhancing the ability of the public health community, policymakers, and other stakeholders, such as research administrators, to understand health research and policy options.
The Impact of New York City’s 1975 Fiscal Crisis on the Tuberculosis, HIV, and Homicide Syndemic
Authors: Freudenberg Nicholas , Fahs Marianne , Galea Sandro , Greenberg Andrew 
Published: February 2006

In 1975, New York City experienced a fiscal crisis rooted in long-term political and economic changes in the city. Budget and policy decisions designed to alleviate this fiscal crisis contributed to the subsequent epidemics of tuberculosis, human immunodeficiency virus (HIV) infection, and homicide in New York City. Because these conditions share underlying social determinants, we consider them a syndemic, i.e., all 3 combined to create an excess disease burden on the population. Cuts in services; the dismantling of health, public safety, and social service infrastructures; and the deterioration of living conditions for vulnerable populations contributed to the amplification of these health conditions over 2 decades. We estimate that the costs incurred in controlling these epidemics exceeded $50 billion (in 2004 dollars); in contrast, the overall budgetary saving during the fiscal crisis was $10 billion. This history has implications for public health professionals who must respond to current perceptions of local fiscal crises.
Complex Causal Process Diagrams for Analyzing the Health Impacts of Policy Interventions
Authors: Joffe Michael , Mindell Jennifer 
Published: February 2006

Causal diagrams are rigorous tools for controlling confounding. They also can be used to describe complex causal systems, which is done routinely in communicable disease epidemiology. The use of change diagrams has advantages over static diagrams, because change diagrams are more tractable, relate better to interventions, and have clearer interpretations. Causal diagrams are a useful basis for modeling. They make assumptions explicit, provide a framework for analysis, generate testable predictions, explore the effects of interventions, and identify data gaps. Causal diagrams can be used to integrate different types of information and to facilitate communication both among public health experts and between public health experts and experts in other fields. Causal diagrams allow the use of instrumental variables, which can help control confounding and reverse causation.
Institutional and Economic Determinants of Public Health System Performance
Authors: Mays Glen P. , McHugh Megan C. , Shim Kyumin , Perry Natalie , Lenaway Dennis , Halverson Paul K. , Moonesinghe Ramal 
Published: February 2006

Objectives. Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services. Methods. Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services. Results. Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services. Conclusions. Reconfiguring the organization and financing of public health systems in some communities—such as through consolidation and enhanced intergovernmental coordination—may hold promise for improving the performance of essential services.
Improving the Effectiveness of Health Care and Public Health: A Multiscale Complex Systems Analysis
Authors: Bar-Yam Yaneer 
Published: February 2006

The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care. Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services. Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients.
Toward Ethical Review of Health System Transformations
Authors: Daniels Norman 
Published: February 2006

Efforts to transform health systems constitute social experiments on a population. Like clinical research, they deploy measures that are unproven in the context of the reform, and they often impose significant risks on some people in order to achieve a social goal: the improvement of health delivery. The rationale for proactively evaluating clinical experimentation on human subjects also applies to these social experiments. We used the “benchmarks of fairness” methodology to illustrate the elements such an evidence-based review should encompass, leaving open the question of who should perform it. The review must include the ethical objectives of reform, namely, an integrated approach to equity, accountability, and efficiency; the fit between measures taken and these objectives; and the governance of the reform.
Public Health Asks of Systems Science: To Advance Our Evidence-Based Practice, Can You Help Us Get More Practice-Based Evidence?
Authors: Green Lawrence W. 
Published: February 2006

Public health asks of systems science, as it did of sociology 40 years ago, that it help us unravel the complexity of causal forces in our varied populations and the ecologically layered community and societal circumstances of public health practice. We seek a more evidence-based public health practice, but too much of our evidence comes from artificially controlled research that does not fit the realities of practice. What can we learn from our experience with sociology in the past that might guide us in drawing effectively on systems science?
Learning from Evidence in a Complex World
Authors: Sterman John D. 
Published: February 2006

Policies to promote public health and welfare often fail or worsen the problems they are intended to solve. Evidence-based learning should prevent such policy resistance, but learning in complex systems is often weak and slow. Complexity hinders our ability to discover the delayed and distal impacts of interventions, generating unintended “side effects.” Yet learning often fails even when strong evidence is available: common mental models lead to erroneous but self-confirming inferences, allowing harmful beliefs and behaviors to persist and undermining implementation of beneficial policies. Here I show how systems thinking and simulation modeling can help expand the boundaries of our mental models, enhance our ability to generate and learn from evidence, and catalyze effective change in public health and beyond.
HIV/AIDS and Other Infectious Diseases Among Correctional Inmates: Transmission, Burden, and an Appropriate Response
Authors: Hammett Theodore M. 
Published: February 2006

Correctional inmates engage in drug-related and sexual risk behaviors, and the transmission of HIV, hepatitis, and sexually transmitted diseases occurs in correctional facilities. However, there is uncertainty about the extent of transmission, and hyperbolic descriptions of its extent may further stigmatize inmates and elicit punitive responses. Whether infection was acquired within or outside correctional facilities, the prevalence of HIV and other infectious diseases is much higher among inmates than among those in the general community, and the burden of disease among inmates and releasees is disproportionately heavy. A comprehensive response is needed, including voluntary counseling and testing on request that is linked to high-quality treatment, disease prevention education, substance abuse treatment, and discharge planning and transitional programs for releasees.
Systemic Intervention for Public Health
Authors: Midgley Gerald 
Published: February 2006

Many calls have been made for a systems approach to public health. My response is to offer a methodology for systemic intervention that (1) emphasizes the need to explore stakeholder values and boundaries for analysis, (2) challenges marginalization, and (3) draws upon a wide range of methods (from the systems literature and beyond) to create a flexible and responsive systems practice. I present and discuss several well-tested methods with a view to identifying their potential for supporting systemic intervention for public health.
Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis
Authors: Weinshenker Brian G. , Wingerchuk Dean M. , Vukusic Sandra , Linbo Linda , Pittock Sean J. , Lucchinetti Claudia F. , Lennon Vanda A. 
Published: February 2006

Abstract ObjectiveWe investigated whether neuromyelitis optica (NMO) IgG seropositivity at the initial presentation of longitudinally extensive transverse myelitis (LETM) predicts relapse of myelitis or development of optic neuritis.MethodsProspective study of patients with initial LETM who were tested for the presence of NMO‐IgG.ResultsEleven of 29 patients (37.9%) were seropositive after a first attack of LETM spanning three or more vertebral segments on magnetic resonance imaging. Of 23 patients followed up for 1 year, none of 14 who were seronegative experienced a relapse or developed optic neuritis. Of 9 seropositive patients, 5 developed a second event: 4 of 9 (44%) developed recurrent transverse myelitis and 1 of 9 (11%) developed optic neuritis (p = 0.004).InterpretationLETM represents an inaugural or limited form of NMO in a high proportion of patients. The 40% of patients who are seropositive for NMO‐IgG are at high risk for relapse. Ann Neurol 2006
Polymere Therapeutika: Konzepte und Anwendungen
Authors: Haag Rainer , Kratz Felix 
Published: January 2006

AbstractPolymere Therapeutika umfassen Polymer‐Protein‐Konjugate, Wirkstoff‐Polymer‐Konjugate und supramolekulare Wirkstofftransportsysteme. Zahlreiche Polymer‐Protein‐Konjugate mit verbesserter Stabilität und Pharmakokinetik wurden z. B. durch Anknüpfen einer Polyethylenglycolkomponte (PEGylierung) an Enzyme oder therapeutisch relevante Proteine entwickelt. Einige davon sind bereits als Medikamente zugelassen, z. B. die PEGylierte Form der Adenosin‐Desaminase. Die Kupplung von niedermolekularen Cytostatika an hochmolekulare Polymere durch einen spaltbaren Linker ist eine effektive Methode zur Verbesserung des therapeutischen Index klinischer Wirkstoffe, und erste Kandidaten wurden bereits klinisch evaluiert, darunter N‐(2‐Hydroxypropyl)methacrylamid‐Konjugate von Doxorubicin, Paclitaxel und Platin(II)‐Komplexen. Zu einem weiteren Typ polymerer Therapeutika, den Wirkstofftransportsystemen, führte der Fortschritt bei definierten multivalenten und dendritischen Polymeren. Beispiele sind polyanionische Polymere als Inhibitoren der zellulären Bindung von Viren, polykationische Komplexe mit DNA oder RNA (Polyplexe) und dendritische Kern‐Schale‐Partikel zur Verkapselung von Wirkstoffen. In diesem Aufsatz geben wir einen Überblick über polymere Therapeutika mit einem Schwerpunkt auf Konzepten und Beispielen, die die besonderen Merkmale des jeweiligen Wirkstofftransportsystems charakterisieren.
Local thermal degradation behavior of heterophasic polypropylene copolymers
Authors: Manabe Norio , Yokota Yoshimitsu , Nakatani Hisayuki , Suzuki Shoutarou , Liu Boping , Terano Minoru 
Published: January 2006

AbstractPolypropylene (PP) impact copolymer is one of the heterophasic PP systems that is improved by rubber modification. Because the copolymer is a complicated polymer blend, which mainly consists of PP and ethylene–propylene rubber (EPR) components, the degradation behavior has hardly been studied. In this study, the thermal degradation of the copolymer was studied through direct observation by atomic force microscopy, which is a powerful tool for observing a local domain in a polymer blend. The degradation behavior was visually captured by the mapping of topological changes. Although the EPR phase was hardly degraded, the neighboring PP matrix was degraded selectively. The degradation behavior of the copolymer was found to be heterogeneous. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 1831–1835, 2006
Characterization of the aging behavior of raw epoxidized natural rubber with a rubber processing analyzer
Authors: Wang Ping‐Yue , Qian Hong‐Lian , Yang Chun‐Liang , Ying‐Chen  
Published: January 2006

AbstractTests of the strain sweep, frequency sweep, and stress relaxation for raw epoxidized natural rubber were carried out with a rubber processing analyzer. The results showed that the complex viscosity, η*, decreased with the prolongation of the aging time in the region of Newtonian flow, but in the region of non‐Newtonian flow, the decrement of η* with a rising shear rate decreased with the prolongation of the aging time. The torque (S′) response from the strain sweep indicated that aging brought about an obvious decrease in the increment of S′ with rising strain in the linear viscoelastic region and a small increase in the slope of the plateau on the curve of the S′ response in the nonlinear viscoelastic region. The stress relaxation rate constants k and b, calculated according to the equations St = S0e−kt and St = S1t−b (where St, S0, and S1 are the stresses at relaxation time t, t = 0, and t = 1, respectively), increased, and the stress relaxation time obtained directly from the rubber processing analyzer shortened with the prolongation of the aging time. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 1277–1281, 2006
Copolymerization of two new kinds of methacrylate monomers and determination of monomer reactivity ratios
Authors: Erol Ibrahim 
Published: January 2006

AbstractNew methacrylate monomers 2‐(p‐methoxyphenoxy)‐2‐oxo‐ethyl methacrylate (pMPOEMA), 2‐(p‐chlorophenoxy)‐2‐oxo‐ethyl methacrylate (pClPOEMA), and 2‐oxo‐2‐phenylamino ethylene methacrylate (PAMA) were synthesized for the first time. The free‐radical‐initiated copolymerization of pMPOEMA and pClPOEMA with PAMA was carried out in 1,4‐dioxane solution at 65°C using 2,2′‐azobisisobutyronitrile (AIBN) as an initiator with different monomer‐to‐monomer ratios in the feed. The monomers and copolymers were characterized by Fourier transform infrared, 1H and 13C NMR spectral studies. The copolymer compositions were evaluated from nitrogen content in polymers. The reactivity ratios of the monomers were determined by applying Fineman–Ross and Kelen–Tüdös methods. The analysis of reactivity ratios revealed that pMPOEMA and pClPOEMA are less reactive than PAMA is, and copolymers formed are statistically in nature. The molecular weights (Mw and Mn) and polydispersity index of the polymers were determined using gel permeation chromatography. Thermogravimetric analysis of the polymers reveals that the thermal stability of the copolymers increases with an increase in the mole fraction of pMPOEMA and pClPOEMA in the copolymers. Glass transition temperatures of the copolymers were found to decrease with an increase in the mole fraction of PAMA in the copolymers. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 1864–1874, 2006