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Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation

October 22, 2014 Comments off

Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation
Source: Journal of Medical Internet Research

Background:
Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers.

Objective:
The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program?

Methods:
Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score.

Results:
The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms.

Conclusions:
There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool.

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Vaccination Coverage Among Children in Kindergarten — United States, 2013–14 School Year

October 22, 2014 Comments off

Vaccination Coverage Among Children in Kindergarten — United States, 2013–14 School Year
Source: Morbidity and Mortality Weekly Report (CDC)

State and local vaccination requirements for school entry are implemented to maintain high vaccination coverage and protect schoolchildren from vaccine-preventable diseases (1). Each year, to assess state and national vaccination coverage and exemption levels among kindergartners, CDC analyzes school vaccination data collected by federally funded state, local, and territorial immunization programs. This report describes vaccination coverage in 49 states and the District of Columbia (DC) and vaccination exemption rates in 46 states and DC for children enrolled in kindergarten during the 2013–14 school year. Median vaccination coverage was 94.7% for 2 doses of measles, mumps, and rubella (MMR) vaccine; 95.0% for varying local requirements for diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine; and 93.3% for 2 doses of varicella vaccine among those states with a 2-dose requirement. The median total exemption rate was 1.8%. High exemption levels and suboptimal vaccination coverage leave children vulnerable to vaccine-preventable diseases. Although vaccination coverage among kindergartners for the majority of reporting states was at or near the 95% national Healthy People 2020 targets for 4 doses of DTaP, 2 doses of MMR, and 2 doses of varicella vaccine (2), low vaccination coverage and high exemption levels can cluster within communities.* Immunization programs might have access to school vaccination coverage and exemption rates at a local level for counties, school districts, or schools that can identify areas where children are more vulnerable to vaccine-preventable diseases. Health promotion efforts in these local areas can be used to help parents understand the risks for vaccine-preventable diseases and the protection that vaccinations provide to their children.

AHRQ — Women: Stay Healthy at Any Age (2014 Update)

October 21, 2014 Comments off

Women: Stay Healthy at Any Age (2014 Update)
Source: Agency for Healthcare Research and Quality

Use this information to help you stay healthy. Learn which screening tests you need and when to get them, which medicines may prevent diseases, and steps you can take for good health.

Healthy Savings: Medical Technology and the Economic Burden of Disease

October 21, 2014 Comments off

Healthy Savings: Medical Technology and the Economic Burden of Disease (PDF)
Source: Milken Institute

The debate continues within the health policy community on the proper balance between the costs and benefits of medical technology. At a time of unprecedented change in health delivery and incentive systems and persistent concern about the cost of care, this debate has significant implications for public policy. Even with medical inflation running at a four-decade low—a condition that might suggest pressures are dissipating—the controversy is only intensifying.

Assessments of the true cost and economic benefit of medical technology (in the form of devices and diagnostics) have been hampered by the fact that direct treatment expenditures associated with technology use can be readily measured, while indirect savings, for example avoiding emergency room care and reducing hospital stays, are more difficult to capture.

Equally important, the economic benefits of reducing the burden of disease through better diagnosis, prevention, treatment, and cures extend beyond the health system to GDP gains from increased labor force participation and productivity. These gains are generated not only by patients, but by the rising participation and productivity of their informal caregivers. Yet these dividends are rarely incorporated into the evaluation of medical technologies.

In this study, we take a systematic approach to documenting the full costs and broader economic benefits of investment in representative medical technologies used to address four prevalent causes of death and disability: diabetes, heart disease, musculoskeletal disease, and colorectal cancer.1

Veteranness : Representations of Combat-related PTSD in U.S. Popular Visual Media

October 20, 2014 Comments off

Veteranness : Representations of Combat-related PTSD in U.S. Popular Visual Media (PDF)
Source: Michigan Technological University (Keranen)

Posttraumatic stress and PTSD are becoming familiar terms to refer to what we often call the invisible wounds of war, yet these are recent additions to a popular discourse in which images of and ideas about combat-affected veterans have long circulated. A legacy of ideas about combat veterans and war trauma thus intersects with more recent clinical information about PTSD to become part of a discourse of visual media that has defined and continues to redefine veteran for popular audiences.

In this dissertation I examine realist combat veteran representations in selected films and other visual media from three periods: during and after World Wars I and II (James Allen from I Am a Fugitive from a Chain Gang, Fred Derry and Al Stephenson from The Best Years of Our Lives); after the Vietnam War (Michael from The Deer Hunter, Eriksson from Casualties of War), and post 9/11 (Will James from The Hurt Locker, a collection of veterans from Wartorn: 1861-2010.) Employing a theoretical framework informed by visual media studies, Barthes’ concept of myth, and Foucault’s concept ofdiscursive unity, I analyze how these veteran representations are endowed with PTSD symptom-like behaviors and responses that seem reasonable and natural within the narrative arc. I contend that veteran myths appear through each veteran representation as the narrative develops and resolves. I argue that these veteran myths are many and varied but that they crystallize in a dominant veteran discourse, a discursive unity that I term veteranness. I further argue that veteranness entangles discrete categories such as veteran, combat veteran, and PTSD with veteran myths, often tying dominant discourse about combat-related PTSD to outdated or outmoded notions that significantly affect our attitudes about and treatment of veterans.

A basic premise of my research is that unless and until we learn about the lasting effects of the trauma inherent to combat, we hinder our ability to fulfill our responsibilities to war veterans. A society that limits its understanding of posttraumatic stress, PTSD and post-war experiences of actual veterans affected by war trauma to veteranness or veteran myths risks normalizing or naturalizing an unexamined set of sociocultural expectations of all veterans, rendering them voice-less, invisible, and, ultimately disposable.

New From the GAO

October 20, 2014 Comments off

New GAO Reports
Source: Government Accountability Office

1. Food Safety: USDA Needs to Strengthen Its Approach to Protecting Human Health from Pathogens in Poultry Products. GAO-14-744, September 30.
http://www.gao.gov/products/GAO-14-744
Highlights – http://www.gao.gov/assets/670/666230.pdf
Podcast – http://www.gao.gov/multimedia/podcasts/666518

2. Changing Crude Oil Markets: Allowing Exports Could Reduce Consumer Fuel Prices, and the Size of the Strategic Reserves Should Be Reexamined. GAO-14-807, September 30.
http://www.gao.gov/products/GAO-14-807
Highlights – http://www.gao.gov/assets/670/666275.pdf

CRS — Hydraulic Fracturing: Selected Legal Issues (September 26, 2014)

October 20, 2014 Comments off

Hydraulic Fracturing: Selected Legal Issues (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Hydraulic fracturing is a technique used to recover oil and natural gas from underground low permeability rock formations. Its use along with horizontal drilling has been responsible for an increase in estimated U.S. oil and natural gas reserves. Hydraulic fracturing and related oil and gas production activities have been controversial because of their potential effects on public health and the environment. Several environmental statutes have implications for the regulation of hydraulic fracturing by the federal government and states.

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