Policy tools for building health education and preventive counseling into managed care

CONTENT: Six policy tools for building health education and preventive counseling into managed care are presented, and the opportunities and barriers to implementing each are described based largely on managed care plans operating in California in 1998. The six policy tools include (1) covering health education and preventive counseling as defined benefits, (2) increasing access to and use of health promotion programs, (3) incorporating health education into disease-management programs, (4) defining quality performance measures for health education and preventive counseling, (5) defining performance targets and guarantees for health education and preventive counseling to hold health plans accountable for providing these services, and (6) building collaboration between public health agencies and managed care on public health education and health promotion. For each of these, the policy option is described, examples of current practice are provided, and the problems and limitations associated with each are discussed.     

The initiation of voluntary movements by the supplementary motor area

Summary The hypothesis is formulated that in all voluntary movements the initial neuronal event is in the supplementary motor areas (SMA) of both cerebral hemispheres.Experimental support is provided by three lines of evidence. 1. In voluntary movements many neurones of the SMA are activated probably up to 200 ms before the pyramidal tract discharge. 2. Investigations of regional cerebral blood flow by the radioactive Xenon technique reveal that there is neuronal activity in the SMA of both sides during a continual series of voluntary movements, and that this even occurs when the movement is thought of, but not excuted. 3. With voluntary movement there is initiation of a slow negative potential (the readiness potential, RP) at up to 0.8 s before the movement. The RP is maximum over the vertex, i.e. above the SMA, and is large there even in bilateral Parkinsonism when it is negligible over the motor cortex.An account is given of the SMA, particularly its connectivities to the basal ganglia and the cerebellum that are active in the preprogramming of a movement. The concept of motor programs is described and related to the action of the SMA. It is proposed that each mental intention acts on the SMA in a specific manner and that the SMA has an inventory and the addresses of stored subroutines of all learnt motor programs. Thus by its neuronal connectivities the SMA is able to bring about the desired movement.There is a discussion of the manner in which the mental act of intention calls forth neural actions in the SMA that eventually lead to the intended movement. Explanation is given on the basis of the dualist-interactionist hypothesis of mind-brain liaison. The challenge is to the physicalists to account for the observed phenomena in voluntary movement.Dedicated to Prof. Richard Jung on the occasion of his 70th birthday     

Approaches to the prevention and control of skin cancer

Skin cancer is the most common and the most preventable form of cancer. Nonmelanoma skin cancers are associated with cumulative exposure to ultraviolet radiation, while melanoma is associated with intense episodes of ultraviolet exposure resulting in sunburns. Numerous risk factors are associated with the development of skin cancer. These include exposure to ultraviolet radiation; phenotypic factors such as skin type, eye and hair color, tendency to burn and tan, and having freckles and moles; a personal or family history of skin cancer; and occupational sun exposure. Primary prevention behaviors include applying SPF 15+ sunscreen 30 minutes before exposure, reapplying SPF 15+ sunscreen every 1¹/₂ to 2 hours or after swimming or sweating, dressing in protective clothing, using shade, limiting exposure during peak sun hours, and avoiding artificial sources of ultraviolet radiation such as tanning beds. Secondary prevention behaviors include screening and early detection in combination with education on the primary prevention behaviors. Interventions designed to increase sun protective behaviors have resulted in increased knowledge and attitudes, but limited behavior change. And while skin cancer screenings have shown promising results, few studies have a follow-up component. Future studies should focus on developing effective strategies for making sun protective behaviors routine and determining the effectiveness of skin cancer screening. To inform approaches to the prevention and control of skin cancer, this paper will summarize key primary and secondary preventive behaviors, highlight primary and secondary prevention programs, and identify key unanswered questions in the area of skin cancer prevention and control.     

加强抗菌药物使用管理前后效果的比较与分析

目的：了解加强抗菌药物使用管理后的临床使用情况，为抗菌药物的合理使用提供科学依据.方法：采用询问和查阅病历的方法，对某院2005年住院患者抗菌药物使用情况及抗菌药物费用所占总药费比例情况进行调查.结果：2005年住院患者抗菌药物总使用率为72.25%，预防性用药占48.20%，联合用药占30.54%.上半年住院患者抗菌药物使用率为80.52%，治疗性用药为41.56%，预防性用药为38.96%，联合用药占40.26%;在加强抗菌药物使用管理后，下半年抗菌药物的使用率、治疗性和预防性用药以及联合用药的比例显著地低于上半年，分别为61.14%，31.88%，29.26%和17.47%，差异有显著意义（P值均小于0.05）.下半年抗菌药物的耗资比例也低于上半年.结论：制定管理措施、加强抗菌药物使用的管理是控制抗菌药物及其合理使用的基本保证.     

About ISAM: Its Inception and Promises

Abstract

Faith-based substance abuse rehabilitation programs provide residential treatment for many substance abusers. To determine key governing concepts of such programs, we conducted semi-structured interviews with sample of eleven clinical and administrative staff referred to us by program directors at six, Evangelical Christian, faith-based, residential rehabilitation programs representing two large, nationwide networks. Qualitative analysis using grounded theory methods examined how spirituality is incorporated into treatment and elicited key theories of addiction and recovery. Although containing comprehensive secular components, the core activities are strongly rooted in a Christian belief system that informs their understanding of addiction and recovery and drives the treatment format. These governing conceptions, that addiction stems from attempts to fill a spiritual void through substance use and recovery through salvation and a long-term relationship with God, provide an explicit, theory-driven model upon which they base their core treatment activities. Knowledge of these core concepts and practices should be helpful to clinicians in considering referrals to faith-based recovery programs.