Strengthening responses to the HIV/AIDS pandemic: an internal evaluation of the Caribbean Health Leadership Institute.

BACKGROUND: Leadership development is a strategy for improving national responses to HIV/AIDS. The University of the West Indies offers the Caribbean Health Leadership Institute (CHLI) to enhance leaders' effectiveness and responses to HIV/AIDS through a cooperative agreement with the Centers for Disease Control and Prevention. CHLI enrolls leaders in annual cohorts numbering 20-40. OBJECTIVES: To examine how CHLI influenced graduates' self-understanding, skills, approaches, vision, commitments, courage, confidence, networks, and contributions to program, organizational, policy, and systems improvements. METHODS: Web-based surveys and interviews of graduates. RESULTS: CHLI increased graduates' self-understanding and skills and strengthened many graduates' vision, confidence, and commitments to improving systems. It helped graduates improve programs, policies, and systems by: motivating them and giving them ideas for changes to pursue, encouraging them to share their vision, deepening skills in areas such as systems thinking, policy advocacy, and communication, strengthening their inclusion of partners and team members, and influencing how they interacted with others. Training both HIV-focused and general health leaders can help both kinds of leaders foster improvements in HIV services and policies. DISCUSSION: Learners greatly valued self-assessments, highly interactive sessions, and the opportunity to build a network of professional colleagues. Projects provided opportunities to address substantive issues and immediately apply learning to work. Leadership development evaluations in the United States have also emphasized the complementary benefits of assessment and feedback, skills development, and network development. Global leadership programs should find ways to combine these components in both traditional face-to-face and distance-learning contexts.

Partnership for front-line success: a call for a national action agenda on workforce development.

Despite more than a decade of dialogue on the critical needs and challenges in public health workforce development, progress remains slow in implementing recommended actions. A life-long learning system for public health remains elusive. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry in collaboration with other partners in federal, state, local agencies, associations and academia is preparing a national action agenda to address front-line preparedness. Four areas of convergence have emerged regarding: (1) the use of basic and crosscutting public health competencies to develop practice-focused curricula; (2) a framework for certification and credentialing; (3) the need to establish a strong science base for workforce issues; and (4) the acceleration of the use of technology-supported learning in public health.

Do proficiency test results correlate with the work performance of screeners who screen Papanicolaou smears?

We rescreened Papanicolaou smear slides from 40,245 women, which had been examined by 81 cytology screeners, scored the screeners' work performance, and compared these scores with the results of the screeners' performance on glass slide and computer-based proficiency tests. All diagnoses (i.e., from the proficiency tests, the original slides, and the rescreened slides) were classified in the 4 diagnostic categories specified in the Clinical Laboratory Improvement Amendments. The rescreening scores were standardized to account for different distributions of abnormalities in the proficiency tests and rescreened slides. We compared a standardized score with the proficiency test scores. Of the cases, 91% were categorized as normal, benign, or reactive changes when rescreened, and 98% of these agreed with the original diagnosis. Sixteen percent of low-grade and 15% of high-grade intraepithelial lesions were classified as normal. The rank correlation between the rescreening scores and both proficiency tests was 0.24 using a scoring scheme for cytotechnologists. The correlation between the rescreening and proficiency testing scores indicates that performance on a 10-slide test gives some indication of the true performance of screeners. The computer-based test shows promise as an alternative to the glass slide test but needs further development and validation.

Full-time employees of U.S. local health departments, 1992-1993.

This article describes a study to assess the most recent data on full-time U.S. local health department (LHD) staff positions. The authors used data from the National Association of County and City Health Officials' 1992-1993 national survey of LHDs. The study concludes that nurses, environmental specialists, sanitarians, and administrators constitute the core of the public health workforce in smaller and mid-sized LHDs. Numerous vacancies in these core occupations signal a weakness in the front lines of public health and vulnerability in its ability to respond to urgent health threats. To address these problems, a renewed commitment to recruiting, retraining, and retaining the local public health worker is urgently needed.

Technical report: Initial experiences with an experimental solid-state universal digital X-ray image detector.

This paper presents a brief technical evaluation and first review of clinical experiences with an experimental direct digital X-ray image detector designed to support both dynamic and snap-shot imaging. Derivatives of this type of image detector can potentially fulfil the majority of the fluoroscopic and radiographic imaging requirements of clinical radiology departments, and initial results suggest that imaging systems using the new technology will provide a high quality dose-efficient solution to the search for a universal digital X-ray image detector.

Expanding the specialty of occupational and environmental medicine: the role of the chief health officer. The Sappington Lecture.

Passage of the Occupational Safety and Health Act in 1971 represented a major milestone for occupational and environmental medicine. Creation of the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) flowed directly from the legislation, and the specialty of occupational medicine entered a new era. As the 25th anniversaries of OSHA and NIOSH are celebrated, consideration of the future of the specialty of occupational and environmental medicine seems timely. In this lecture, an expanded role for the specialty is proposed, based on an analysis of the forces shaping the practice of public health and the opportunities that these forces present. This analysis suggests considering the concept of a "Chief Health Officer" serving the broad health needs of the workplace.

Medical and public health services at the 1996 Atlanta Olympic Games: an overview.

Planning for the 2000 Sydney Olympic Games may benefit from the experience of the 1996 Atlanta Olympics. Excellent health promotion and prevention activities before and during the Games resulted in fewer medical and public health problems than anticipated. Despite this, there was room for improvement in the level of communication and cooperation between the many service providers to ensure the most appropriate and efficient responses.

Prevention and the reforming U.S. health care system: changing roles and responsibilities for public health.

This review presents historical and cost-effectiveness perspectives of prevention in health care; discusses the nature, extent, and determinants of health system change, particularly the transition to managed care with large integrated health care corporations; and identifies implications for public health agencies and opportunities for prevention within the reforming health system.

Information and surveillance systems and community health: building the public health information infrastructure.

The scope and purpose of public health injury and disease surveillance systems will expand in response to the increasing information needs of communities and health organizations. Public health leaders must focus on the entire information infrastructure. Surveillance and information systems need to evolve to include targeting and evaluating community-wide prevention programs. Standards governing exchange as well as data content will become central to these new systems and the emerging health information infrastructure. Future surveillance systems will face challenges in forming partnerships with managed care organizations, in developing new information tools, and in training the public health workforce.

CDC's Information Network for Public Health Officials (INPHO): a framework for integrated public health information and practice.

To strengthen the public health infrastructure, the Centers for Disease Control and Prevention (CDC) initiated the Information Network for Public Health Officials (INPHO). CDC INPHO has three goals: (1) to make communication among public health practitioners throughout the United States easy, (2) to make information accessible, and (3) to make secure data exchange as swift and smooth as contemporary technology will allow. Based on a systems approach to supporting the core functions of public health, CDC INPHO achieves its goals by creating a flexible and user-responsive infrastructure of open communications and information exchange.

Successful reversal of hepatic encephalopathy with intentional occlusion of transjugular intrahepatic portosystemic shunts.

PURPOSE: To establish a safe and effective method for occluding a transjugular intrahepatic portosystemic shunt (TIPS) in patients who develop uncontrollable, disabling encephalopathy. PATIENTS AND METHODS: The study population consisted of five patients who developed refractory encephalopathy following TIPS. The indication for TIPS was bleeding in four patients and ascites in one. Wallstents that were 10 mm in diameter and 68 mm long were used to bridge the hepatic parenchyma in all patients. The onset of encephalopathy from the time of the TIPS procedure ranged from 24 hours to 210 days. Because encephalopathy was not responsive to conventional medical management, shunt thrombosis was induced by means of temporary inflation of an 11.5-mm-diameter latex occlusion balloon within the midportion of the stent. RESULTS: All shunts were successfully thrombosed when the balloon was inflated for 12 hours or more. Encephalopathy resolved in four patients and improved in the remaining patient. One patient experienced recurrent bleeding within 24 hours of the TIPS occlusion that was controlled medically. CONCLUSION: Temporary occlusion of a TIPS with latex balloons successfully induces shunt thrombosis and improves encephalopathy. However, the patient is again exposed to risks related to complications of portal hypertension.

A review of recent research on health effects of human occupational exposure to organic solvents. A critical review.

The health impact of workplace solvent exposure remains an issue of substantial interest and concern to occupational health professionals. As a result of research performed in the 1970s and 1980s, policies and programs were developed throughout the world to control excessive exposure to solvents. To an extent, these programs have been responsible for reduction of the occurrence of solvent-associated encephalopathy and other health effects. In this review of research performed since 1985, particular attention is given to issues of reversibility of neurotoxicity following exposure cessation. Furthermore, health effects involving other organ systems, particularly reproductive, renal, and hepatic disorders, are discussed. Future research directions are discussed. Finally, the practical implications of these recent research findings are described with a focus on the management of prevention programs at the work site.