Organization of the Saudi health system

Using existing data, we reviewed the organizational structure of the Saudi Arabian health system: its demography and history, principal health indicators, organization and management, type and distribution of facilities, financial base, and the impact on it of the Haj. We noted duplication of services, inadequate coordination between some health industry sectors, and the need for a more extensive and rational health centre network with improved information systems and data collection. We also noted scope for a greater role for the private health sector and increased cooperation between it and the public sector to improve health service delivery and population health.

Conflicts of interest in Germany: a legal perspective

In spite of recent efforts to promote cooperation between universities and industry, Germany still lacks a sufficient legal framework for regulating potential conflicts of interest resulting from university-industry cooperation. Prospective regulation of conflicts of interest has to take into account specific constraints imposed by the German constitution. It has to follow stringent procedural and material requirements and carefully weigh the individual researcher's right to academic freedom against the public demand for objectivity in research. Because of this cautious consideration of the conflicting interests constitutionally mandated in Germany, a potential regulation legitimate in this country may serve as a model for other countries facing the need of the adoption of such a regulation.

Turning point: rethinking violence--evaluation of program efficacy in reducing adolescent violent crime recidivism

BACKGROUND

The link between medicine and violence prevention is self-evident, yet the literature reveals few studies that scientifically document effective interventions. The Turning Point: Rethinking Violence (TPRV) program is a unique multiagency program developed to expose, educate, and remediate first-time violent offenders and their parents regarding the real-world consequences of violence. Four key components are integrated into a 6-week, court-ordered program (14 total contact hours): the Trauma Experience (tour, video, discussions), the Victim Impact Panel (presented by parent survivors), Group Process, and Community Networking (individualized mental health referral). We hypothesize that TPRV delivers lower outcomes regarding violence recidivism (VR) when compared with standard court sentencing options (100 hours of community service) for first-time violent offenders.

METHODS

The study group subjects (n = 38) met inclusion criteria and were blindly and randomly sentenced to attend the TPRV program. The control group (n = 38) were pulled from a subject pool of first-time offenders who received standard sentencing options, met the same inclusion criteria with regard to age and types of offenses, and were matched by race to the study group. Both groups were studied for VR within the year after the first violent conviction, and comparison was performed by a (2 analysis of recidivism rates.

RESULTS

Results reveal a statistically significant difference between the study group and the control group for VR (p <or= 0.05). The study group revealed a recidivism rate of 0.05 within the year after program completion, whereas the control group revealed a recidivism rate of 0.33. The lower recidivism rate also occurred with a shorter overall time investment (14 hours vs. 100 hours).

CONCLUSION

The TPRV program decreases VR when compared with standard sentencing options. The broad-spectrum approach (real-world exposure, parental involvement, peer support, follow-up) appears successful in addressing recidivism, and could potentially reduce the epidemic in adolescent violence and the subsequent impact on trauma care.

Advancing Public Health Through the Assessment Initiative

The CDC Assessment Initiative provided funds to six states to promote the development of innovative partnerships between traditional public health agencies and other public and private partners. Novel and creative approaches and methods of assessment were developed to monitor progress toward achieving measurable national, state, and community health objectives. In this article, the strategies and accomplishments of the participant states are summarized.

Tuberculosis control in Alberta. A federal, provincial and regional public health partnership

The number of cases of tuberculosis in Alberta or Canada may not be large, but the public health and medical costs of just a few cases can be prohibitive. For example, the costs of managing cases of multidrug-resistant tuberculosis and their contacts, can exceed the entire annual budget of a program. This was evident in New York City in the late 1980s and early 1990s, when $1 billion in public funds were spent reversing a major resurgence of drug-resistant and susceptible tuberculosis. In Canada, the Walkerton Inquiry has identified an apparent failure of provincial public policy to adequately address public health needs. This has resulted in decreased public confidence and potential liabilities for the policy-makers. In the design of the Tuberculosis Control Program of Alberta, the notion of a quasicentralized or quasidecentralized program is rejected. Rather there is an appeal to the notion of a partnership of responsibility that recognizes jurisdictional and non-jurisdictional public health, case management and epidemiologic realities, the integral contribution of each level of government and the need to be accountable to the public's health and purse. For levels of government not to properly discharge their responsibilities may be perceived as an abrogation of the public trust and a disregard of the Tuberculosis Control Policy Package and operational directives of the World Health Organization.

Academic-industrial relationships: opportunities and pitfalls

Over the past 50 years, academic-industrial collaborations and technology transfer have played an increasingly prominent role in the biomedical sciences. These relationships can speed the delivery of innovative drugs and medical technologies to clinical practice, creating important public health benefits as well as income for universities and their faculty. At the same time, they raise ethical concerns, particularly when research involves human subjects in clinical trials. Lapses in oversight of industry sponsored clinical trials at universities, and especially patient deaths in a number of trials, have brought these issues into the public spotlight and have led the federal government to intensify its oversight of clinical research. The leadership of Harvard Medical School convened a group of leaders in academic medicine to formulate guidelines on individual financial conflicts of interest. They and other groups are working to formulate a national consensus on this issue.

Learning about interagency collaboration: trialling collaborative projects between hospitals and community health services

Interagency collaboration has increasingly been viewed as an important strategy to encourage the co-ordination of healthcare. It is seen to have a number of positive outcomes, including: improved service delivery for people requiring multiple services; more efficient use of healthcare resources; and a means for managers to share the responsibility of community care and reduce organizational stress caused by pressures of increasing demand for services within a climate of cost containment. However, establishing collaborative interagency relationships can be a challenging, long-term and complex process. The present article describes some of the findings of a research project that evaluated collaborative strategies adopted and trialed by a group of four publicly funded healthcare agencies in the southern metropolitan area of Adelaide, South Australia. Key findings from the literature about the factors supporting and impeding collaboration are discussed in the light of some of the findings from the evaluation project. Some of the themes emerging from the Adelaide study include: the need for resources for change; experience of multidisciplinary work; professional barriers to collaboration; the importance of agreed aims, agendas and project ownership; and the importance of supportive leadership. This article concludes with a discussion of the difficulties and opportunities for collaboration between community-based primary healthcare agencies and acute care hospitals. The development of partnerships which are either based on trust, or on the open negotiation of power differences and professional territories, and the management of mistrust are found to be important foundations for achieving greater genuine collaboration between primary and tertiary level healthcare.

Ohio hospital PR pros collaborate on crisis communications plan

Two member hospitals of the Akron Regional Hospital Association (ARHA), Ohio, experienced crisis situations which severely strained their public relations resources. These events were the genesis for the development of a comprehensive plan for sharing public relations resources among 11 member hospitals. The plan details procedures for sharing help in the event of a crisis or specific hospital media event. It identifies three potential situations in which it can be implemented: internal disaster, external disaster, or a specific incident unique to one of the hospitals. No occasion has yet arisen to implement the plan.

A collaborative model: twenty healthcare agencies and academic institutions share resources to educate preceptors

The Boston Collaborative Learning Group (BCLG), a 20-member consortium of healthcare agencies and academic institutions, originated in 1996 in response to a demand for innovative cost-effective measures. Directors of Staff Development and academicians collaborate and share resources in planning preceptor education programs. Over 750 Boston area nurses have attended 1 of 10 programs offered. This article provides an historical perspective on forming a consortium and the benefits of this collaborative model.

Conference summary. Conflict of interest and its significance in science and medicine. Warsaw, Poland, 5-6 April, 2002

This article summarizes the April 5-6, 2002 conference on Conflict of Interest and Its Significance in Science and Medicine. Several themes are identified and addressed, including the globalization of science, the widespread presence of conflicts, the increased interest and involvement in conflict of interest by a number of organizations, the difference between academic research and research conducted by industry, and the tension between science and medicine. At the heart of the matter lies objectivity in research and the need for transparency to ensure objectivity. Several future activities were discussed, including the need to share specific examples of how conflict has been managed, and the need for behavioral research to provide a sound empirical understanding of the best ways to provide informed consent for research subjects.

Assessment Partnerships Between Managed Care and Public Health

This article explores factors that facilitate or impede data sharing and linkage collaborations between state public health agencies and managed care organizations (MCOs). The exploration is based upon a review of both recent literature and the four years' experience of the Massachusetts Health Assessment Partnership (MHAP). MHAP has undertaken six collaborative data sharing and linkage projects that have involved diverse topics and methods. This article summarizes both exogenous and endogenous factors that have affected MHAP as a successful collaboration and indicates those factors that might be replicated in future collaborations between public health agencies and MCOs in other locations.

Individual and institutional conflict of interest: policy review by research universities in the United States

This paper is a discussion of efforts to manage real and potential conflicts of interest in university research in the United States. The focus is on the report by an Association of American Universities (AAU) task force that addresses both individual and institutional conflict of interest issues.

Developing effective school-based drug abuse prevention programs

OBJECTIVE

To research effective drug prevention strategies for school-aged populations from drug prevention programs funded by the USDHHS Center for Substance Abuse Prevention (CSAP).

METHOD

Nine directors and staff members from model CSAP-funded programs were interviewed.

RESULTS

Fifteen strategies that focus on building trusted relationships, selecting well-qualified staff using existing communication networks, and providing timely evaluation feedback are discussed, with examples from the agencies cited.

CONCLUSION

Formulating effective partnerships that support both the goals of the outside agency with drug prevention resources and the mission of a school can contribute toward effective school-based drug prevention programs.

Building transcultural knowledge through intercollegiate collaboration

Although the importance of providing culturally congruent care is widely recognized among nurses, many nurses lack the skill and knowledge necessary to successfully provide culturally competent care. Nursing programs need to better prepare students in transcultural nursing. This article describes an innovative collaborative learning activity that was implemented between two different nursing programs in different states aimed at improving students' transcultural knowledge. Students worked in small groups and used the Internet to collaborate on case studies that focused on transcultural health care issues. Responses collected by anonymous evaluations at the end of three semesters identified both strengths and weaknesses of the project. Results and suggestions for improvement are reported.

An International Collaboration in Nursing Education Viewed Through the Lens of Critical Social Theory

Critical social theory, including the work of Jurgen Habermas, provides a valuable lens for viewing phenomena within their sociopolitical contexts. According to Habermas, the lives and experiences of individuals, groups, and societies in the western world are strongly influenced by the forces of economics and power. These influences may interfere with communication and, therefore, the transmission and regeneration of culture and its meaning. This article describes the experience of initiating an international exchange program at a university school of nursing in the eastern United States. Examined through the lens of Habermas' theory, constraints and obstacles encountered in this process are revealed. Specifically, the inhibiting influence that politics and economics may have on active communication and the potential benefits of shared meaning and understanding achieved by interaction and discourse are examined.

Doing "good" vs. doing "well": the role of nonprofits in society

Nonprofit organizations play a unique role in American life. However, they cannot exist alone; they have a complex, interdependent relationship with the economy's two other sectors-business and government. Driving the success of both for-profit and nonprofit organizations is the corporate board. This column explores the dynamics of boards, the connections among the three sectors, and our nation's growing reliance on nonprofits.

Interagency collaboration: head start and a school of nursing

Agency collaboration is gaining importance for schools of nursing as changes in health care systems focus on the community as a principal environment for health care delivery. Nursing faculty seeking settings in the community to prepare future nurses find Head Start especially interesting as a model of comprehensive care for low-income families. The skill required to develop successful collaboration between community agencies and schools of nursing is often underestimated. Polivka in a conceptual framework for community interageacy collaboration identifies factors to consider. Successful collaborative relationships require that goals be achieved, that relationships be satisfying, and that outcomes have value for all collaborators.