世界経済・社会統計 = World development indicators

Building Leadership Effectiveness This program encourages leaders to develop practices that transform values into action, vision into realities, obstacles into innovations, and risks into rewards. Participants will be introduced to the five practices of exemplary leadership: modeling the way, inspiring a shared vision, challenging the process, enabling others to act, and encouraging the heart Coaching & Communicating for Performance Coaching & Communicating for Performance is a highly interactive program that will give supervisors and managers the opportunity to build skills that will enable them to share expectations and set objectives for employees, provide constructive feedback, more effectively engage in learning conversations, and coaching opportunities. Skillful Conflict Management for Leaders As a leader, it is important to understand conflict and be effective at conflict management because the way conflict is resolved becomes an integral component of our university’s culture. This series of conflict management sessions help leaders learn and put into practice effective strategies for managing conflict.

기독교 사역과 Leadership

福祉関連職におけるMaslach Burnout Inventoryの因子構造の比較

Objectives. —To determine (1) the number and proportion of Americans living with chronic conditions, and (2) the magnitude of their costs, including direct costs (annual personal health expenditures) and indirect costs to society (lost productivity due to chronic conditions and premature death). Design. —Analysis of the 1987 National Medical Expenditure Survey for prevalence and direct health care costs; indirect costs based on the 1990 National Health Interview Survey andVital Statistics of the United States. Setting. —US population. Participants. —For the estimate of prevalence and direct costs, the National Medical Expenditure Survey sample of persons who reported health conditions associated with (1) use of health services or supplies or (2) periods of disability. Interventions. —None. Main Outcome Measures. —The number of persons with chronic conditions, their annual direct health care costs, and indirect costs from lost productivity and premature deaths. Results. —In 1987, 90 million Americans were living with chronic conditions, 39 million of whom were living with more than 1 chronic condition. Over 45% of non-institutionalized Americans have 1 or more chronic conditions and their direct health care costs account for three fourths of US health care expenditures. Total costs projected to 1990 for people with chronic conditions amounted to $659 billion—$425 billion for direct health care costs and $234 billion in indirect costs. Conclusions. —The prevalence and costs of chronic conditions as a whole have rarely been estimated. Because the number of persons with limitations due to chronic conditions is more regularly reported in the literature, the total prevalence of chronic conditions has perhaps been minimized. The majority of persons with chronic conditions are not disabled, nor are they elderly. Chronic conditions affect all ages. Because persons with chronic conditions have greater health needs at any age, their costs are disproportionately high.

https://jamanetwork.com/journals/jama/articlepdf/410506/jama_276_18_029.pdf

Persons With Chronic Conditions: Their Prevalence and Costs

We previously proposed that socioeconomic status (SES) is a fundamental cause of health inequalities and, as such, that SES inequalities in health persist over time despite radical changes in the diseases, risks, and interventions that happen to produce them at any given time. Like SES, race in the United States has an enduring connection to health and mortality. Our goals here are to evaluate whether this connection endures because systemic racism is a fundamental cause of health inequalities and, in doing so, to review a wide range of empirical data regarding racial differences in health outcomes, health risks, and health-enhancing resources such as money, knowledge, power, prestige, freedom, and beneficial social connections. We conclude that racial inequalities in health endure primarily because racism is a fundamental cause of racial differences in SES and because SES is a fundamental cause of health inequalities. In addition to these powerful connections, however, there is evidence that racism, larg...

Is Racism a Fundamental Cause of Inequalities in Health

For almost three decades researchers have sought to quantify the benefits of home and community care for the elderly, invariably assuming that such care would be an economical substitute for institutionalization. Twenty-seven studies that met rigorous criteria of design, size, and subject were analyzed and the results were synthesized to address the effects on institutional utilization and expenditures, and patient health status and well-being. Home- and community-based health care services are shown to raise overall utilization and costs. Health status effects are limited primarily to patient and caregiver contentment and reduction of unmet needs. Recommendations are made for reaping this considerable benefit more efficiently.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-0009.2005.00434.x

The Past and Future of Home- and Community-Based Long-Term Care

Article on a longitudinal assessment and the consequences of empowered CAN teams in nursing home settings.

/pdf/consequences-of-empowered-cna-teams-in-nursing-home-settings-4q42l0dqtj.pdf

Consequences of Empowered CNA Teams in Nursing Home Settings: A Longitudinal Assessment

Objectives: The three objectives of this
research were: 1) to examine the use of Pap smear tests among
low-income women, including minority and immigrant women who were
patients in a safety-net healthcare system; 2) to identify policy
relevant variables that could lead to changes in use of Pap smear
screening services for these women; and 3) to contribute to the
literature on use of Pap smear screening, especially among minorities
and immigrants. The Behavioral Model for Vulnerable Populations was
used as the theoretical framework. Methods: Pap smear screening predictors were
examined using telephone interviews with a random sample of women aged
18–60, including 465 Non-Hispanic Whites, 285 African
Americans, 164 Hispanic Americans, and 256 Hispanic immigrants,
enrolled in a safety-net healthcare system in Texas in Fall
2000. Binary logistic regression analysis was used. Results: The research revealed that
Non-Hispanic Whites were most likely to have been screened ever and in
the past 3 years, followed by African Americans, Hispanic immigrants,
and Hispanic Americans. Among Hispanics, immigrants were most likely
to have had Pap smear screening, supporting the “healthy
immigrant hypothesis.” Older women were most likely to have
ever been screened, with younger women, most likely in the past
year. Having a usual source of healthcare and a checkup for current
pregnancy increased screening, while competing needs (food, clothing,
housing) affected screening negatively. Conclusions: Culturally competent,
community-based care for women is needed to increase Pap smear
screening among minority groups, especially Hispanic immigrant and
Hispanic American women.

Race and Ethnic Disparities in Cervical Cancer Screening in a Safety-Net System

A national sample of institutionalized and noninstitutionalized aged was created by merging the 1977 National Nursing Home Survey and its counterpart, the National Health Interview Survey for the same year. A weighted logistic regression analysis was conducted to identify factors that might be useful in calculating home- and community-based long-term care clients' risk of institutionalization. A model containing patient characteristics, nursing home bed supply, and a climate variable correctly classified 98.2 percent of cases residing in nursing homes or the community. Physical dependency, mental disorder and degenerative disease, lack of spouse, being white, poverty, old age, unoccupied nursing home beds, and climate all appear to be determinants of institutional residency among the aged.

Toward a model for improved targeting of aged at risk of institutionalization.

Purpose This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. Design and methods A quasi-experimental design is underway where certified nurse aide (CNA) teams are being established in five nursing homes (NHs) in the Dallas-Fort Worth metropolitan area, and five additional NHs are being treated as comparison NHs. Results As of March 2004 CNA teams were established in five NHs, and baseline survey data were collected from the CNAs, nurses, residents, and family members in each of these NHs as well as from those in the five comparison homes. Implications Qualitative analyses show positive effects of CNA teams. Quantitative analyses will not be complete until follow-up survey data are collected 12 months after team implementation. Steps for implementing teams include surveying management to be sure that they want nurse teams; orienting and training the managers, nurses, and nurse aides; and facilitating the teams. Management of the teams includes routine feedback from management to the teams and vice versa while using a give-and-take approach.

Cynthia M. Cready

Papers

The Past and Future of Home- and Community-Based Long-Term Care

Consequences of Empowered CNA Teams in Nursing Home Settings: A Longitudinal Assessment

Race and Ethnic Disparities in Cervical Cancer Screening in a Safety-Net System

Toward a model for improved targeting of aged at risk of institutionalization.

Self-Managed Work Teams in Nursing Homes: Implementing and Empowering Nurse Aide Teams