Toward Achieving Health Equity: Emerging Evidence and Program Practice.

Health equity, in the context of public health in the United States, can be characterized as action to ensure all population groups living within a targeted jurisdiction have access to the resources that promote and protect health. There appear to be several elements in program design that enhance health equity. These design elements include consideration of sociodemographic characteristics, understanding the evidence base for reducing health disparities, leveraging multisectoral collaboration, using clustered interventions, engaging communities, and conducting rigorous planning and evaluation.

Challenges and strategies in applying performance measurement to federal public health programs.

Performance measurement is widely accepted in public health as an important management tool supporting program improvement and accountability. However, several challenges impede developing and implementing performance measurement systems at the federal level, including the complexity of public health problems that reflect multiple determinants and involve outcomes that may take years to achieve, the decentralized and networked nature of public health program implementation, and the lack of reliable and consistent data sources and other issues related to measurement. All three of these challenges hinder the ability to attribute program results to specific public health program efforts.

Monitoring and evaluation in flour fortification programs: design and implementation considerations.

Designing and implementing effective monitoring and evaluation (M&E) is an integral element of wheat flour fortification programs. This review provides practical guidance for designing a M&E system for a flour fortification program. The Centers for Disease Control and Prevention's Framework for Program Evaluation in Public Health has been adapted to identify key issues in the development of an integrated M&E system.

The evaluation of comprehensive cancer control efforts: useful techniques and unique requirements.

This article discusses evaluation of comprehensive cancer control efforts as developed in the United States by involved partners at all levels -- community, regional, state, tribal, territorial, and national. Evaluation of comprehensive cancer control can concern the evaluation of a program, a plan or activities from a plan. In its development, it is grounded in both theory and practice, and the results are used in program development and implementation to document activities, inform decision making, and demonstrate accountability.

Building an academic-community partnership for increasing representation of minorities in the health professions.

We evaluated collaboration among academic and community partners in a program to recruit African American youth into the health professions. Six institutions of higher education, an urban school system, two community organizations, and two private enterprises became partners to create a health career pipeline for this population. The pipeline consisted of 14 subprograms designed to enrich academic science curricula, stimulate the interest of students in health careers, and facilitate entry into professional schools and other graduate-level educational programs.

Moving diabetes care from science to practice: the evolution of the National Diabetes Prevention and Control Program.

The National Diabetes Prevention and Control Program has a dynamic and evolving scientific foundation. This article describes this program and how seminal research studies provide an impetus for its public health policy and programs. The charge and challenges of integrating science into past, current, and future program designs are detailed, as are the program's accomplishments.

Key challenges and concepts in health risk communication: perspectives of agency practitioners.

The public demands that federal agencies provide information that is responsive to their fears and explains health risks clearly. In 1998 the Health Risk Communication Coordination Committee of the Agency for Toxic Substances and Disease Registry, a federal public health agency, conducted three focus groups with agency staff to identify current knowledge and understanding of health risk communication (HRC); HRC issues, problems, and best practices; and most appropriate HRC training content. The results indicate a need for clearer communications with communities, greater sensitivity to community concerns and fears, more balanced media coverage, and more accuracy in reporting, among other findings.

Private sector health care organizations and essential public health services: potential effects on the practice of local public health.

This article focuses on the activities of eight private health care organizations undertaking public health and prevention activities. Few activities were motivated by or integrated into the business or operating strategy of the organizations and poor integration with the business strategy puts the long-term future of these activities in jeopardy. The lack of integrated activity can be attributed to: slow pace of managed care implementation; low penetrance of full-risk capitated reimbursement; and fragmented, competitive health care markets.

Extragenital syphilitic chancres.

Two patients with extragenital chancres are presented to emphasize unusual expressions of primary syphilis. The clinical presentations and differential diagnosis of extragenital chancres are discussed.

Disuse contractures in a patient with tinea manuum and irritant contact dermatitis.

Disuse contractures are reported in a patient with tinea manuum and irritant contact dermatitis. The case is presented to alert the physician to the potential for this problem in any patient with a chronic fissured dermatosis of the hands.

Evaluation of the limulus amebocyte lysate assay for presumptive diagnosis of gonorrhea in men at a clinic for sexually transmitted diseases.

Specimens of urethral exudate from 200 men with uncomplicated urethritis were tested for Neisseria gonorrhoeae by the limulus amebocyte lysate assay, culture on modified Thayer-Martin medium, and gram-stained smear. As compared with cultures, the sensitivity and specificity of the limulus assay were 94.8% and 89.

Pseudomonas chromonychia.

The patient reported on herein presented with a greenish black great toenail. The discoloration was due to Pseudomonas aeruginosa. This report should alert the practitioner to the fact that Pseudomonas chromonychia may occasionally be mistaken for color changes produced by subungual hematomas, nevi, or malignant melanomas.

Becker's melanosis: an organoid hamartoma.

Herein we have reported the histologic findings in two cases of Becker's melanosis. In one patient the lesion showed hyperplasia or hair muscles and in the other patient the lesion was associated with an underlying neurofibroma. The proliferative changes seen in the epidermis and dermis in Becker's melanosis can best be explained by the concept of an organoid hamartoma with involvement of the epidermis, pilar structures, and some other dermal components.

Histologic findings in mummified skin.

Skin specimens from five mummies were examined histologically. The specimens ranged in age from 2,000 to 3,200 years. Material from two mummies had carbonized and showed only amorphous debris.

The signs and symptoms of secondary syphilis.

The signs and symptoms of 105 patients with secondary syphilis were evaluated in a clinic for treatment of sexually transmissible diseases. The symptoms were, in order of decreasing frequency, pruritus, 44 patients; sore throat, 16; headache, nine; muscle aches, nine; fever, five; meningismus, three; loss of scalp hair, three; loss of appetite, two; loss of weight, two; and visual disturbances, one. The dominant morphologic characteristics of the lesions, in order of decreasing frequency, were maculopapular, 73 patients; papular, 13; macular, 10; annular papular, six; papulopustular, two; and psoriasiform papular, one.

Enzymatic detection of Neisseria gonorrhoeae.

In a study using a non-serological enzymatic approach for the detection of Neisseria gonorrhoeae in cervical and urethral swabs, the technique was shown to be technically feasible. The enzyme, 1, 2-propanediol oxidoreductase, was used as a presumptive diagnostic marker for N gonorrhoeae. Enzymatic activity was measured with a fluorometer.

Psoriasis with tinea corporis.

The case report presented herein documents the unusual simulaneous occurrence of psoriasis and tinea corporis in a patient and reviews the diagnostic and therapeutic problems that arose during the treatment of these two morphologically similar papulosquamous diseases. The report emphasizes the need for careful re-evaluation of patients who have atypical response to therapy.