RESUMEN
Widespread, convenient access to COVID-19 testing has been challenging in the United States. We make a case for provisioning COVID-19 tests through the United States Postal Service (USPS) facilities and demonstrate a simple method for selecting locations to improve access. We provide quantitative evidence that even a subset of USPS facilities could provide broad access, particularly in remote and at-risk communities with limited access to health care. Based on daily travel surveys, census data, locations of USPS facilities, and an established care-seeking model, we estimate that more than 94% of the US population would be willing to travel to an existing USPS facility if warranted. For half of the US population, this would require traveling less than 2.5 miles from home; for 90%, the distance would be less than 7 miles. In Georgia, Illinois, and Minnesota, we estimate that testing at USPS facilities would provide access to an additional 4.1, 3.1, and 1.3 million people and reduce the median travel distance by 3.0, 0.8, and 1.2 miles, respectively, compared with existing testing sites per 28 July 2020. We also discuss the option of distributing test-at-home kits via USPS instead of private carriers. Finally, our proposal provides USPS an opportunity to increase revenues and expand its mission, thus improving its future prospects and relevance.
Asunto(s)
Prueba de COVID-19 , Servicios Postales/organización & administración , COVID-19/diagnóstico , Accesibilidad a los Servicios de Salud , Humanos , Población Rural , SARS-CoV-2 , Estados UnidosRESUMEN
BACKGROUND: Guidelines recommend walking to increase moderate to vigorous physical activity (MVPA) for health benefits. OBJECTIVES: To assess the effectiveness, cost-effectiveness and acceptability of a pedometer-based walking intervention in inactive adults, delivered postally or through dedicated practice nurse physical activity (PA) consultations. DESIGN: Parallel three-arm trial, cluster randomised by household. SETTING: Seven London-based general practices. PARTICIPANTS: A total of 11,015 people without PA contraindications, aged 45-75 years, randomly selected from practices, were invited. A total of 6399 people were non-responders, and 548 people self-reporting achieving PA guidelines were excluded. A total of 1023 people from 922 households were randomised to usual care (n = 338), postal intervention (n = 339) or nurse support (n = 346). The recruitment rate was 10% (1023/10,467). A total of 956 participants (93%) provided outcome data. INTERVENTIONS: Intervention groups received pedometers, 12-week walking programmes advising participants to gradually add '3000 steps in 30 minutes' most days weekly and PA diaries. The nurse group was offered three dedicated PA consultations. MAIN OUTCOME MEASURES: The primary and main secondary outcomes were changes from baseline to 12 months in average daily step counts and time in MVPA (in ≥ 10-minute bouts), respectively, from 7-day accelerometry. Individual resource-use data informed the within-trial economic evaluation and the Markov model for simulating long-term cost-effectiveness. Qualitative evaluations assessed nurse and participant views. A 3-year follow-up was conducted. RESULTS: Baseline average daily step count was 7479 [standard deviation (SD) 2671], average minutes per week in MVPA bouts was 94 minutes (SD 102 minutes) for those randomised. PA increased significantly at 12 months in both intervention groups compared with the control group, with no difference between interventions; additional steps per day were 642 steps [95% confidence interval (CI) 329 to 955 steps] for the postal group and 677 steps (95% CI 365 to 989 steps) for nurse support, and additional MVPA in bouts (minutes per week) was 33 minutes per week (95% CI 17 to 49 minutes per week) for the postal group and 35 minutes per week (95% CI 19 to 51 minutes per week) for nurse support. Intervention groups showed no increase in adverse events. Incremental cost per step was 19p and £3.61 per minute in a ≥ 10-minute MVPA bout for nurse support, whereas the postal group took more steps and cost less than the control group. The postal group had a 50% chance of being cost-effective at a £20,000 per quality-adjusted life-year (QALY) threshold within 1 year and had both lower costs [-£11M (95% CI -£12M to -£10M) per 100,000 population] and more QALYs [759 QALYs gained (95% CI 400 to 1247 QALYs)] than the nurse support and control groups in the long term. Participants and nurses found the interventions acceptable and enjoyable. Three-year follow-up data showed persistent intervention effects (nurse support plus postal vs. control) on steps per day [648 steps (95% CI 272 to 1024 steps)] and MVPA bouts [26 minutes per week (95% CI 8 to 44 minutes per week)]. LIMITATIONS: The 10% recruitment level, with lower levels in Asian and socioeconomically deprived participants, limits the generalisability of the findings. Assessors were unmasked to the group. CONCLUSIONS: A primary care pedometer-based walking intervention in 45- to 75-year-olds increased 12-month step counts by around one-tenth, and time in MVPA bouts by around one-third, with similar effects for the nurse support and postal groups, and persistent 3-year effects. The postal intervention provides cost-effective, long-term quality-of-life benefits. A primary care pedometer intervention delivered by post could help address the public health physical inactivity challenge. FUTURE WORK: Exploring different recruitment strategies to increase uptake. Integrating the Pedometer And Consultation Evaluation-UP (PACE-UP) trial with evolving PA monitoring technologies. TRIAL REGISTRATION: Current Controlled Trials ISRCTN98538934. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 37. See the NIHR Journals Library website for further project information.
Asunto(s)
Promoción de la Salud/organización & administración , Enfermeras y Enfermeros/organización & administración , Servicios Postales/organización & administración , Atención Primaria de Salud/organización & administración , Caminata/fisiología , Actigrafía , Factores de Edad , Anciano , Índice de Masa Corporal , Pesos y Medidas Corporales , Análisis Costo-Beneficio , Femenino , Promoción de la Salud/economía , Humanos , Londres , Masculino , Cadenas de Markov , Salud Mental , Persona de Mediana Edad , Enfermeras y Enfermeros/economía , Servicios Postales/economía , Atención Primaria de Salud/economía , Evaluación de Programas y Proyectos de Salud , Años de Vida Ajustados por Calidad de Vida , Grupos Raciales , Características de la Residencia , Autoeficacia , Factores Sexuales , Factores Socioeconómicos , Caminata/psicologíaRESUMEN
Direct-to-consumer personalized genomic medicine has recently grown into a small industry that sells mail-order DNA sample kits and then provides disease risk assessments, typically based upon results from genome-trait association studies. The companies selling these services have been largely exempted from FDA regulation in the United States. Testing kit companies and their supporters have defended the industry's unregulated status using two arguments. First, defenders have argued that mere absence of harm is all that must be proved for mail-order tests to be acceptable. Second, defenders of mail-order testing have argued that there is an individual right to the tests' information. This article rebuts these arguments. The article demonstrates that the direct-to-consumer market has resulted in the sidelining of clinical utility (medical value to patients), leading to the development of certain mail-order tests that do not promote customers' interests and to defenders' downplaying of a potentially damaging empirical study of mail-order genomic testing's effects on consumers. The article also shows that the notion of an individual right to these tests rests on a flawed reading of the key service provided by mail-order companies, which is the provision of medical interpretations, not simply genetic information. Absent these two justifications, there is no reason to exempt direct-to-consumer personalized genomic medicine from stringent federal oversight.
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Pruebas Genéticas/estadística & datos numéricos , Servicios Postales/ética , Medicina de Precisión/estadística & datos numéricos , Comportamiento del Consumidor , Pruebas Genéticas/legislación & jurisprudencia , Pruebas Genéticas/métodos , Genoma Humano , Humanos , Derechos del Paciente/legislación & jurisprudencia , Servicios Postales/organización & administración , Valor Predictivo de las Pruebas , Factores de Riesgo , Estados Unidos , United States Food and Drug AdministrationRESUMEN
The anthrax attacks of 2001 created risk communication problems that cannot be fully understood without appreciating the dynamics among organizations. Case studies of communication in New Jersey, consisting of interviews with a range of participants, found that existing organizational and professional networks facilitated trust among decisionmakers. This interpersonal trust improved communication among agencies and thereby risk communication with the public. For example, "white powder scares" were a problem even in places without contamination. Professionals' trust in each other was vital for responding productively. Conversely, organizational challenges, including conflict among agencies, hindered communication with key audiences. Although centralization and increased control are often seen as the remedy for communicative confusion, they also can quash the improvisational responses needed during crises.
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Carbunco/epidemiología , Bioterrorismo/psicología , Comunicación , Toma de Decisiones en la Organización , Relaciones Interinstitucionales , Administración en Salud Pública , Medición de Riesgo , Carbunco/microbiología , Carbunco/prevención & control , Carbunco/psicología , Bacillus anthracis/patogenicidad , Correspondencia como Asunto , Miedo , Conocimientos, Actitudes y Práctica en Salud , Humanos , Comunicación Interdisciplinaria , Entrevistas como Asunto , New Jersey , Estudios de Casos Organizacionales , Innovación Organizacional , Servicios Postales/organización & administración , Confianza , Estados UnidosRESUMEN
Shared (Induced) Delusional Disorder commonly occurs in close relationships and involves a varying number of participants who may be nonconsanguineous. The disorder has been associated with forensic and fatal consequences. Its occurrence in three nonrelated, incarcerated individuals is described in this article. This case of folie à trois has forensic implications and raises several questions of ethics that relate to autonomy, confidentiality, safety, and risk estimation. The presentation, management, and outcome of the patients suggest that a high index of suspicion is needed to detect cases in similar settings. The report concludes that the rarity of the disorder in a forensic mental health population may be the result of underdetection, given that conditions are conducive to the development of the disorder. Telltale signs of its manifestation are hypothesized as being responsible for some events in incarcerated populations. Physical separation and antipsychotic medications remain the mainstay of treatment.
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Confidencialidad/ética , Psiquiatría Forense , Servicios de Salud Mental/organización & administración , Servicios Postales/organización & administración , Prisioneros/psicología , Prisiones/legislación & jurisprudencia , Trastorno Paranoide Compartido/diagnóstico , Adulto , Terapia Combinada , Confidencialidad/normas , Psiquiatría Forense/ética , Humanos , Masculino , Servicios de Salud Mental/ética , Servicios de Salud Mental/estadística & datos numéricos , Servicios Postales/ética , Servicios Postales/métodos , Prisioneros/legislación & jurisprudencia , Prisiones/estadística & datos numéricos , Saskatchewan , Trastorno Paranoide Compartido/psicología , Trastorno Paranoide Compartido/terapia , Medio SocialRESUMEN
BACKGROUND: Online cancer-related support is an under-studied resource that may serve an important function in the information seeking, care, and support of cancer patients and their families. With over 9.8 million cancer survivors (defined as anyone living with cancer) in the United States alone and the number growing worldwide, it is important to understand how they seek and use online resources to obtain the information they need, when they need it, and in a form and manner appropriate to them. These are stated cancer communication goals of the US National Cancer Institute. OBJECTIVES: Our purposes are to (1) present background information about online mailing lists and electronic support groups, (2) describe the rationale and methodology for the Health eCommunities (HeC) study, and (3) present preliminary baseline data on new subscribers to cancer-related mailing lists. In particular, we describe subscribers' use of mailing lists, their reasons for using them, and their reactions to participating shortly after joining the lists. METHODS: From April to August 2004, we invited all new subscribers to 10 Association of Cancer Online Resources mailing lists to complete Web-based surveys. We analyzed baseline data from the respondents to examine their perceptions about cancer-related mailing lists and to describe how cancer patients and survivors used these lists in the period shortly after joining them. RESULTS: Cumulative email invitations were sent to 1368 new mailing list subscribers; 293 Web surveys were completed within the allotted time frame (21.4% response rate). Most respondents were over age 50 (n = 203, 72%), white (n = 286, 98%), college graduates (n = 161, 55%), and had health insurance (n = 283, 97%). About 41% (n = 116) of new subscribers reported spending 1 to 3 hours per day reading and responding to list messages. They used the mailing lists for several reasons. Among the most frequently reported, 62% (n = 179) strongly agreed they used mailing lists to obtain information on how to deal with cancer, 42% (n = 121) strongly agreed they used mailing lists for support, and 37% (n = 109) strongly agreed that they were on the mailing lists to help others. Smaller proportions of new subscribers strongly agreed that others on the mailing lists had similar cancer experiences (n = 23, 9%), that they could relate to the experiences of others on the lists (n = 66, 27%), and that others on the list gave them good ideas about how to cope with cancer (n = 66, 27%). CONCLUSIONS: Cancer-related online mailing lists appear to be an important resource, especially for information seeking but also for support of cancer survivors. These were the primary motivators most members reported for joining mailing lists. The modest proportion of subscribers who strongly agreed that they could relate to others' cancer experiences (as well as similar responses to other process questions) is undoubtedly due at least in part to the short duration that these subscribers were involved with the mailing lists. Emerging data, including our own, suggest that mailing lists are perhaps under-used by minority patients/survivors. These preliminary data add to a growing body of research on health-related online communities, of which online mailing lists are one variant.
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Internet , Neoplasias , Sistemas en Línea , Servicios Postales/organización & administración , Personal de Salud , Encuestas Epidemiológicas , Humanos , Internet/estadística & datos numéricos , Neoplasias/terapia , Reproducibilidad de los Resultados , Listas de EsperaRESUMEN
It is an interesting detail of the present reform of national public health service in Germany that mail-order and internet pharmacies will be founded in future as new (e-commerce) business models. Main points of conceivable business systems can be characterised as well as critical success factors. No potential participant can ever have all the necessary resources and competences to implement a competitive business system without external support. This is why cooperation seems to be a useful tool for competence management. The Resource-based View will serve as theoretical background for analysis. The required and available competences of conceivable players can be identified. Features of resources can be described that recommend special types of cooperation with the intention of establishing and operate a business system. Especially German and international pharmaceutical wholesalers can be identified as conceivable "parents" of mail-order pharmacies in the future.
Asunto(s)
Internet , Servicios Farmacéuticos/organización & administración , Servicios Postales/organización & administración , Difusión de Innovaciones , Alemania , Modelos Organizacionales , Innovación OrganizacionalAsunto(s)
Carbunco/prevención & control , Toma de Decisiones , Exposición a Riesgos Ambientales/prevención & control , Salud Ambiental , Política de Salud , Formulación de Políticas , Servicios Postales/organización & administración , Carbunco/transmisión , Vacunas contra el Carbunco/administración & dosificación , Vacunas contra el Carbunco/efectos adversos , Bioterrorismo , Infección Hospitalaria/prevención & control , Infección Hospitalaria/transmisión , Humanos , Medición de Riesgo , Valores Sociales , Valores Limites del Umbral , Incertidumbre , Estados Unidos , Recursos HumanosRESUMEN
An organizational change among 82 postal workers was studied with the aim of evaluating the effects on the work environment, work ability, and musculoskeletal complaints. The study was undertaken in 2 suburbs of Stockholm, Sweden. Psychological work demands were estimated to be reduced at the 1-year follow-up but physical work demands had changed very little. In an observation study in a subgroup of older workers, the risk of overexertion at work and musculoskeletal complaints was reduced. In spite of that, most of the older participants (>/=35 years) had unchanged or increased musculoskeletal symptoms. This shows the need for early preventive measures.
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Ergonomía , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/prevención & control , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Salud Laboral , Servicios Postales/organización & administración , Simplificación del Trabajo , Lugar de Trabajo/organización & administración , Adulto , Distribución por Edad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Innovación Organizacional , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo , Encuestas y Cuestionarios , SueciaAsunto(s)
Neoplasias de la Mama/terapia , Tamizaje Masivo , Filatelia , Servicios Postales , Neoplasias de la Próstata/diagnóstico , Apoyo a la Investigación como Asunto , Femenino , Política de Salud , Promoción de la Salud , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Maniobras Políticas , Masculino , Filatelia/economía , Filatelia/historia , Filatelia/legislación & jurisprudencia , Servicios Postales/historia , Servicios Postales/legislación & jurisprudencia , Servicios Postales/organización & administración , Estados UnidosRESUMEN
Increased employee control and participation are recommended to achieve both "flexible organization" and improvements in health, as outlined in occupational stress intervention models. This study evaluates the impact of a participatory organizational intervention on job stress and job characteristics. The intervention was carried out in two post offices in the Norwegian Postal Service. "Local theories" were seen as the key drivers for organizational improvement and increased control. The underlying dynamics of the intervention were to manipulate employees' learning opportunity and decision authority so as to improve work environment and health. Work groups, in dialogue with a steering committee, conducted diagnosis, action planning, and action taking. Work conditions deteriorated during the observation period in the control groups. In one of the intervention groups, this negative trend was reduced by the intervention. Lack of positive results in the other intervention group may have been due to organizational restructuring and turbulence.