Optimizing the review process of food additive and GRAS petitions. Overview of the workshop.
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Food Additives↗
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Results for “Health Planning Guidelines”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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How many neurosurgeons do we want to educate in Europe annually? The Danish proposal.
The neurosurgical population consists of professors, consultants, specialised senior registrars, and doctors in training (senior registrars, trainees and young doctors to be educated as neurosurgeons). Knowing number and size of the neurosurgical departments in each European country, the number of staff members, the politics of retirement (age, educational level) and the age of every neurosurgeon it is possible to calculate the exact number of trainees needed per year to maintain a state of balance in every single European country. With Denmark as a model we based our assessments partly on a simple calculation model of the exact annual number of neurosurgical trainees or senior registrars and partly used an actuary flow model for calculation. In Denmark with 5 neurosurgical departments, 5.2 mill. population and a retirement age of 70, we have an average of 1-2 newcomers per year and maintain a bulk of 10 senior registrars in education. Thus there will be a balance between intake of newcomers and retirement, of course with some unknown factors as unforeseen dismissal or resignation, death rate among neurosurgeons and transfer to private practice.
Adult↗
[The resources of the social network of single person households during acute illness. Basic data for home care planning in an influenza epidemic].
UNLABELLED: 230 single persons living in the city of Zurich, 60% aged 18-45, 10% 45-65 and 22% older than 64 years; 70% males were subject to an enquiry. The questioned persons mostly live in two-room-apartments, on average for 11 years, they are single for 8.5 years on average. Solely 5.4% have no living relatives but 32% see them only irregularly (same for all age groups) and 4% are not persistently in touch with friends or acquaintances. 36% were needing help in the past because of sickness or accident. They got it from neighbours (38%), friends, acquaintances (36%), family members (17%) and from home care organisations (9%). In case of a heavy wave of influenza only 14% would not help their neighbours, they would help an average of four neighbours but also they would surely not help four neighbours. The answering persons know 23 singles (= 10%) who presumably would not get any help and 20 (= 9%) who would decline help. 90% of the questioned persons believe, that they would get help by family members or friends, even if those live far away, but still 29% expect help from home care organisations, of the questioned over 64 years old even 52%. CONCLUSION: 10-30% of city singles need help in form of home care in case of an acute illness like heavy influenza.
Adolescent↗
A joint effort in the field of environment and health.
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Environmental Health↗
The case against mandatory newborn screening for HIV antibodies.
The paper examines the controversy surrounding legislative proposals in New York State that would require amending the public health law's stringent confidentiality provisions; the legislation calls for "unblinding" the results of a 7-year old statewide HIV seroprevalence study that tests newborns for HIV antibodies in order to track the incidence of HIV infection among parturient women. The pivotal point is made that mandatory disclosure of the test results is tantamount to mandatory testing of the mother, since presence (or absence) of HIV antibodies conclusively reveals the mother's HIV status. The author presents the history of the epidemiological study and documents the ongoing discussion of mandatory testing, within the medical, bioethical and public health community. Citing numerous papers, including the report of the Subcommittee on Newborn Screening of the New York State AIDS Advisory Council, the author--a member of both the council and its subcommittee--argues against the principle of mandatory testing in general and "unblinding" of the seroprevalence survey in particular. Besides making a strong argument from the ethical viewpoint, the paper provides ample medical data to support the argument that mandatory testing of newborns is poor public health policy that would be essentially ineffectual in the effort to stem the spread of HIV.
Advisory Committees↗
Consideration of special populations in the drug treatment system of a large metropolitan area.
This article provides a descriptive overview of the characteristics of a large metropolitan drug treatment system in relation to special populations of substance abusers enrolled in the system and the services provided. The findings are based on self-report responses to a comprehensive survey of 294 drug treatment programs in Los Angeles County. The special populations are grouped by health status, ethnic background, language needs, and gender-related needs. The groups are not mutually exclusive. Survey results indicated a generally high proportion of programs capable of meeting the unique needs of a variety of special population clients and most programs having some mix of special population clients in their current caseload. The types of services offered varied by modality and by special populations being served. Implications for program planning and service delivery include consideration of whether or not to offer specialized programs for unique client types.
Adolescent↗
Health of the public: An academic challenge.
Academic medicine has contributed to the successes of the U.S. health care system, including excellence in biomedical research, extensive dissemination and use of medical technologies, lowered death rates for heart disease and stroke, and decreased rates of cigarette smoking. However, its substantial degree of public support and its central social role mandate that it become more involved in improving the health of the public. Relevant problems include poor health status and disproportionately high expenditures for medical care, inappropriate mix and distribution of medical manpower, and insufficient attention to chronic illness and disability. To help address these problems, Health of the Public, funded jointly by the Pew Charitable Trusts and the Rockefeller Foundation, has established programs in six academic health centers: Columbia; Johns Hopkins; Tufts; and the Universities of New Mexico, North Carolina, and Washington. These programs support population-based education for medical students and residents, research and training in clinical prevention, and reorientation of senior faculty members toward population-based concepts.
Academic Medical Centers↗
Australia's population growth, composition and distribution: emerging research needs.
"In 1993 the charter of the [Australia] Bureau of Immigration Research (BIR) was widened to encompass other areas of population and its name changed to the Bureau of Immigration and Population Research (BIPR).... The aim of this paper is to identify some emerging research needs in the area of Australia's population growth, composition and distribution that the BIPR might profitably address.... The paper attempts to put forward some issues which the writer believes are important gaps in our present knowledge regarding the growth, composition and distribution of Australia's population."
Australia↗
Deprivation: different implications for forensic psychiatric need in urban and rural areas.
BACKGROUND: Ecological relationships between deprivation and forensic psychiatric admission rates may differ in urban and rural areas. AIMS: The aim of the study was to compare the relationship between material deprivation and forensic admission rates in rural and urban areas for a whole-national service in Ireland over a 3-year period. METHOD: All Irish forensic admissions from 1997 to 1999 were allocated to the appropriate small area. Material deprivation scores were calculated from census data. Mean annual admission rates and Bayesian standardised forensic admission ratios for small areas were aggregated by material deprivation score and population density. RESULTS: At small area level, there were significant non-linear increases in forensic admissions with increasing deprivation. The increases in urban areas (population density >10/hectare) were absent in less densely populated areas. CONCLUSIONS: Deprivation alone may not be the key factor in predicting forensic service utilisation. Factors associated with specifically urban deprived areas may be of greater relevance in planning services.
Adolescent↗
Norms for mental health services in South Africa.
BACKGROUND: In the aftermath of apartheid, South Africa has inherited a fragmented, under-resourced and inequitable public sector mental health service. Attempts are being made to reform mental health services, in keeping with new health policy, which proposes the downscaling of psychiatric institutions and the development of community-based services. This study set out to develop a set of service norms for the care of people with severe psychiatric conditions (SPC) in South Africa, to assist the implementation of the new policy. METHODS: A national situation analysis of current public sector mental health services was conducted. A model was developed for estimating the mental health service resource needs of people with SPC. Following consultation with provincial stakeholders, a set of service norms were developed taking into account national indicators from the situation analysis (as a baseline level) and proposals of the model (as a target level). RESULTS: The study recommends an increase in the number of acute psychiatric beds in general hospitals; development of community-based residential care; redistribution of staff from hospital to community services, particularly in rural areas; and the development of information systems to monitor the transitions to community-based care. CONCLUSIONS: The norms proposals presented in this study express mental health service needs in terms of quantifiable service resource and utilisation levels. In doing so, the study attempts to make explicit the assumptions and values on which planning is based.
Community Mental Health Services↗
The President's New Freedom Commission: capitalizing on opportunities to advance school-based mental health services.
The report from President George W. Bush's New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission's recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.
Advisory Committees↗
Deficit Reduction Act of 2005 and its adverse impact on medicare beneficiary access to positron emission tomography.
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General Surgery↗
From preventive policy to preventive practice.
Characteristics of the relationship of preventive policy to preventive practice are reviewed. The relatively low emphasis on prevention compared with treatment programs is discussed and the particular problem of the "anonymity" of prevention is defined. Prevention programs suffer in part because of the lack of identity of the specific individuals benefited. Examples from the cardiovascular diseases are used to illustrate the general points. The contrast between community- and patient-oriented prevention is important. Adequate levels of disease prevention and health promotion will never be attained one case at a time. Interactions among individuals are determinants of environmental behavioral factors relevant to health. The policy forming process is intrinsically interactive in nature. The Institute of Medicine's 1988 study of the future of public health is reviewed with respect to its emphasis on professional participation in the health policy process. Prevention is an essentially multidisciplinary area requiring the participation of many professions and disciplines. This property of prevention will be enhanced in the future. Ten principles which can be useful in translating preventive policy into preventive practice are presented.
Cardiovascular Diseases↗
Tobacco-use reduction among high-risk youth: recommendations of a National Cancer Institute Expert Advisory Panel.
The National Cancer Institute's efforts to prevent tobacco-related cancers have resulted in numerous activities to reduce smoking prevalence throughout the United States. Two decades of research activity has provided much of the information needed for interventions through channels such as mass media, physician/dentist training, self-help strategies, and school-based prevention programs. However, in the area of adolescent tobacco-use reduction, it has been consistently observed that youth who have the highest tobacco-use rates are among those least likely to be reached through school-based or other programs. Thus, these youth, often labeled "high-risk," are seen as a cornerstone for tobacco use prevention efforts. Although they pose a particularly difficult access problem, many valuable recommendations for strategies to identify and reach this group were made by a recent NCI-convened Expert Advisory Panel on the Prevention and Cessation of Tobacco Use by High-Risk Youth. The Panel considered this issue from three perspectives--methods of identifying these youth, strategies for reaching them with appropriate tobacco-use prevention/cessation programs, and identification of research needs. Their recommendations and conclusions are summarized in this article. Support for research addressing the prevention and cessation of tobacco use among high-risk youth is currently being considered by the NCI.
Adolescent↗
Supply projections as planning: a critical review of forecasting net physician requirements in Canada.
This study involves a critical review of the current methods used to establish net future physician manpower requirements in Canada. The paper explores specific examples of physician manpower forecasting in Canada, and contrasts them with an extensive U.S. exercise completed recently. The conceptual and measurement difficulties inherent in the Canadian methodology are outlined. Particular attention is paid to the various factors that can potentially influence physician requirements but which are omitted from consideration in traditional forecasting. The paper concludes with a discussion of the definition of 'need' in the context of physician requirements.
Canada↗
Community satisfaction with primary health care services: an evaluation undertaken in the Morogoro region of Tanzania.
Satisfaction is an important element of the quality of health care, often determining patient willingness to comply with treatment and influencing the effectiveness of care. However, few specific assessments of patient satisfaction in developing countries have been undertaken. This paper presents findings from such a study, carried out in Tanzania and primarily undertaken through the use of qualitative interviewing techniques. The study illustrates the perceived problems of the care available, such as structural and inter-personal skill failings, both of which were seen to influence drug availability and maternal services--key weaknesses of the available care. Health centres were perceived to be little better than dispensaries. Although church health care was generally perceived to be better than government care, there was considerable variation in community judgements and clear signs of poor quality church care. The use of villagers' own words and experiences brought into sharp focus the problems they experience in relation to health care and allow planning lessons are identified.
Adult↗
Defining localities for health planning: a GIS approach.
The National Health Service in Britain is undergoing far-reaching changes. While District and Regional Health Authorities are currently merging, professionals agree that primary health care is most efficiently managed at the local level. This paper uses geographical information systems (GIS) capabilities to identify a nested hierarchy of localities for the management of primary health care in West Sussex, England. GIS coverages were developed which contained key criteria for defining local areas, including nodes or focal points of service provision, edges which act as physical or psychological barriers to movement, districts such as official administrative areas and interaction criteria such as journey to work, school and family doctor (GP) surgeries. Central to the derivation of the localities was a large matrix of patient to GP flows based on postcoded data. Once managed, these data revealed clear geographical patterns of patient to GP allegiance. A large-scale field survey obtained supporting information on the perception of areas from local residents.
Catchment Area, Health↗
Restructuring long-term care and the geography of ageing: a view from rural New Zealand.
This paper examines the major points of contact between the restructuring of long-term care and the evolving geography of the elderly in the Waikato, one of New Zealand's agricultural heartlands. The time frame of the study is 1981-91, a decade in which new Zealand embarked on a sweeping program of service restructuring and privatization. Comparative analysis of data on the evolving distribution of the elderly and on the shifting supply of long-term care beds reveals that restructuring has sharpened contrasts between urban and rural contexts for ageing. Almost all the urban centres in the Waikato benefited from an expansion of long-term care driven by private-sector initiatives, while rural communities suffered a broad-based depletion of services. However, the data indicate that, contrary to the trend in long-term care, more older elderly people (defined as those aged 80 or older) are "staying on' in rural communities. The paper concludes with a consideration of emergent policy issues; we speculate that it through the aggregate outcomes of decisions to "stay on' that the personal troubles of the elderly residents of service-depleted communities may yet become an important policy issue in rural New Zealand.
Aged↗