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PubMedDate not supplied

Main-streaming NFP into the Department of Health of the Philippines: opportunities and challenges.

In 1994, the Department of Health (DOH) of the Philippines issued a circular which reaffirmed natural family planning (NFP) as one of the basic services to be offered in all government family planning service sites and urged family planning workers to develop competence in teaching NFP methods. Although the circular represented a major policy breakthrough for the main-streaming of NFP it found the department without the capability or experience to directly provide NFP services. The two approaches the department is taking to respond to this new policy initiative are described in this paper. The selection of these approaches was influenced by the devolution of central government authority to local government units. The approaches include developing department capability in NFP training, service provision and service installation and creating a supportive program and policy environment. DOH partnership with an NFP non-government organization (NGO) has been critical in developing NFP capability within the government sector, particularly in NFP training and service installation.

Family Planning Services↗
PubMed1952

Medical care and public health services.

Medical care applies to the individual, and public health to the community. One is the concentrated application of diagnosis and treatment for the life, the comfort of a patient, and includes guidance in health as for motherhood, infancy, childhood and old age. Public health services, provided by the community through its local government and the local department of health, are concerned with the prevention of diseases of all kinds. Some are controlled by sanitary authority, but the majority of preventable diseases are dealt with by public health education. It is not the function of the health department to treat the sick. The family physicians, the hospitals and dispensaries provide for medical care. Medical care of the sick and public health protection are two parallel activities to make use of medical science, one for treatment, the other for prevention of disease.

Delivery of Health Care↗
PubMed2000

Asbestos worker protection. Environmental Protection Agency (EPA). Final rule.

In this Final Rule, EPA is amending both the Asbestos Worker Protection Rule (WPR) and the Asbestos-in-Schools Rule. The WPR amendment protects State and local government employees from the health risks of exposure to asbestos to the same extent as private sector workers by adopting for these employees the Asbestos Standards of the Occupational Safety and Health Administration (OSHA). The WPR's coverage is extended to State and local government employees who are performing construction work, custodial work, and automotive brake and clutch repair work. This final rule cross-references the OSHA Asbestos Standards for Construction and for General Industry, so that future amendments to these OSHA standards are directly and equally effective for employees covered by the WPR. EPA also amends the Asbestos-in-Schools Rule to provide coverage under the WPR for employees of public local education agencies who perform operations, maintenance, and repair activities. EPA is issuing this final rule under section 6 of the Toxic Substances Control Act (TSCA).

Asbestos↗
PubMedDate not supplied

[Traffic accidents: a qualitative approach from Campinas, São Paulo, Brazil].

This article takes an interdisciplinary qualitative approach to the problem of traffic accidents in Campinas, São Paulo, Brazil. The authors begin by analyzing the "municipalization" (i.e., decentralization to the municipal level) of transport and traffic management in Campinas based on social representations by members of the local government's technical staff. Data demonstrate a significant drop in traffic accident mortality in Campinas in the last ten years. The findings illustrate how new transport and traffic policies had several positive effects. Special attention is given to the objectives, strategies, and obstacles dealt with by local government in the "municipalization" of traffic. The paper concludes by emphasizing the need for specific public policies to revitalize urban mass transportation, including special traffic safety educational programs.

Accidents, Traffic↗
PubMed1979

Intergovernmental issues raised by the national health planning program.

Raab uses the National Health Planning and Resources Development Act of 1974(P.L.93-641)which designated state and substate regional planning agencies, as a departure for discussion of a larger issue: federalism. Administration of the law has raised issues about the allocation of power among national, state and local governments. The author tries to set this question in historical context by tracing the history of U.S. intergovernmental relations and highlighting key issues. He focuses on two perspectives of federalism: cooperative and competitive relations between governments. From this survey, Raab draws three conclusions: conflict has become "inevitable" as governments pursue their own objectives in administering national grants-in-aid; state and local officials have grown more concerned with administrative structure than the substance of policy; and the growth of lobbies for state and local governments has reduced the prospect of conflict.

Conflict, Psychological↗
PubMed1992

Census adjustment and the distribution of federal spending.

In 1989, programs that use population counts to determine the distribution of their funds transferred $236 per capita to state and local governments. If the 1990 census were adjusted to reflect undercounting, about 40% of state and local governments would receive increased grants averaging $56 per miscounted person; other jurisdictions would lose an almost equal amount of grant money. The surprisingly small reallocations arise because 1) total funds allocated by population are essentially fixed; 2) allocations depend on other factors in addition to population; and 3) programs vary as to whether they allocate funds in direct or inverse proportion to population.

Community Health Services↗
PubMed2003

Patterns and characteristics of ambulance attendance at heroin overdose at a local-area level in Melbourne, Australia: implications for service provision.

The monitoring of heroin use and related harms is undertaken in Australia with a view to inform policy responses. Some surveillance data on heroin-related harms is well suited to inform the planning and delivery of heroin-related services, such as needle and syringe provision. This article examines local-area variation in the characteristics of nonfatal heroin overdoses attended by ambulances in Melbourne over the period June 1998 to October 2000 to inform the delivery of services to the heroin-using population in Melbourne. Five so-called hot spot local government areas were considered in relation to the remainder of the Melbourne metropolitan area. Significant local-area variations in the characteristics of nonfatal heroin overdoses were evident over the study period, including the number of heroin overdoses, the age and sex of the people attended, the time of the attendance, the likelihood of hospitalization, and the likelihood of police coattendance. The implications of the findings are discussed in terms of service provision (e.g., opening hours) within the five hot spot local government areas, and it is argued that the analyses undertaken could easily be applied to other jurisdictions for which comparable data are available.

Adolescent↗
PubMed1998

Preemption or prevention?: lessons from efforts to control firearms, alcohol, and tobacco.

The judicial doctrine of preemption allows federal or state governments to restrict the ability of state or local governments, respectively, to regulate in a given area. Industries whose products create substantial public health risks have begun to promote preemptive legislation which prevents the lower levels of government from adopting strong public health protections. This article discusses the implications of preemptive legislation concerning three of the most harmful products available in America: tobacco, firearms and alcohol. These examples illustrate the potential danger that preemptive legislation poses to efforts to prevent illness, injury and death caused by these products.

Alcoholic Beverages↗
PubMed1995

Knowledge, attitude and practice of family planning in rural communities in Nigeria.

Maternal and infant mortality rates, coupled with a high population growth rate, are unacceptably high in Nigeria. More recently, the Nigerian government endorsed the promotion of reproductive health, including family planning, through maternal and child health services. The Ohaozara Local Government Area (LGA) introduced a Five-Year Action Plan (FYAP) in 1989. To appraise the Ohaozara Five-Year Action Plan, 600 persons stratified by geographical location and sex were interviewed in three randomly selected autonomous communities in the Ohaozara Local Government Area to determine their knowledge, attitude and practice (KAP). The findings in this study showed a high awareness level with a moderately positive attitude and generally low level of practice. Comprehensive reproductive health education (RHE), budgetary increase, evaluation of FYAP, and program coordination are recommended.

Adult↗
PubMed1975

The purpose of occupational medicine.

The purposes of occupational medicine are described in terms of its clinical medical, environmental medical, research, and administrative content. Each of these components is essential in different proportions in comprehensive occupational health services for different industries, and can only be satisfactorily provided by occupational physicians and occupational health nurses who are an integral part of their organizations. Two-thirds of the working population in the United Kingdom are without the benefits of occupational medicine. The reorganization of the National Health Service and of local government presents the opportunity to extend occupational health services to many more workers who need them. It is suggested that area health authorities should provide occupational health services for all National Health Service staff and, on an agency basis, for local government and associated services, eventually extending to local industry. Such area health authority based services, merged with the Employment Medical Advisory Service, could conveniently then be part of the National Health Service, as recommended by the British Medical Association, the Society of Occupational Medicine, and the Medical Services Review Committee.

Environmental Health↗
PubMed1989

Public and private immunisation services: a comparison of costs.

Cost inputs to infant immunisation programs were identified for both the public and private health systems, based on data from the fourteen local government areas which made up the Western Metropolitan Health Region in Sydney, New South Wales. The public health approach is shown to be significantly less costly than private immunisation services. The costs of the latter, however, are largely hidden within the national health bill, while the costs of the former are spread across all three levels of government. Total public sector costs of immunisation could be decreased, but only with increased input at the local government level. Thus, under present distribution and funding arrangements in NSW, covert fostering of the less cost efficient private immunisation services is likely to continue.

Child↗
PubMed1999

Income inequality and mortality in England.

BACKGROUND: Despite the increasing evidence that income inequality causes reductions in life expectancy in developed countries, this relationship has not been explored in the United Kingdom, where local income data are not routinely available. We have surmounted this problem by employing an ecological design which applies national income data to local mortality and occupational data. METHODS: This ecological, cross-sectional study used 1991 mortality and Census data on the 366 English local government districts, and 1991 New Earnings Survey data for England, to determine the independent effect of income inequalities within English local authorities on the variation in all cause mortality between them. The subjects were all men and women recorded as economically active in the 1991 Census. We carried out linear regression analyses between all cause, all ages standardized mortality ratios, income inequality indexes and mean income levels of the local government districts. Results Both income inequality and mean income were independently associated with mortality. CONCLUSIONS: It is likely that income inequality makes an independent contribution to life expectancy in English local authorities. This finding adds further to the international evidence supporting the potentially positive health impact of increasing the scale of redistributive fiscal policies.

Cross-Sectional Studies↗
PubMed2000

The early NHS and the crisis of public health nursing.

Establishment of the NHS in 1948 is rightly seen as a major turning point in health care in the United Kingdom. Notwithstanding conditions of severe austerity, the NHS succeeded remarkably well in its basic remit to make all essential medical care available to the entire population, free at point of delivery. The benefits of the new system extended across the entire front of its services. However, it is important to recognise that the reforms of 1948 were uniformly advantageous. It has for instance long been recognised that the NHS failed to bring about the expected transformation in standards of general medical practice. In this short paper the author argues that public health represented a further major sphere of underdevelopment. The fact that, with minor exceptions, public health is the least studied aspect of the early NHS is itself suggestive of its status as the Cinderella of the modern health services. The author also underlines the adverse implications of this inferior position for domiciliary midwifery, district nursing and health visiting. These constituted small but strategically important sectors of nursing, all of which fell under public health administration in the new health service. The author concentrates on the first phase of the NHS, the period between 1948 and 1974, now often regarded as its golden age. For the purposes of this discussion, most of the evidence relates to the formative phase of the new service, when many major policy questions relating to public health were first confronted. It is suggested that the early neglect of public health and its constituent nursing functions has left a legacy of problems that have still not entirely been resolved. For the purposes of this paper the term will be used to embrace the totality of health functions administered by departments of local government in the period from 1948 to 1974. Most of these services fell within the public health departments of local government, headed by the Medical Office of Health (MOH). However, some important functions involving the nurses were located in other departments. Especially important was the School Health Service, which was reformed in 1944, ahead of the NHS. This was a largely independent service under the administration of Local Education Authorities. Some of the problems of public health nursing related to this fragmentation of responsibility.

History, 20th Century↗
PubMed1995

National survey of dental caries status and treatment needs in Nigeria.

Data on dental caries status and treatment needs among Nigerians were obtained for planning purposes. Details of male and female subjects of all ages from model urban and rural local governments in each state were obtained and a quota sample of about 100 subjects was selected in each local government area (N = 4692). Data were collected using WHO criteria. Chi-square test was used to analyze differences between frequencies. Results from different states were pooled together according to their Primary Health Care (PHC) classification. Percentages of decayed teeth (DT) were: 30, 43, and 44 per cent respectively for subjects aged 12, 15, and 35-44 years old. Percentage DT showed significant (P < 0.01) variation between zones, although the rural/urban differences were not consistent in all ages and significant (P = 0.01) differences were reported for 12 and 15 year olds. Mean DMFT in the respective ages were 0.7, 1.3 and 2.5. The level of restorative care (FT/DMFT) was very low, being 1.5, 1.6 and 1.2 percent for the respective ages. Percent MT/DMFT increased with age. Extrapolating from sample estimates, 7.3 and 22.9 million Nigerians were projected to need dental extraction and conservative care respectively. There is a need to develop an oral health system that includes screening the population and treating those in need of care. Consideration should be given to the training of Expanded Function Dental Auxiliaries.

Adolescent↗
PubMed1992

RURALSIM: the design and implementation of a rural EMS simulator.

Why were these applications of simulation technology unsuccessful? Parochialism, the volunteer nature of EMS planning, and limited regional commitment to resolve such complex problems at the local level all combined to present significant barriers to implementation. Political factors which posed the most significant barriers included: conservative attitudes concerning the funding and regulation of EMS activities by local governments; general opposition to governmental intervention in the private sector; strong resistance to mandatory standards for EMS; jurisdictional disputes between EMS-related agencies; lack of cooperation between the local governments; competition between prehospital-care providers and between hospitals; overemphasis on local jurisdictional boundaries in the planning and delivery of services; and the allocation of EMS resources, such as ambulances, according to political priorities, rather than more objective criteria. Based upon the results of the four field tests, the following observations are relevant: 1. RURALSIM is a very complex simulator. While every effort was made to assure generalizability, for any given situation, it required extensive modification and tailoring. The result was a model capable of handling a rather diverse set of situations, but one that could not be turned over to the general public for use. To implement RURALSIM required the participation of the University of Pittsburgh research team. The newer simulation languages now available alleviate this problem somewhat. 2. RURALSIM's complexity was needed to examine the different alternatives proposed by local planners. It was particularly needed in order to simulate each region's existing system. Such "base-line" simulations were required in order to achieve face validity and provide a basis for comparing alternatives. 3. With hindsight, a major weakness was the limited amount of face-to-face interaction between local planners and decision makers and the University of Pittsburgh staff. Only two trips to the region were budgeted. This proved to be insufficient and placed too much responsibility for model interpretation and analysis on the local contractors. 4. In none of the four test sites did the contractors and/or local health planners have the authority, influence and/or incentives necessary to develop regional EMS systems. In particular, none of the contractors were in the position to be decision makers, nor was there ever only one decision maker. This is not a criticism of the contractors, who did their best under difficult circumstances. Rather, it is a criticism of the state of eMS system development in the US in the early 1980s. There were few examples where regional systems developed successfully in the face of serious opposition from local interests.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Simulation↗
PubMed2001

Occupation and the risk of laryngeal cancer in Turkey.

OBJECTIVES: A hospital-based case-referent study was conducted in Turkey to provide further information on occupational risk factors and laryngeal cancer. METHODS: Among 7631 cancer cases seen at an oncology treatment center between 1979 and 1984, 958 laryngeal cancer cases were identified among men. Occupational history, tobacco and alcohol use, and demographic data were obtained from patients with a standardized questionnaire. Special 7-digit standard occupational and industrial codes were created to classify the job and industrial titles of the subjects. After exclusions, 940 laryngeal cancer cases and 1519 referents were available for study. Age-, smoking- and alcohol-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. RESULTS: Excess laryngeal cancer occurred among guards (OR 1.5, 95% CI 1.1-2.1), production supervisors (OR 1.8, 95% CI 1.1-3.1), textile workers (OR 1.9, 95% CI 1.2-3.3), drivers (OR 1.7, 95% CI 1.1-2.4), construction workers (OR 1.7, 95% Cl 1.2-2.6), and workers in grain mills (OR 3.1, 95% CI: 1.3-7.6), trade unions (OR 3.6, 95% CI: 1.1-11.7) and local government services (OR 4.7, 95% CI 1.7-12.5). Supraglottic cancer was excessive among the textile workers, construction workers, and local government laborers, all with potential dust exposure. The risks of the general managers, electricians, and workers from industries such as pharmaceutical production, industrial machinery production, electric utilities, and retail services were lower than expected. CONCLUSIONS: The risk of laryngeal cancer was associated with several occupations, and supraglottic larynx cancer appears to be more common among workers in dusty occupations and industries.

Aged↗
PubMed1998

[Evaluation of factors associated with well-being of elderly in an aged society by analytic hierarchy process analysis].

In the coming aged society in Japan, where about one quarter of the citizens will be aged 65 or more, the social policy concerning the well-being of the elderly will become very important for the local government. In this analysis, the authors evaluated the importance of future social programs on this subject using the Analytic Hierarchy Process (AHP) technique in a community of Fukuoka prefecture. Fifty-three participants in this study regarded six keywords as important for the well being of the elderly in the coming aged society in the following order: health, family hobby life-long education, friends community, economic conditions, and social participation. Considering the contribution to each of the six keywords, composite priorities among the four programs were determined by the AHP technique to be in the following order: assistance for the social autonomy of the elderly, health promotion programs, development of welfare services, and development of medical services. These results indicate that for Japan to achieve a comfortable aged society, a democratic government made possible by autonomous individual citizen is desirable, with wide participation of individual in services provided by autonomous local governments that incorporate the structured elements shown to be important in this study.

Aged↗