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PubMed1991

The application of operational research (OR) procedures to maternal mortality from puerperal sepsis in a rural community.

An operation research (OR) procedure on maternal mortality from puerperal sepsis was carried out in Irepodun Local Government Area of Kwara State of Nigeria. The study involved ten focus groups discussion (FGD) in two districts of the Local Government Area. The findings were analysed from three broad perspectives, that is, consumers' views, providers' views and community decision takers' views. In general, the analysis revealed that the community knowledge of puerperal sepsis is poor. In addition, limited access and prohibitive cost of orthodox health care services prevented the community from full utilization of the few available health care centres in the community. The study also revealed that there is urgent need to introduce three key interventions for an improved maternity care in the community. These interventions are community health education, health institutions development and community participation in provision of ancillary services such as transportation.

Female↗

PubMed1992

The future of environmental health in Scotland.

This paper reviews the considerable progress which the environmental health profession has achieved, particularly during the course of the past 10-20 years. The future of the profession is considered particularly in relation to the development of higher degree opportunities and progress of research, the expanding use of support and associate specialist staff, and the thorny area of meat inspection. Further re-organisation of local government is inevitable and the paper suggests the development of a broader based environmental health and public safety service within local government, mirrored nationally by a similar department at the Scottish Office. The key roles of the Environmental Health (Scotland) Unit and the Royal Environmental Health Institute of Scotland in the future development of the profession are highlighted.

Education, Medical, Graduate↗

PubMed1997

New federalism and intergovernmental fiscal relationships: the implications for health policy.

This paper explores a number of popular but largely inaccurate myths about American federalism in order to clarify the fundamental structures and processes that characterize American federal governance. Examination of financial and political trends over the past several decades reveals the development of a form of functional specialization among national, state, and local governments based on pragmatic responses to policy problems rather than decisions based on clearly articulated "principles." These responses have increasingly come from states in a wide variety of policy areas, including health care, where the energetic reform activity of the past decade provides a sharp contrast to the inability of the national government to enact reform. Recent pressure to devolve more authority to the states is thus much more than an ideological fad; it reflects widespread agreement among political elites that state and local governments have become capable governing partners. Nonetheless, there are limits to devolution which guarantee that close fiscal and political ties between the nation and the states will remain in place. Devolution does not, because it cannot, mean separation.

Aid to Families with Dependent Children↗

PubMed1981

Federal funding formulas and the 1980 census.

Distribution of federal funds has achieved equal status with Congressional reapportionment as a motivation and justification for the Census of Population and Housing. This article describes the effects that U.S. population redistribution during the 1970s, as measured by the 1980 Census, will have on the spatial distribution of federal grants-in-aid provided to state and local governments through programs with formula-based funding systems. The conclusion is that funding changes will not match population changes. The overall redistribution of federal grants-in-aid to state and local governments occurring in response to incorporation of 1980 Census population counts into federal funding formulas will be far less than the level of population redistribution since 1970. Use of intercensal data, formula specifications, limited geographic specificity in many formula allocations, and nonformula determinants of formula-based grants all weaken the relationship between Census-measured population change and the receipt of federal funds at the local level. Despite all the intervening factors, it is probably that in many programs there will be some redistribution of funds when the 1980 Census counts are incorporated into the allocation formulas. But the importance of measurement errors and threshold and reclassification effects may equal that of true population change in determining the funds received by local communities.

Financing, Government↗

PubMed2004

Mental health first aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541].

BACKGROUND: A Mental Health First Aid course has been developed which trains members of the public in how to give initial help in mental health crisis situations and to support people developing mental health problems. This course has previously been evaluated in a randomized controlled trial in a workplace setting and found to produce a number of positive effects. However, this was an efficacy trial under relatively ideal conditions. Here we report the results of an effectiveness trial in which the course is given under more typical conditions. METHODS: The course was taught to members of the public in a large rural area in Australia by staff of an area health service. The 16 Local Government Areas that made up the area were grouped into pairs matched for size, geography and socio-economic level. One of each Local Government Area pair was randomised to receive immediate training while one served as a wait-list control. There were 753 participants in the trial: 416 in the 8 trained areas and 337 in the 8 control areas. Outcomes measured before the course started and 4 months after it ended were knowledge of mental disorders, confidence in providing help, actual help provided, and social distance towards people with mental disorders. The data were analysed taking account of the clustered design and using an intention-to-treat approach. RESULTS: Training was found to produce significantly greater recognition of the disorders, increased agreement with health professionals about which interventions are likely to be helpful, decreased social distance, increased confidence in providing help to others, and an increase in help actually provided. There was no change in the number of people with mental health problems that trainees had contact with nor in the percentage advising someone to seek professional help. CONCLUSIONS: Mental Health First Aid training produces positive changes in knowledge, attitudes and behaviour when the course is given to members of the public by instructors from the local health service.

Adolescent↗

PubMedDate not supplied

Healthy cities: overview of a WHO international program.

Health is the outcome of all the factors and activities impinging upon the lives of individuals and communities. The last decade has seen an emerging understanding within development circles that living conditions are greatly affected by local action, by the work of local government, and by community groups and organizations. In addressing health and environmental issues and making interventions, an integrated approach, based on 'settings', exemplified in the Healthy Cities approach, has proved most effective. A Healthy City project can involve people and organizations in the programs and activities that are needed for better health, and enables a city or neighborhood to mobilize the human and financial resources required to address many health and quality of life issues. The WHO program involves implementating city projects and networks in all regions of the world and serves as a vehicle for many health programs, including major disease control initiatives. Healthy City projects allow Ministries of Health to develop stronger partnerships with local government organizations (such as the Union of Local Authorities and its members, "Local Agenda 21" initiatives, and others). One focus for the program is the development of 'multi-'multi-city action plans' for major global priority issues, including AIDS, sanitation, women's health, and violence, to ensure that major public health programs are strengthened by wider community participation. It is recognized that city networking--at national, regional, and international levels--now must be better exploited by individual cities and municipalities to solve local health problems.

Environmental Health↗

PubMed2004

Local authority scrutiny of health: making the views of the community count?

OBJECTIVE: To look at the preparations being made for the introduction of scrutiny of local health services by social service local authorities. DESIGN: A baseline postal survey carried out in late 2002 of all social service local authorities in England. SETTING: Against a backdrop of changing structures and policy, both within local government and the National Health Service (NHS) in England and before the official introduction of health scrutiny in January 2003. Survey from the local authority perspective. RESULTS: Progress is being made in the implementation of this new policy, and many local authorities have already carried out pilot scrutiny exercises of local health provision. The survey highlights the different approaches authorities are taking to initiate implementation of health scrutiny and the importance of support, in terms of resources, guidance and training, for overview and scrutiny to be successful. DISCUSSION AND CONCLUSIONS: Further evaluation of the implementation of health scrutiny is required to examine the impact on local governance of the NHS and partnership working.

Community Health Services↗

PubMed2003

Development of sustainability indicators by communities in China: a case study of Chongming County, Shanghai.

Public participation as a means of identifying sustainability indicators for Chongming County, Shanghai, China was evaluated by an international group drawing on established best practice. An initial 'long list' of 86 sustainability indicators, based on previous indicator systems developed in China, was identified. This 'long list' was reduced via consultations with local academics and local-government officers from Shanghai City and Chongming County to a 'short list' of 17 indicators. This short-list was subjected to further community consultation involving 159 local-government officers, teachers, students (aged 12-14 years), farmers and workers. Data from the consultations indicated differences in the understanding of sustainable development among the different sectors. By combining the data from the different sectors it was possible to identify a consensus around 4 core and 7 additional indicators. These are proposed as indicators which could be used to steer local activities directed towards sustainable development. The list of indicators produced by the people of Chongming Island was compared to local indicator systems in Europe. In comparison with European lists the Chongming list was found to have a greater emphasis on economic development but a similar level of concern for environmental matters. This study has special significance as it reports on the implementation of a process involving local resident participation in the process of sustainable development in China.

Adolescent↗

PubMed2001

[The medical system and its characteristics during the Koryo Dynasty period].

This article explores the medical system of the Koryo Dynasty period and its social characteristics. First, the structure of medical system and roles of medical institutions during the Koryo Dynasty period will be summarized. Then, the characteristics of the medical system will be identified through exploring the principles of its formation in a view of social recognition of medical care and a view of public policy. During the Koryo Dynasty period, medical experts were trained in national education institutions from the early days of Dynasty. After trained, they were appointed to the posts at government service with their medical profession. In the meantime, they sought ways to ascend their social position. Physicians of Oriental medicine were appointed to the posts at each local government and troops to take charge of medical treatments of the common people. Also, the state tried to assume the reins of medical system by actively taking part in circulation (collection and distribution) of herb. Taeuigam and Sangyakguk represent central medical institutions of the Koryo, taking charge of medical service for the aristocracy and the bureaucracy. The Common people were treated at DongSeoDaeBiWOn, JeWuiBo, HyeMinGuk, and YakJum in SeoKyung. However, activities of these institutions became less active around the days of military officials regime, as officers became negligent and financial base went broken. The roles of medical institutions of the Koryo government were not restricted to the treatment of diseases. Policies for the common people were constituted by two main policies, the policy for encouraging agriculture and the policy for giving relief to people. Medical institutions, with other social systems, had a social responsibility to support the governing system of the Koryo and maintain the stability of the society. In this aspect, medical institutions such as DongSeoDaeBiWon and JeWuiBo, and relief institutions such as UiChang, were all related and connected organically, and they were results of, and bases of the relief policy. However, medical system for the common people was made up first for practical needs and then improved successively. Allocation of medical experts and execution of relief work were carried out by each local government, except the case of serious disaster, which central government took part in. As the Koryo Dynasty went into its latter period, temporary institutions and one - time benefits replaced permanent institutions. These four characteristics described above were systemic characteristics of medical system during the Koryo Dynasty period.

History, Medieval↗

PubMed2006

A qualitative study exploring barriers to a model of shared care for pre-school children's oral health.

OBJECTIVE: To explore the oral health beliefs and practices of primary health care professionals which may act as barriers to the development of a model of shared care for the oral health of pre-school children. DESIGN: Qualitative focus group discussions and semi-structured interviews. SETTING: Four rural local government areas in Victoria, Australia, 2003. SUBJECTS AND METHODS SUBJECTS: maternal and child health nurses, general medical practitioners, dental professionals and paediatricians working in the four local government areas. DATA COLLECTION: discipline specific focus groups and semi-structured interviews. DATA ANALYSIS: transcription, coding, clustering and thematic analysis. RESULTS: Several strong themes emerged from the data. All participants agreed that dental caries is a significant health issue for young children and their families. Beliefs about the aetiology of dental caries and its prevention were variable and often simplistic focusing predominantly on diet. Dental professionals did not believe that they had a primary role in the oral health of pre-school aged children but that others particularly maternal and child health nurses did. However other health care professionals were not confident in assuming this role. CONCLUSIONS: This study has identified important barriers and possible strategies for the development of an integrated and shared approach to preventing dental caries in pre-school aged children. Clear and consistent oral health information and agreed roles and responsibilities need to be developed.

Attitude of Health Personnel↗

PubMed2000

Mortality in sahelian goats in Nigeria.

The cause of mortality in sahelian goats was investigated in three local government areas of Borno State (Kukawa, Maiduguri and Mongonu) that are known for high goat production. A total of 150 selected flocks (50 flocks from each of the local government areas) were administered questionnaires through spot visits and interviews of the flock owners. On the whole, 644 (21.8%) goats died between May 1996 and April 1997 out of the 2956 goats in the 150 flocks. Mortality (41.4%) was higher in kids (<6-month old) than in adults (14.4%). Gastrointestinal disorders (dyspepsia), and respiratory diseases were the most-common causes of mortality. Cause-specific mortality risks did not differ between kids and adults.

Animals↗

PubMed2005

[Establishment of Healthy Japan 21 Regional plans according to local community type].

OBJECTIVE: To examine the establishment of Health Japan 21 regional plans according to the local community type. METHODS: We sent all the Japanese local governments a questionnaire regarding the establishment of health Japan 21 regional plans with a request to provide a hardcopy of established regional plans. RESULTS: Of the respondent 1954 local communities, the proportions regarding establishment of plans (including "Completed" and "In the course of") according to the community type were: major, middle sized cities and Tokyo metropolitan wards, 100%; other cities, 64.9%; towns, 40.7%; and villages, 38.8%. Of the 500 local communities which answered "Completed establishment", the proportions with release onto the internet (including "Completed" and "In the course of") were: major cities, 100%; middle sized cities, 67.7%; Tokyo metropolitan wards, 85.7%; other cities, 38.8%; towns, 13.5%; and villages, 14.3%. We examined whether each of the 462 collected regional plans included each of the national Health Japan 21's target themes and items, and found a tendency for smaller community' regional plans to be less likely to give comprehensive coverage. CONCLUSION: More support for smaller local governments is necessary to achieve establishment and effective implementation of Health Japan 21 regional plans.

Benchmarking↗

PubMed1996

Surveillance system of infectious diseases in Japan.

The surveillance system of infectious disease in Japan started in 1981 and has been providing useful epidemiological information on 27 communicable diseases. The system consists of medical institutions (fixed monitoring stations), institutions of hygienic sciences, health centers, local governments and the ministry of health and welfare. There are two types of information about infectious diseases. One is clinical reports of incidence cases from medical institutions, and the other is laboratory information about etiologic agents. Between health centers, local governments and the department of statistics and information in the ministry of health and welfare, information is transmitted through the on-line network. Collected information is analyzed and submitted by both local and central committees of analysis. From the epidemiological point of view, quality control of the data and integration of other sources of data would be the next goal of the system.

Databases, Factual↗

PubMed1993

A holosphere of healthy and sustainable communities.

Public health practice is in a transitory state, expanding considerably beyond medical and behavioural models of health and disease to encompass physical and social environmental health determinants. A new public health practice is emerging, apparent in initiatives like the international healthy cities/communities projects. This new public health practice must integrate the challenge of sustainable development, as defined by the 1987 World Commission on Environment and Development. The holosphere framework locates health as its central metaphor, and defines six interacting environmental spheres: a viable natural environment, a sustainable economic environment, a sufficient economy, an equitable social environment, a convivial community, and a livable built environment. There are five functional roles for local government: policy, legislation, education, partnerships and advocacy. Representative actions from each of the six environmental spheres of the holosphere framework are identified and discussed, using the five functional roles of local government. There is a need for new intersectoral forums to act upon the knowledge generated by integrative models such as the holosphere. Canadian Round Tables on Environment and Economy are encouraging examples of such intersectoralism.

Economics↗

PubMed1996

A retrospective study of the role of intracavitary brachytherapy and prognostic factors determining local tumour control after primary radical radiotherapy in 903 non-disseminated nasopharyngeal carcinoma patients.

The aims of this retrospective study were to determine the role of intracavitary brachytherapy given shortly after external beam radiotherapy in the primary radical treatment of non-metastatic nasopharyngeal (NPC) cancer patients, and the prognostic factors governing local tumour control. From 1984 to 1989, 903 patients with non-disseminated NPC who had had no previous treatment were managed at the Prince of Wales Hospital, where investigation and treatment methods had been standardized according to a departmental protocol. The external radiotherapy dose of 60.0-62.5 Gy in 6 weeks was given to all patients. Parapharyngeal booster radiotherapy with a single photon beam to 20 Gy in 2 weeks was given to those with parapharyngeal tumour extension. Computed tomography of the nasopharynx and skull base, and pretreatment nasopharyngoscopy and biopsy were performed in all patients. Nasopharyngoscopy was repeated at 4 weeks after the last day of external irradiation. Local persistence in 99 patients was treated additionally by intracavitary brachytherapy to 24 Gy in three fractions over 15 days. Fifty-one patients with early stage primary disease (Ho Stage T1 and T2n (nasal)) who responded completely to external radiotherapy were given adjuvant intracavitary brachytherapy to 18 Gy in three fractions over 15 days. Intracavitary therapy was an inadequate salvage treatment for the locally persisting T3, T20 (oropharyngeal) and T2p (parapharyngeal) disease, but there was a trend towards improved local control after intracavitary brachytherapy for the locally persisting T1 tumours. Adjuvant brachytherapy did not enhance local tumour control for the early T-stage tumours that completely responded to external radiotherapy. Both forms of intracavitary brachytherapy were safe with few and acceptable complications. In the 903 non-disseminated NPCs, the patient's age and tumour involvement of the skull base and cranial nerves were significant independent prognostic factors governing local tumour control. In the 358 patients with Ho T3 disease, tumour involvement of the orbits and the laryngopharynx significantly worsened local tumour control. The presence of local persistence at 4 weeks after external radiotherapy, for which therapeutic brachytherapy was given, was marginally significant as a prognostic factor in addition to the presence of cranial nerve palsy.

Actuarial Analysis↗

PubMed1985

Language skills of general practitioners in Sydney.

Nearly 50% of the general practitioners in nine representative local-government areas of Sydney spoke one of 27 languages other than English. The most common languages were Chinese dialects, Indian dialects, Italian, German and French. Bilingual and multilingual doctors tended to practise in local government areas with relatively large non-English-speaking populations. Nevertheless, some language groups would not have easy access to a general practitioner, particularly to a female doctor, who speaks their language.

Australia↗

PubMed1996

[Accuracy of participation rate data for health examination research].

Each local government conducts health examinations based on the Health and Medical Law for the Aged. However, since some residents are able to take health examinations at their own work places, for example, and the local government are allowed to exclude such people from taking the law-mandated health examination, it is difficult to obtain an accurate picture of the examination rate in each area. We investigated the actual participation status for health examination services of all of the 6,080 persons 20 years and over in age in Sakuragawa-mura, Ibaraki Prefecture. A comparative investigation was made on 3,655 non-bedridden/non-hospitalized persons of 40 years and over to ascertain the reliability of responses to questions about participation in lung cancer and gastric cancer examination services given by the village. The rate of valid responses was extremely low in those who had not participated in health examinations (male 54%, female 55% for the lung cancer, and male 53%, female 56% for the gastric cancer). These discrepancies are assumed to be the result of confusing the current health examinations with: (1) the health examination given in the previous year, (2) other kinds of health examinations, or (3) the health examination given in the work place or the like. A comparative investigation through logistic regression analysis, between the responses to the questions in this investigation and the actual health examination participation records, for persons who had not yet taken either lung cancer examinations or gastric cancer examinations (908 males and 938 females for the former, and 1,038 males and 1,187 females for the latter). Results showed that the influence of (1) and (2) were more or less detected in every kind of cancer examination, and the influence of (1) on the gastric cancer examination was particularly clear. No definite result was obtained about (3), because the actual record of the health examination service at the work place, etc. was unavailable. The results of this study suggests the necessity of a careful examination of methods when conducting a comprehensive service investigation for the health examinations.

Female↗

PubMed1997

The effect of spatial definition on the allocation of clients to screening clinics.

We compared four strategies for inviting 91,456 women aged 50-69 years to one of six clinics for mammography screening and 40,142 men aged 60-79 years to one of 10 clinics for abdominal aortic aneurysm (AAA) screening. The strategies were invitation to the clinic nearest to the client and invitation to the clinic nearest to the client's area of residence defined by census small area, postcode and local government area. For each strategy we calculated the expected demand at each clinic and the travel distances for clients. We found that when women were allocated to mammography clinics on the basis of the local government area instead of their individual address, expected demand at one clinic increased by 60%, and 19% of clients were invited to attend a more remote clinic, entailing 99,000 km of additional travel. Similar results were obtained for men allocated to AAA clinics by their postcode of residence instead of their individual address: 55% difference in expected demand, 13% to a more remote clinic and 60,000 km of extra travel. Allocation on the basis of small areas did not show such great differences, except for travel distance, which was about 5% higher for each clinic type. We recommend that allocation of clients to screening clinics be made according to residential address, that assessment of the location of clinics be based on distances between residences and nearest clinic, but that planning new locations for clinics be aided with spatial analysis tools using small area demographic and social data.

Aged↗