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PubMed2005

The use of nominal group technique in identifying community health priorities in Moshi rural district, northern Tanzania.

This article highlights issues pertaining to identification of community health priorities in a resource poor setting. Community involvement is discussed by drawing experience of involving lay people in identifying priorities in health care through the use of Nominal Group Technique. The identified health problems are compared using four selected village communities of Moshi district in Kilimanjaro region, Tanzania. We conducted this study to trace the experience and knowledge of lay people as a supplement to using 'health experts' in priority setting using malaria as a tracer condition. The patients/caregivers, women's group representatives, youth leaders, religious leaders and community leaders/elders constituted the principal subjects. Emphasis was on providing qualitative data, which are of vital consideration in multi-disciplinary oriented studies, and not on quantitative information from larger samples. We found a high level of agreement across groups, that malaria remains the leading health problem in Moshi rural district in Tanzania both in the highland and lowland areas. Our findings also indicate that 'non-medical' issues including lack of water, hunger and poverty heralded priority in the list implying that priorities should not only be focused on diseases, but should also include health services and social cultural issues. Indeed, methods which are easily understood and applied thus able to give results close to those provided by the burden of disease approaches should be adopted. It is the provision of ownership of the derived health priorities to partners including the community that enhances research utilization of the end results. In addition to disease-based methods, the Nominal Group Technique is being proposed as an important research tool for involving the non-experts in priority setting in Tanzania.

Community Networks↗
PubMedDate not supplied

[Opinion on health priorities in the community of Valencia].

In this study we have used a qualitative approach partially based on the Delphi technique to establish the ten priorities for health in the Valencian Community for the next five years. Two rounds of mail surveys were made sending questionnaires to 1834 people including Health Councillors of the Town Halls, nurses and doctors of the three valencian provinces. The overall response rate was 28.3%. The priorities which were perceived as most important by the respondents were the development of primary care, improvements in the management of health services and the development of preventive medicine. The fourth and fifth places of the ranking were: improvements of emergency services and increasing the budget devoted to hospital care. The 6th priority was preventive measures in cardiovascular diseases, the 7th actions against drug abuse, the 8th special attention to childhood and ageing populations and the last two priorities were protection of the environment and infectious diseases prevention. We consider this approach as useful to obtain additional valuable information complementary to the information obtained from traditional statistics or health surveys specially in the areas of management, diseases prevention and actions towards special groups of population.

Delphi Technique↗
PubMed2003

Rural health priorities in America: where you stand depends on where you sit.

PURPOSE: To assess levels of agreement on priority areas among state and local rural health leaders nationwide. METHODS: Analysis of responses to a mail survey sent to 999 rural health leaders, with 501 responses. Respondents were asked to rank importance to rural health of focus areas named in Healthy People 2010. FINDINGS: There was substantial agreement on top rural health priorities among state and local rural health leaders across the 50 states. "Access to quality health services" was the top priority among leaders of state-level rural agencies and health associations, local rural public health agencies, rural health clinics and community health centers, and rural hospitals. It was the top priority across all 4 major census regions of the nation as well. The next 4 top-ranking rural priorities--"heart disease and stroke," "diabetes," "mental health and mental disorders," and "oral health"--were selected as 1 of the top 5 rural priorities by one third or more of respondents across most groups and regions. At the same time, some observed differences in rural health priorities suggest opportunities for community partnership strategies or for regional multistate policy initiatives by states sharing similar rural health priorities.

Attitude of Health Personnel↗
PubMed2006

Physicians' preparedness for bioterrorism and other public health priorities.

OBJECTIVES: Potential bioterrorism challenges policy makers to balance competing public health priorities. Earlier surveys showed low physician bioterrorism preparedness but did not assess physicians' general public health preparedness, compare the preparedness of emergency and primary care physicians, or assess temporal trends. METHODS: This was a national, cross-sectional, random-sample survey conducted in 2003. RESULTS: Overall, 744 of 1,200 eligible physicians responded (response rate, 62%). Of these, 58% of emergency physician respondents and 48% of primary care physician respondents reported having learned a lot about responding to bioterror since September 11, 2001 (p < 0.01). However, only 43% of emergency physicians and 21% of primary care physicians agreed they are generally "well prepared to play a role in responding to a bioterror attack" (p < 0.001). Beliefs about balancing public health priorities were similar among emergency and primary care respondents. Seventy-eight percent of respondents believed that local health care systems need to be prepared for bioterrorism, and 92% believed that local health care systems need to be prepared for natural epidemics. By contrast, only 23% and 46% of respondents reported that their local health care systems are well prepared for bioterrorism and natural epidemics, respectively. Meanwhile, 77% agreed that "influenza is a greater threat to public health than bioterrorism," and 21% reported that bioterrorism preparedness efforts are diverting resources from more important public health problems. CONCLUSIONS: In 2003, most emergency and primary care physicians reported that they and their local health care systems were not yet well prepared to respond to a bioterror attack, and many believed that more resources should go toward preparing for natural epidemics. These findings highlight the importance of expanding bioterrorism preparedness efforts to improve the public health system more broadly.

Attitude of Health Personnel↗
PubMed2004

Identifying priority health conditions, environmental data, and infrastructure needs: a synopsis of the Pew Environmental Health tracking project.

In this article we describe the methodologic approaches of the Pew Environmental Health Commission at the Johns Hopkins Bloomberg School of Public Health used to identify priority environmental health conditions and develop recommendations to establish a national environmental public health tracking network. We present the results of a survey of public health and environmental practitioners to uncover state and local health tracking needs and priorities. We describe the steps that combined the findings from the state and local health tracking survey and a review of the state of the science on environmental impacts on health to identify priority health end points. Through an examination of national health and health care databases, we then describe trends and public health effects of those diseases that may be linked to the environment. Based on this analysis, respiratory diseases and neurologic diseases are recommended as priorities for tracking. Specific end points recommended for tracking include asthma and chronic respiratory diseases, and chronic neurodegenerative diseases such as multiple sclerosis. Based on trends in reported prevalence, consideration should also be given to developmental disabilities, reproductive disorders, and endocrine/metabolic disorders. Strengthening of current efforts to track cancer and birth defects should also be included as components of a nationwide health tracking network. Finally, we present the recommendations for environmental public health tracking. These recommendations provided the groundwork for the development of the Centers for Disease Control and Prevention's National Environmental Public Health Tracking Progam that now includes 21 states, three cities, and three academic centers throughout the nation.

Centers for Disease Control and Prevention, U.S.↗
PubMed1994

Diabetes mellitus--a priority health care issue for women.

Diabetes occurs in more than 13 million persons in the United States, and approximately 60% of the new cases are diagnosed in women. This review examines health issues related to women with diabetes mellitus. The following issues are discussed in the review. The prevalence of diabetes is higher in Native-American, black, and Hispanic women than in white women. Women with upper-body obesity are at risk for developing non-insulin-dependent diabetes mellitus (NIDDM) and women with diabetes are at risk for developing heart disease. Diabetes, obesity, and heart disease are all modifiable by nutrition. White women with diabetes derive approximately 40% of energy from fat, which is 10% greater than the national goal. Women with a history of gestational diabetes are at risk for developing NIDDM. Women with insulin-dependent diabetes mellitus (IDDM) are at high risk of developing complications in pregnancy, and pregnancy outcomes improve with preconceptual counseling. Women with IDDM are at risk for developing eating disorders, although not to a greater extent than the nondiabetic population. Women with diabetes are at risk for developing endometrial cancer. Both IDDM and NIDDM prevention clinical trials are in progress, although none target women specifically. Dietetics practitioners are encouraged to use local and national diabetes resources.

Diabetes Mellitus, Type 1↗
PubMed2003

Determining public health priorities for an ageing population: the value of a disability survey.

In order to determine which diseases and health problems were most strongly associated with long-term disability among the Thai elderly and to determine their public health priority, a national cross-sectional multistage random sampling survey was conducted in 1997. Four thousand and forty-eight Thai older persons aged 60 years and over were recruited and interviewed by trained interviewers. Overall, 769 (19%) people reported having a long-term disability. Participants with long-term disability (LD) reported having between one and 21 long-term diseases or health problems. Eighteen of these problems were independently associated with LD in logistic regression analysis. Nearly half of the cases with LD (46.4%) suffered from two or more health problems. The odds of LD increased with the number of problems suffered. The problems contributing most to the population burden of disease as assessed by population attributable risk fractions were hemiparesis, arthritis, accidents (unintentional injuries), blindness and other eye diseases, kyphosis, weakness of limbs, deafness, and hypertension. This ranking of public health priority differs from conventional approaches using mortality statistics and disability adjusted life years (DALYs). In conclusion, national disability surveys provide a valuable means of assessing the population burden of disability and determining the underlying causes of disability. These methods provide a direct assessment of disability prevalence and disease priorities for rapidly ageing transitional countries where death certification may be incomplete or inaccurate.

Aged↗
PubMed1991

Health status and national health priorities.

Various measures of the health status of the population of the United States show there is considerable room for improvement. Compared with other industrialized nations, we are spending more for health care but our health is worse. These data form the basis for setting national priorities. Four selected policy issues are discussed, including access to medical care, maternal and child health care, the acquired immunodeficiency syndrome, and long-term care. Examination of these issues leads to the conclusion that universal and affordable health care is the major national health priority, requiring a commitment by the people of the United States and its leaders to develop a viable solution.

Female↗
PubMed1975

Alternate methods for health priority assessment.

Four methods for assessing priorities of health problems were use in a 15-county Appalachian region. Despite overall similarities the tendency is for providers to focus on categorical disease problems while consumers focus more on organization and financing problems. Only one of the methods described, community diagnosis, uses objective data; thus, the health professional must assume an educational role and help consumers use and interpret data. Prioritization of health problems allows for more appropriate use of limited resources.

Attitude to Health↗
PubMed1991

[Priority health targets in the new Germany from the view point of oral health].

The global pattern of caries prevalence has undergone some changes since the seventies. This has occurred with some remarkable geographic differences. Comparative statistical analysis shows an acceptable situation at the current moment for the population of the new "Bundesländer". The globally given goals of oral health for the various age groups can be reached or have already been accomplished in part. For the youth population the state of good oral health corresponds always to the caries protective availability of fluorides, for the adult population to the remarkable state of a tooth-preservative oriented curative care. For the senior citizen population the high loss of teeth is an indication of past neglect in dental care. Future development of oral health of the population depends largely on all-encompassing preventive and tooth-preservative concepts of dental care.

Adolescent↗