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At least 433 records · Page 24Linked to original sources
PubMed2006

Cold-induced cutaneous vasoconstriction is mediated by Rho kinase in vivo in human skin.

Cutaneous vasoconstriction (VC) is the initial thermoregulatory response to cold exposure and can be elicited through either whole body or localized skin cooling. However, the mechanisms governing local cold-induced VC are not well understood. We tested the hypothesis that Rho kinase participates in local cold-induced cutaneous VC. In seven men and women (20-27 yr of age), up to four ventral forearm skin sites were instrumented with intradermal microdialysis fibers for localized drug delivery during cooling. Skin blood flow was monitored at each site with laser-Doppler flowmetry while local skin temperature was decreased and maintained at 24 degrees C for 40 min. Cutaneous vascular conductance (CVC; laser-Doppler flowmetry/mean arterial pressure) was expressed as percent change from 34 degrees C baseline. During the first 5 min of cooling, CVC decreased at control sites (lactated Ringer solution) to -45 +/- 6% (P < 0.001), increased at adrenoceptor-antagonized sites (yohimbine + propranolol) to 15 +/- 14% (P = 0.002), and remained unchanged at both Rho kinase-inhibited (fasudil) and adrenoceptor-antagonized + Rho kinase-inhibited sites (yohimbine + propranolol + fasudil) (-9 +/- 1%, P = 0.4 and -6 +/- 2%, P = 0.4, respectively). During the last 5 min of cooling, CVC further decreased at all sites when compared with baseline values (control, -77 +/- 4%, P < 0.001; adrenoceptor antagonized, -61 +/- 3%, P < 0.001; Rho kinase inhibited, -34 +/- 7%, P < 0.001; and adrenoceptor antagonized + Rho kinase inhibited sites, -35 +/- 3%, P < 0.001). Rho kinase-inhibited and combined treatment sites were significantly attenuated when compared with both adrenoceptor-antagonized (P < 0.01) and control sites (P < 0.0001). Rho kinase mediates both early- and late-phase cold-induced VC, supporting in vitro findings and providing a putative mechanism through which both adrenergic and nonadrenergic cold-induced VC occurs in an in vivo human thermoregulatory model.

1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine↗
PubMed2005

Breaking away from the medical model: perceptions of health and health care in suburban Sydney youth.

OBJECTIVES: To identify perceptions of health, health concerns, and health service needs among young people in a suburb of Sydney, New South Wales. DESIGN: Qualitative study using focus groups. SETTING: Berowra, a geographically isolated suburb on the outskirts of Sydney, between December 2002 and April 2003. PARTICIPANTS: 40 Berowra residents aged 14-24 years, recruited from two local government high schools (two groups), a local youth drop-in centre (one group), and the community, through advertising at the youth centre, local schools and church groups (one group). RESULTS: Focus group findings were classified into four broad themes. 1: Personal safety is a primary health concern. Berowra needs more recreational facilities to prevent drug and alcohol use related to boredom. 2: Health is more about quality of life than disease and illness. 3: Most health information comes from sources other than health providers. Health education must enable young people to make wise choices for the future. 4: Access to health services is of concern. More education is required on how Medicare works. Young people need to trust their service provider and will only see a doctor if they perceive themselves to be severely ill. Young people value meeting general practitioners in the school and community setting and not just in the doctor's consulting room. CONCLUSIONS: Young people desire a whole lifestyle approach to health rather than the traditional model based on diagnosis and disease. Health information needs to be accessible anonymously, and healthy lifestyles need to be promoted throughout the whole community, using youth workers and sporting leaders as role models.

Adolescent↗
PubMedDate not supplied

Local public health performance measurement: implementation strategies and lessons learned from aligning program evaluation indicators with the 10 essential public health services.

This case study summarizes the development and implementation of the evaluation framework, preliminary data results, and lessons learned for overcoming barriers and challenges. The framework development was based on best practices in evaluation and the Public Health Essential Services. Results were as follows: (1) implemented a department-wide framework for program evaluation; (2) developed and implemented 34 program evaluation plans; (3) collected data on 52 indicators across 492 measurable objectives; and (4) identified challenges and recommendations to improve evaluation processes. Although the importance of program evaluation is recognized in public health, program evaluation models do not take into account the variety of goals inherent in the diversity of public health programming. The case study presented provides guidance and lessons learned for the evaluation of public health practice in local governments.

Benchmarking↗
PubMed2001

NHS scrutiny. Here's looking at you, kid.

Bringing NHS organisations under the scrutiny of local government, as proposed by the NHS plan, will strengthen democratic monitoring. The proposed arrangements give an opportunity for greater integration of services. NHS organisations can gain from local authority experience in areas such as best value.

Decision Making, Organizational↗
PubMed1996

Eldercare in Sweden: issues in service provision and case management.

Sweden's extensive eldercare system emphasizes home and community-based care provided by municipal government. Recent policy reform is designed to improve the provision and coordination of long-term care by transferring the responsibility and resources for the health care component from regional to local government. Policy designed to help older people manage at home has emphasized formal care, but support for family caregivers is now receiving increased attention. Care managers in municipal eldercare are responsible for individual client need assessment and level of care determination. Recent reforms in service provision combined with a weaker economy in the 1990s have increased the importance of the care manager's role in Sweden. Many municipalities are now testing new forms of service delivery that focus on the roles of care managers. These include a purchaser-provider model in which the care manager decides on a package of care and purchases some of the services from private or public providers. Under this system the care manager has increased responsibility for monitoring outcomes and determining how resources are used more effectively.

Aged↗
PubMed1987

Joint finance: promoting a new balance of care and responsibilities in England?

British government policy has long aimed at substituting local government community services for centrally-funded long-stay hospital services. Thus, the health service has depended on the willingness of locally administered and financed services to accept a shift in the balance of care. A special financial programme--joint finance--was introduced in 1976 to provide local authorities with an incentive to implement this shift. The programme apparently provided health authorities with the power to ensure that joint finance spending met their own priorities for service development. In practice, a number of influences combined to ensure that local authority interests and priorities prevailed. The principal lesson of this initiative, and its successor, is the importance of devising balanced incentives which prevent either party from exercising a veto over inter-agency transactions.

Community Mental Health Services↗
PubMed2000

The impact of risk shifting and contracting on mental health service costs in California.

This paper identifies the impact of "program realignment," a 1991 California state policy that significantly enhanced local governments' financial risk and programmatic authority for public mental health services, on treatment costs per user, and on the mix of inpatient and outpatient service costs. The study employs a natural pre-realignment and post-realignment design using the 59 California local mental health authorities (LMHAs) as the unit of analysis over a seven-year period spanning policy implementation. Total treatment and inpatient cost per user decreases and outpatient cost per user increases after program realignment. Higher levels of contracting with private providers tend to enhance this trend, while risk for institutional services reduces user costs uniformly. Financial and programmatic decentralization can enhance cost efficiency in treatment, while promoting substitution of outpatient services for inpatient services. Local conditions such as risk and contracting determine the extent of the policy response.

Adolescent↗
PubMed2005

Local building ban is tossed. After an Indiana judge rejects a county CON ordinance, attention shifts to the state level in hospital construction battles.

In states without CON laws, some local governments have been instituting their own control over hospital construction. Now a federal judge has struck down a CON ordinance in Morgan County, Ind., clearing the way for a $40 million hospital expansion project. "This experiment of trying to do (CON) at the local level won't work," says Joseph Chappelle, left, the attorney for Morgan County.

Certificate of Need↗
PubMed2006

Scoping supermarket availability and accessibility by socio-economic status in Adelaide.

METHODS: We use a geographic information system to measure availability and accessibility of supermarkets in four case study local government areas (LGAs). The location of supermarkets is analysed in relation to residential dwellings, car ownership and in terms of travel distance along the road network. RESULTS: This methodology identifies differences in both availability and accessibility between and within LGAs. It shows that a local-level approach to the issue of food deserts is warranted and suggests that generalisations based on large geographic areas are unlikely to be meaningful. CONCLUSIONS: A significant number of households live in 'food deserts' in Adelaide and these can only be identified using a local-level approach.

Geographic Information Systems↗
PubMed2003

Sustainable urban development in Brisbane City--the Holy Grail?

Impacts from urban stormwater runoff on receiving environments have been well documented, particularly through specific regional scientific studies. Using various local government planning and management elements, urban developments in Brisbane City are now able to address stormwater management in an increasingly holistic context. One key initiative includes facilitating Water Sensitive Urban Design (WSUD) components within an Integrated Water Management Strategy that looks at policy formation, planning strategies, design option, community marketing and acceptance, maintenance programs and finally evaluation of various WSUD approaches. These can include the use of Natural Channel Designs, grassed swales, bio-filtration systems, porous pavements and roofwater tanks in several economic combinations. By linking with the Cooperative Research Centre for Catchment Hydrology, Brisbane City Council has influenced the design of WSUD planning tools and benefited the city with academic inputs into extensive evaluation programs. As well, it has also contributed to the Cooperative Research Centre's research outcomes. These evaluation programs are increasingly providing better understanding of various stormwater quality best management practices throughout Australia. As part of the overall implementation process, active involvement by a range of stakeholders has been crucial. These stakeholders have included internal planning, development assessment and design staff, external consultants, developers, and other local and state government agencies. The latter two groups are assisting in the important task of "regionalisation" of Brisbane City Council's policies and guidelines. Implementation of WSUD initiatives and stormwater re-use strategies under Council's new "Integrated Water Management" agenda are showing some excellent results, suggesting that sustainable urban development is no longer like the search for the Holy Grail.

Conservation of Natural Resources↗
PubMed1997

Community contact persons promote utilization of obstetric services, Anambra State, Nigeria. The Enugu PMM Team.

PRELIMINARY STUDIES: Focus group discussions revealed delay in seeking and reaching emergency care as a factor contributing to maternal mortality in Njikoka Local Government Area. INTERVENTIONS: After obstetric services at local hospitals had been upgraded, 48 community contact persons were recruited. They were trained to improve community awareness of obstetric complications and to facilitate referral of women with complications. They were responsible for establishing links with pregnant women, improving access to transport, and mobilizing the community to donate blood. RESULTS: Over 18 months, community contact persons referred 18 women with major obstetric complications for treatment at health facilities. Fifty-two pregnant women were referred for other reasons. A total of 129 women were assisted by the community contact persons. This number declined sharply over time, from 60 in the first half of 1994 to 16 in the first half of 1995. COSTS: The community contact persons intervention cost approximately US $635, with 64% coming from project funds, 25% from government and 11% from the community. CONCLUSIONS: Community contact persons can perform a valuable role in facilitating referral of women with obstetric complications and supporting health education activities.

Female↗
PubMed1986

Localized, operable soft tissue sarcoma of the lower extremity.

Recent developments in adjuvant treatment of soft tissue sarcomas of the extremities have altered the surgical approach to this disease. To assess the effects of changing management on local recurrence rates and to examine factors governing local failure, we reviewed the records of 315 adults with operable, nonmetastatic soft tissue sarcoma of the lower extremity who were treated at one institution over a ten-year period. The median follow-up was 8.2 years. One third of our patients presented with locally recurrent tumors after initial treatment elsewhere. Sixty-six percent of the lesions were above the knee, and 60% were high grade. Two thirds of the patients underwent limb-sparing surgery (LSS), which in the latter half of the study period outnumbered amputations by four to one. Local recurrence was directly related to the adequacy of the surgical margins. Adjuvant radiotherapy and chemotherapy did not significantly decrease local recurrence in patients who underwent LSS, although favorable trends were observed. A significantly increased risk of local failure was associated with age greater than 53 years, presentation with local recurrence, high tumor grade, deep location, positive nodes, and less than adequate surgical margins. Local failure also varied significantly with histologic type and was highest in patients with embryonal rhabdomyosarcoma and neurofibrosarcoma. Improved local control, particularly in patients with high-grade tumors, was observed in the latter half of the study period despite the increased use of LSS. When the data were subjected to multivariate analysis, the following variables emerged as independent predictors of local failure: age greater than 53 years, presentation with local recurrence, high grade, less than adequate margins, embryonal rhabdomyosarcoma, and neurofibrosarcoma. The key to local control of sarcomas of the extremities is resection of the tumor with adequate margins. The role of adjuvant treatment, particularly following LSS, is still being evaluated. The risk factor profile should be considered when selecting a treatment program for patients with lower extremity sarcomas.

Adolescent↗
PubMed1991

Ambulatory care in the public sector: perinatal care in Los Angeles County.

In planning its response to the increasing demand for perinatal services and the increasing rate of infant mortality and low-birthweight infants the Los Angeles County Department of Health Services faces a formidable set of tasks. Initiatives already in place are attempting to deal with some of the most pressing problems. However, increased services must be made available to enable the increasing number of women to access the system of care, and further outreach is necessary to encourage more women to begin prenatal care early in pregnancy. The county needs to increase the availability of perinatal care services, and these services must respond to the cultural and socioeconomic needs of pregnant women. Financial barriers to care must be eased, and the process of qualifying for Medi-Cal must be simplified. Additional private providers need to be brought into the system, and alternative care providers--such as birthing centers and delivery by midwives--should be expanded for low-risk pregnancies. The DHS has been forced to respond to staggering increases in demands for perinatal care services, and the population pressures and the widening socioeconomic gaps are unlikely to decrease in the near future. These same forces also require the DHS to respond to the increased demand for other health services. The DHS is being required to develop and maintain a complex program of health services without adequate financial resources. The solution to the perinatal care crisis in Los Angeles County and other localities with high rates of poverty cannot be found solely within local governments. It is unrealistic to expect that local taxation can support an increase of this magnitude in the need for care, and increased state and federal support is essential. Other nations, spending far less for health care, produce significantly better results: how much longer will it take this nation to recognize its responsibilities to its most vulnerable citizens?

Adolescent↗
PubMed2003

Public health, law, and local control: destruction of the US chemical weapons stockpile.

Destruction of US chemical weapons has begun at one of the 8 sites in the continental United States, was completed on Johnston Island in the Pacific Ocean, and is scheduled to begin in at least 3 other locations during the upcoming year. About 25% of the stockpile and 38% of the munitions had been destroyed as of December 31, 2002. However, the program has become controversial with regard to choice of technology, emergency management, and cost. This controversy is in large part due to efforts by some state and local governments and activist groups to play a more central role in a decision making process that was once fully controlled by the US Army.

Chemical Warfare Agents↗
PubMed2005

What lessons can be drawn from tuberculosis (TB) control in China in the 1990s? An analysis from a health system perspective.

China has made a significant achievement in tackling the TB epidemic over the last decade, due largely to the implementation of directly-observed treatment strategy (DOT). The cure rate of TB cases reached more than 90% for registered TB patients. However, the case detection rate has, unfortunately, been very low (some 30%). Using available information, this paper identifies four main problems facing TB control in China, these are, low case finding, a substantial proportion of TB patients failing to complete standardised treatment, increased proportion of MDR TB patients, and lack of effective TB control among "floating populations". The paper also analyses the possible causes of these problems associated with socio-economic barriers in care seeking, ineffectiveness of TB services, particularly in poor areas, lack of co-operation between health facilities, and weakness of political and financial commitments of local governments to TB control. The paper ends with the discussion of opportunities and challenges facing TB control and makes recommendations for further actions and research.

China↗
PubMed1997

Attempts to decentralize in recent Brazilian health policy: issues and problems, 1988-1994.

Decentralization became an official policy in the Brazilian health sector after the fall of the military regime of 1964-1985. In this article the author reviews the concept and types of decentralization, with particular attention to the process of decentralization itself. There is a gap between the type of decentralization (devolution) called for in the national constitution and the deconcentration of activities actually implemented. This gap is explained by Brazil's centralist tradition and its supporters, staff resistance at the national level, and the weakness of local governments. Several methods could be used to redirect the reforms toward their original purpose, such as improving community participation, establishing a clear agenda for the decentralization process, and setting up some mechanisms to enhance this policy.

Brazil↗
PubMed2002

Balancing responsibility for sanitation.

In response to the failure of existing means of service provision, environmental health policy is increasingly adopting a framework of governance for providing sanitation. Governance refers to the patterns of interaction between civil society and government. It is viewed here in terms of four dimensions: political, institutional, technical and cultural. The interactions are often described as partnerships and imply a balancing of joint responsibility. A number of issues can be identified in the literature as requiring consideration when adopting a joint responsibility for environmental health issues. These include, the need to distinguish between community and individual rights; the extent to which there is a shared interest in a community rights issues; the institutional framework for upholding the rights of citizens and the need to guard against new inequalities. The research question was: what are the factors that may inhibit or promote the involvement of community-based organisations (CBOs) in the sanitation provision process? From October 1996 to March 1997, an exploration of these factors was conducted in Cape Town, South Africa. A multiple-case study, with an embedded design, of two CBOs was conducted. This paper focuses on the extent to which there was a shared responsibility between local government and CBOs towards sanitation provision in the context of a bill rights which provides people with a right to a healthy living environment. It was found that institutional and technical capacity, political will and cultural diversity will impact on the balance between rights and responsibility. The four dimensional framework of governance is thus a useful tool for exploring the dynamic and diverse nature of environmental health.

Attitude to Health↗
PubMed2004

Planning continuity and the actual conditions of shopping malls.

The main purpose of this study is to investigate the continuity of the planning of shopping malls in downtown areas of Japan and to look into the tendencies of the current existing malls until today. This paper is a summary of a survey conducted on the actual conditions of current shopping malls and a questionnaire administered to local governments in the survey areas. The results of this study allow us to summarize the reasons for and changes caused by renewal efforts directed toward the streets, public spaces, and urban elements (pavement, bench, streetlight, arcade, sculpture, etc.) in shopping malls. Furthermore, these results also help us to understand the scale of the renewal efforts as well as their timing in relation to when the shopping mall was originally constructed.

Commerce↗