Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Development Policy”

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.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2000

PROFILE: Comparative Analysis of New Zealand and US Approaches for Agricultural Nonpoint Source Pollution Management.

/ Nonpoint source (NPS) pollution from widespread agricultural/pastoral land use in New Zealand can result in receiving water quality problems, but the Resource Management Act of 1991 requires the sustainable management of land and water resources. Many similar types of problems occur in the United States, where the Clean Water Act is the primary legislation addressing NPS pollution and progress has been made on the development and use of a variety of management approaches. However, little evaluation and comparison of approaches or cooperation between the two countries has occurred in the past. This type of analysis could provide information that is useful for more effective management of the problem. The goal of this study is to evaluate and compare approaches used in New Zealand and the United States for management of agricultural NPS pollution.The role of the central government in New Zealand is generally limited to research and policy development, and regional councils are responsible for most monitoring and management of the problem. The role of the federal government in the United States includes research and monitoring, policy development, and regulation. States also have a significant management role. Both countries rely on voluntary approaches for NPS pollution management. Very few national water quality standards exist in New Zealand, whereas standards are widely used in the United States. Loading estimates and modeling are often used in the United States, but not in New Zealand. A wide range of best management practices (BMPs) are used in the United States, including buffer strips and constructed/engineered wetlands. Buffer strips and riparian management have been emphasized and used widely in New Zealand.Many approaches are common to both countries, but management of the problem has only been partly successful. The primary barriers are the inadequacy of the voluntary approach and the lack of scientific tools that are useful to decision-makers. More work needs to be performed on the evaluation of approaches developed in both countries that could be applied in the other countries. In addition, more cooperation and information/technology transfer between the two countries should be encouraged in the future.

Journal Article↗
PubMedDate not supplied

Application of core function concepts to local health department occupational safety and health activities.

To illustrate how core function concepts might be useful in evaluation of specific local health department (LHD) programs, we analyzed preliminary results from a national questionnaire survey of LHD occupational safety and health (OSH) activities during 1992-1993 in categories corresponding to the three core functions: assessment, policy development, and assurance. Overall, 2,079 (71%) LHDs returned completed questionnaires. With regard to the first core function (assessment), the state health department was the most frequent source of data used by the respondent LHDs (47%) to assess worker health and occupational hazards. Concerning the second core function category (policy development), 5% of LHDs had conducted an appraisal in the past three years to summarize the OSH needs of their communities. With regard to the third core function category (assurance), 23% of LHDs directly provided worksite health promotion activities for workers in their communities. We conclude that core function concepts can be a useful adjunct in evaluation of specific LHD programs. Additional research is needed to further refine and improve core function indicators providing insights into specific LHD programs, as well as into overall LHD performance.

Community Health Services↗
PubMedDate not supplied

The impact of critical events of the 1980s on core functions for a selected group of local health departments.

Directors of 14 public health departments were surveyed for their perceptions on the impact of 20 critical events of the 1980s on public health performance. The departments were selected in 1979 from among those that were highly regarded by public health experts for exemplary performance, especially with regard to personal health services. The departments were the subjects of intensive case studies in 1979, 1983, and again in 1992. The public health functions that were most benefited in the 1980s were assessment and policy development. The assurance function was equivocally affected. Greatest positive impact was exerted by the acquired immunodeficiency syndrome-human immunodeficiency virus epidemic, by increase in fee income, and by the Institute of Medicine report, "The Future of Public Health." Negative influences, especially on the assurance function were exerted by loss of Federal grants, demographic changes, substance abuse, and economic downturn. Other critical events had equivocal or idiosyncratic effects. Analysis of public health practice according to the functions of assessment, policy development, and assurance appears to have utility for purposes of evaluation and planning.

Data Collection↗
PubMed1998

Dr. Miller goes to Washington: you should, too.

Otolaryngologists, like most physicians, tend to avoid local, state, and national politics for a variety of reasons. Although physicians and their patients are frequently affected by policies made in these political arenas, physicians tend to avoid active participation because of inexperience, lack of time, lack of knowledge about ways to influence policy development, and a general distaste for the political process. Otolaryngologists need to participate in the process to ensure that their particular perspectives and concerns are heard. However, otolaryngologists also need to look beyond their personal or specialty interests to influence the broader health care debate. Before we are specialists, we are first physicians who have a fiduciary responsibility to mankind (our patients) to improve the health care system for all Americans. We have a moral and ethical obligation to address, influence, and support health care beyond the specialty level. Health policy developed in an absence of physician input is missing the insight of expertise and experience.

Health Planning↗
PubMed2000

A study of factors associated with cost and variation in prescribing among GPs.

BACKGROUND: Inappropriate prescribing has the potential to harm both the individual and society. Previous research has identified doctor or demographic characteristics that influence prescribing variation but which were not amenable to change. OBJECTIVES: To identify modifiable factors associated with GP prescribing variance and cost. METHOD: Qualitative research methods were used in semi-structured taped interviews with 17 GPs in Avon, South West NHS Region, UK. RESULTS: GPs considered themselves cautious and conservative prescribers. Prescribing decisions often were justified by the prescriber, despite conflicting clinical or cost arguments. A personally developed drug formulary was used to reduce dilemmas potentially associated with prescribing uncertainty. Willingness to reflect upon, and measure, prescribing habits against set professional standards varied considerably. The absence of monitoring mechanisms of prescribing decisions, coupled with under utilization of the community pharmacist, resulted in uncertain prescribing outcomes. Some GPs found it difficult to keep up to date professionally due to perceived time constraints. Excessive patient demand was considered to influence their prescribing, but GPs stated that they were not unduly influenced by the drug representative. CONCLUSIONS: Prescribing makes a considerable impact on health and budgets and yet remains a contentious issue. Improved partnerships between patient, doctor and pharmacist must be established. Better prescribing decision monitoring and support through policy development and educational intervention is needed to reduce prescribing uncertainty. Newly established Primary Care Groups may need to reflect upon the difficulties facing prescribers, particularly when prescribing within cash-limited budgets, to avoid discord between prescribing behaviour and local policy development.

Adult↗
PubMed2000

The use of information technology in improving medical performance. Part III. Patient-support tools.

Despite the proliferation of computer-based resources for patients, usefulness has been limited to date. Already, 17,000 biomedical Internet sites exist, and patients are increasingly finding support and knowledge on the Internet, but the accuracy of the information found is highly variable and difficult for patients to assess. Patients have also found value in electronic communication with physicians, although relatively few physicians routinely use email to communicate with patients on a regular basis. Nonetheless, patient-focused information technologies potentially will have profound effects on medical care. With advancing sophistication of technology, patients will increasingly be able to compare and choose doctors using the Internet and to access information that allows them to monitor and regulate the quality of their own care. Further, technologies will likely be developed to allow patients to increasingly manage their own care -- whether they are patients with chronic illnesses such as diabetes or congestive heart failure who use customized software to adjust drug dosages and other treatments or patients with such common illnesses as headache or gastrointestinal infection who access self-management programs that may even write prescriptions for them. Thoughtful analysis and policy development will be critical for ensuring that the benefits are maximized and potential harm minimized. Specific areas include assessing the effects on outcomes and the characteristics of patients and technologies that succeed with self-management, and developing policies regarding liability for Web-based medical transactions and the privacy of information provided to physicians by email and via interactive Web sites.

Biomedical Technology↗
PubMed1986

Health educators in the workplace: helping companies respond to the AIDS crisis.

As the number of cases of AIDS increases, more and more companies will have to decide how to handle employees with AIDS and those at high risk. AIDS creates medical, legal, and ethical issues in the workplace, all of which are emotional and complex; managers need expert assistance to guide their decision-making and policy development. This article identifies various dimensions of the AIDS-related issues emerging in corporations nationwide, including: confidentiality, the right of patients to work, benefits and insurance, HTLV-III screening, fears of contagion among workers, needs of companies to avoid financial and legal exposure, and effects on worker productivity. Health educators are in a unique position to contribute to the satisfactory resolution of AIDS-related problems in the workplace through their training and experience in education, policy development and the relevant legal and ethical issues in the health care field. However, they will have to initiate discussions with corporation executives themselves in order to reach this most important audience.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The political development of "Program Realignment": California's 1991 mental health care reform.

This article reviews the legislative process that resulted in the most significant reform of California's public mental health system in nearly 25 years. The reform, termed "Program Realignment," decentralized administrative and fiscal control of the mental health system from the state to the county level. The system prior to Program Realignment is discussed here to reveal an already diverse and decentralized county mental health system, fiscal distress, and general dissatisfaction with the system. From these conditions, the objectives of the relevant political actors arose. By tracing the policy development process of Program Realignment, several independent variables are revealed that help explain how and why this legislation came into being and allow generalization of this case to other states' experiences. These independent variables are an urgent need for action within a limited timeframe, a preexisting knowledge base and well-developed policy networks, a spirit of bipartisan cooperation, and the presence of strong leadership. Preliminary evidence suggests that consolidation of fiscal and programmatic authority at the local level has reduced fragmentation of services and increased fiscal flexibility. However, there is concern that the quality of care offered by the state's 59 local mental health programs will become increasingly disparate and that increased financial flexibility may not be used to improve services for clients but to save money for local governments. Lessons from California's experience can alert other states to the pros and cons of this policy approach to providing mental health services and inform policymakers in other states of the steps involved in bringing about such a policy change.

Budgets↗
PubMed1996

From genes to public health: the applications of genetic technology in disease prevention. Genetics Working Group.

OBJECTIVES: With advances in the Human Genome Project, the implications of genetic technology in disease prevention should be assessed. METHODS: The paradigm suggested in The Future of Public Health--assessment, policy development, and assurance--was used to examine the continuum from genetic technology to public health practice. RESULTS: First, important public health functions are to (1) assess the impact of genes and their interactions with modifiable disease risk factors on the health status of the population and (2) assess the impact and safety of genetic testing on the population. Second, given the many implications of genetic testing, the public health community should participate in policy development related to the timing and use of genetic testing in disease prevention. Third, whenever appropriate, the public health community needs to ensure the development of public health genetics programs (e.g. newborn screening) and evaluate the quality and effectiveness of the use of genetic testing in disease prevention. CONCLUSIONS: Although most current genetic tests are not ready for disease prevention, there is an important role for the public health community in translating genetic technology into disease prevention.

Ethics, Medical↗
PubMed1995

Developing a health informatics policy for South Africa.

In a developing country, is it possible to produce a comprehensive national policy for health informatics in a rational and democratic way? This report argues that it is--if close attention is paid to the process of policy development. Although we have recently started our journey down this road, it is possible to draw useful conclusions. With sufficient funding to cover meeting costs and a supportive environment, such a project has a good chance of succeeding. The process should involve key stakeholders; agreement on definitions, purpose and scope should be obtained early. The policy should contain a strategy for implementation, measurable goals, plans for training and long term maintenance, and specifications for regular review. Health information systems should not be promoted as panaceas. Debates arising from the policy development process should promote realistic expectations shared by policy makers, system implementers, and managers. The process itself has significant benefits for the participants who both learn and establish networks with other people. Although developing countries depend on aid from international agencies, unexpected management problems may arise.

Health Policy↗
PubMed2000

Calling the shots: immunization finance policies and practices. Executive summary of the report of the Institute of Medicine.

Federal, state, and private-sector investments in vaccine purchases and immunization programs are lagging behind emerging opportunities to reduce the risks of vaccine-preventable disease. Although federal assistance to the states for immunization programs and data collection efforts rapidly expanded in the early part of the 1990s, significant cutbacks have occurred in the last 5 years that have reduced the size of state grant awards by more than 50% from their highest point. During this same period, the vaccine delivery system for children and adults has become more complex and fragmented. This combination of new challenges and reduced resources has led to instability in the public health infrastructure that supports the U. S. immunization system. Many states have reduced the scale of their immunization programs and currently lack adequate strength in areas such as data collection among at-risk populations, strategic planning, program coordination, and assessment of immunization status in communities that are served by multiple health care providers. If unmet immunization needs are not identified and addressed, states will have difficulty in achieving the national goal of 90% coverage by the year 2010 for completion of the childhood immunization series for young children. Furthermore, state and national coverage rates, which reached record levels for vaccines in widespread use (79%, 1998), can be expected to decline and preventable disease outbreaks may occur as a result, particularly among persons who are vulnerable to vaccine-preventable disease because of their underimmunization status. The Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices has therefore concluded that a renewal and strengthening of the federal and state immunization partnership is necessary. The goal of this renewed partnership is to prevent infectious disease; to monitor, sustain, and improve vaccine coverage rates for child and adult populations within more numerous and increasingly diversified health care settings; and to respond to vaccine-safety concerns. To achieve this renewal, states require a consistent strategy, additional funds, and a multiyear finance plan that can help expedite the delivery of new vaccines; strengthen the immunization assessment, assurance, and policy development functions in each state; and adapt childhood immunization programs to serve the needs of new age groups (especially adults with chronic diseases) in different health care environments. The IOM committee recommends that federal and state governments adopt a national finance strategy that would allocate $1.5 billion in federal and state resources over the first 5 years to strengthen the infrastructure for child and adult immunization-an annual increase of $175 million over current spending levels. These resources would consist of $200 million per year in state infrastructure grants awarded by the Centers for Disease Control and Prevention (the Section 317 program) and an additional $100 million per year in increased state contributions. The committee also recommends that the Congress replace the current discretionary Section 317 grants with a formula approach for state immunization grant awards to improve the targeting and stability of federal immunization grants. The formula should provide a base level of support to all states, as well as additional amounts related to each state's need, capacity, and performance. The committee further recommends that Congress introduce a state match requirement for the receipt of increased federal funds to help strengthen and stabilize the infrastructure that supports long-term public health assessment, assurance, and policy development efforts. (ABSTRACT TRUNCATED)

Adult↗
PubMedDate not supplied

National profile: overview of capabilities and core functions of local public health jurisdictions in 47 states, the District of Columbia, and 3 U.S. territories, 2000-2002.

This is the first nationally conducted survey targeting the full population of all local public health jurisdictions to assess the three core functions of public health: assessment, policy development, and assurance, as well as overall capabilities. Data were analyzed from 2,007 local public health jurisdictions in 47 states, the District of Columbia, and 3 U.S. territories (American Samoa, Northern Mariana Islands, and Puerto Rico) between July 2000 and April 2002, in a collaborative effort between the Centers for Disease Control and Prevention and the Department of Justice. An unweighted overall mean summary score of 65.4% (on a scale of 0% to 100%) was calculated from the responses to the 20-question survey. The mean summary scores across all 2,007 local public health jurisdictions for assessment, policy development, and assurance were 66.8%, 67.4%, and 63.0%, respectively. Also, data was analyzed by the population size of jurisdiction and the type of jurisdiction. The results provide national population baseline data for estimates of local public health jurisdiction capabilities and core functions that may be useful in identifying areas for improvement, in building a stronger U.S. public health system to better serve each community, and in educating the public about the core functions of public health to help ensure that public health agencies are accountable to those they serve.

Community Health Centers↗
PubMed2003

Self-rated performance of quality specialists in Korea.

This study was conducted to explore the self-rated performance level of quality specialists in Korea in order to provide information to direct the future needs for education and role orientation. The formal identification and appointment of quality specialists in health-care organizations in Korea began in the mid-1990s. The majority of quality specialists, appointed by their hospital, assumed positions without undergoing the prerequisite training or education. Extensive variation in performance has been recognized. The sample (n = 29) in this study included all quality specialists at hospitals in Seoul and Kyung-Gi province. Their performance was rated using a postal questionnaire consisting of a set of activities in five domains (policy development, data collection and analysis, communication and report, education and support, and administration). The response rate was 100%. The respondents had an average of 25.5 months of experience as quality specialists. Self-rated performance of quality-related activities demonstrated wide variation, independent of personal, departmental, or hospital-specific characteristics. The respondents rated their performance highly in the area of communication and reporting. The performance of administrative activities was rated lowest. Perceived differences between desired and actual performance were statistically significant in all activities of each domain, and were largest in policy development, and next in education and support. Self-rated performance among the five domains demonstrated positive, significant correlations. Hence, the findings imply the necessity of a formal education for quality specialists to accelerate balanced growth in all domains of quality activities.

Data Collection↗
PubMed1997

Recommendations for chemoprophylaxis after occupational exposure to human immunodeficiency virus: a public health agency perspective.

Public health agencies across the country uniformly retain three core functions, as identified in a 1988 Institute of Medicine report: assessment, assurance, and planning and policy development. The conduct of these functions will influence the ways the Public Health Service recommendations for postexposure prophylaxis are implemented locally. State, territorial, and local health departments play a key role in the monitoring and prevention of occupationally acquired human immunodeficiency virus (HIV) infections. Through assessment, public health agencies often are responsible for investigating healthcare workers who apparently have contracted HIV infection through an occupational exposure. In their function of providing assurance, public health agencies disseminate the national recommendations and may provide expert consultation taking into consideration local conditions. Specific healthcare worker exposure situations may pose complex medical and legal challenges best handled by public health agencies. In their role of providing policy development, public health agencies may convene an expert panel to review local data that affect postexposure prophylaxis, such as antiretroviral drug resistance and drug availability. The recommendations may result in legislative action in the form of mandatory testing of patients or other groups, and public health agencies must be wary of such attempts that are of unproven efficacy. Public health agencies nationwide must see that exposed healthcare workers and the clinicians counseling them are adequately informed about the risks of HIV transmission and the options available for prophylaxis.

Anti-HIV Agents↗
PubMedDate not supplied

Local health department effectiveness in addressing the core functions of public health.

Objective 8.14 of the Year 2000 National Health Objectives calls for 90 percent of the population to be served by a local health department effectively carrying out the three core functions of public health--assessment, policy development, and assurance. To provide a benchmark of local health department effectiveness in addressing the core functions and to assess implications for achieving the year 2000 target, a random national sample (stratified by jurisdiction and population base) of local health departments was surveyed to determine self-reported compliance with 10 public health practice performance measures that operationalize the core functions. Overall compliance with the 10 performance measures was 50 percent, based on weighted responses of 208 responding health departments. Compliance was highest for the practices related to the assurance function and least for practices related to the policy development function. Compliance was also high for departments serving a population of 50,000 or more and those smaller departments organized at the city and city-county levels. Using two different definitions developed by the investigators, 19 and 31 percent of the health departments were judged to be effective in addressing the core functions of public health. These data suggest that less than 40 percent of the U.S. population was served by a health department effectively addressing the core functions of public health in 1993. It appears that considerable capacity building within the public health system will be needed to achieve the year 2000 target of 90 percent.

Community Health Services↗
PubMed1981

Medical drugs of limited commercial interest: profit alone is a bitter pill.

Medical drugs of limited commercial interest frequently are unavailable to the public even though their therapeutic efficacy is well established. At present, availability of a particular drug is unpredictable, and determined largely by pharmaceutical industry willingness to produce the drug potentially at no profit. Anticipated profitability also profoundly guides drug development decisions by industry. Federal efforts by both the executive and legislative branches to develop policy aimed at facilitating development and distribution of medical drugs of limited commercial interest have intensified. Thorough analysis of the problems and of proposed plans for their amelioration is necessary to effect a policy which takes into account the social, political, and scientific factors, as well as the profit motive.

Commerce↗