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PubMedDate not supplied

Preventable feto-infant mortality: application of a conceptual framework for perinatal health surveillance to Manitoba perinatal outcomes.

BACKGROUND: Perinatal health surveillance systems have lacked conceptual frameworks to translate data into information for policy and program planning. This paper demonstrates the application of a conceptual framework in the analysis of feto-infant mortality data in the province of Manitoba. METHODS: Fetal and infant deaths were categorized according to a two-dimensional framework of birthweight and age-at-death, and grouped into four broad categories of contributors to perinatal health: Maternal Health, Maternal Care, Newborn Care, and Infant Care. Birth Weight Proportionate Mortality Rates (BWPMR) were calculated for each of the four categories, and preventable "excess" feto-infant mortality was estimated through comparisons to a benchmark sub-population. RESULTS: Between 1985 and 1998, feto-infant mortality declined from 12.3 to 9.8 deaths per 1000 births in Manitoba. Much of this decline occurred in the Newborn Care category; there were only slight declines in deaths attributed to Maternal Health and Infant Care factors. Comparison of the feto-infant mortality rate to the benchmark rate revealed an excess of 3.46 deaths per 1000 births, an "opportunity gap" of 33%. Substantial regional variations in feto-infant mortality rates were observed. SUMMARY: Application of this conceptual framework provided useful information to aid in policy and program planning. As the greatest excess feto-infant mortality was observed in the Maternal Health and Infant Care categories, attention to the broader determinants of health which influence these categories will be required.

Adult↗
PubMed2006

Harriton, Waller And Australian negligence law: is there a place for wrongful life?

Following the decision by the Supreme Court of New South Wales in Harriton and Waller, the controversial action for wrongful life has been thrown back into the public spotlight. This article examines the legal and public policy dilemmas arising from a wrongful life claim in light of the Court of Appeal's reasons for its decision in the jointly heard cases of Harriton (by her tutor) v Stephens; Waller (by his tutor) v James; Waller (by his tutor) v Hoolahan (2004) 59 NSWLR 694 and analyses whether there is a sound doctrinal basis for recognising the claim within the Australian tort system. It will be argued that each of the legal elements comprising the claim fall squarely within the traditional tort framework and that public policy considerations favouring recognition of the claim outweigh those raised against it.

Antithrombin III Deficiency↗
PubMed2006

Analysing ethnobotanical and fishery-related importance of mangroves of the East-Godavari Delta (Andhra Pradesh, India) for conservation and management purposes.

Mangrove forests, though essentially common and wide-spread, are highly threatened. Local societies along with their knowledge about the mangrove also are endangered, while they are still underrepresented as scientific research topics. With the present study we document local utilization patterns, and perception of ecosystem change. We illustrate how information generated by ethnobiological research can be used to strengthen the management of the ecosystem. This study was conducted in the Godavari mangrove forest located in the East-Godavari District of the state Andhra Pradesh in India, where mangroves have been degrading due to over-exploitation, extensive development of aquaculture, and pollution from rural and urbanized areas (Kakinada).One hundred interviews were carried out among the fisherfolk population present in two mangrove zones in the study area, a wildlife sanctuary with strong conservation status and an adjacent zone. Results from the interviews indicated that Avicennia marina (Forsk.) Vierh., a dominant species in the Godavari mangroves, is used most frequently as firewood and for construction. Multiple products of the mangrove included the bark of Ceriops decandra (Griff.) Ding Hou to dye the fishing nets and improve their durability, the bark of Aegiceras corniculatum (L.) Blanco to poison and catch fish, and the leaves of Avicennia spp. and Excoecaria agallocha L. as fodder for cattle. No medicinal uses of true mangrove species were reported, but there were a few traditional uses for mangrove associates. Utilization patterns varied in the two zones that we investigated, most likely due to differences in their ecology and legal status. The findings are discussed in relation with the demographic and socio-economic traits of the fisherfolk communities of the Godavari mangroves and indicate a clear dependency of their livelihood on the mangrove forest.Reported changes in the Godavari mangrove cover also differed in the two zones, with significantly less perceptions of a decrease in the protected area, as compared to the adjacent non-protected area. A posteriori comparisons between sequential satellite imagery (retrospective till 1977) and respondents that were at least 15 years back then, revealed a mangrove decrease which was however perceived to different extents depending on the area with which the fishermen were familiar. While local needs had not been incorporated in the existing policy, we created a framework on how data on ethnobotanical traditions, fishery-related activities and local people's perceptions of change can be incorporated into management strategies.

Adolescent↗
PubMed1992

A template for health information.

The Template for Health Information is a software package for microcomputers developed by the National Task Force on Health Information of Statistics Canada. The Template software provides a conceptual framework for the collection, analysis and utilization of health information for policy planning and management uses. This framework involves interactions between a population of individuals, their external environment, and sets of potential health-affecting interventions. The Template is seen as a pedagogical device for incorporating the many perspectives of different health constituencies. A floppy diskette is provided with the article to demonstrate the potential of the Template.

Canada↗
PubMed2000

A comparison of health care financing policies for incontinence products in European countries.

OBJECTIVES: This paper offers an overview of the different health care financing policies for incontinence products in 16 European countries and provides health care decision-makers with a framework for positioning their financing policy for incontinence products versus other European countries. METHODS: A questionnaire was sent to institutions or persons acquainted with the health care financing system towards incontinence products in 19 countries. Further details were collected by additional telephone interviews and information from several informants. Three countries did not provide information. RESULTS: Financing systems for incontinence products differ widely from country to country. In all countries, hospitalized incontinent patients are better covered than patients residing in institutions for geriatric care. It is furthermore a common phenomenon that patients living at home receive even less coverage. Moreover, most countries apply a fairly uniform type of financing system, meaning that, once assessed in need, financial coverage is very similar for all patients (i.e. not very much differentiated with respect to the nature and severity of their incontinence problems). CONCLUSION: Given the serious potential impact of incontinence on citizens' quality of life and given the substantial variations in degree of incontinence, most countries could improve their utilization of (scarce) health care resources devoted to incontinence by developing more 'selective' payment policies, whereby reimbursement is 'tailored' to patients' needs.

Europe↗
PubMed1990

Population aging and social security: a politico-economic model of state pension financing.

"The present paper attempts to provide a positive, politico-economic explanation of actual social security policies [in developed countries]. A theoretical framework is devised which integrates individual utility maximization and governmental maximization of expected political support. Individual support depends on how net economic benefit from a pay-as-you-go financed state pension scheme is translated into a probability of voting for the government. The relation between net economic positions, public policy parameters, and voting probabilities is made explicit by referring to the logit model of qualitative choice. The analysis is set in an overlapping generations framework. Optimal state pension policies are characterized, relating such diverse factors as population aging, political power distribution, social solidarity, and income taxation." (SUMMARY IN FRE AND GER)

Demography↗
PubMed2004

Principles and perspectives.

BACKGROUND, AIM AND SCOPE: With respect to the enormous increase of chemical production in the last decades and the tens of thousands of individual chemicals on the market, the permanent improvement of chemical management is a permanent target to achieve the goals of sustainable consumption and production set by the WSSD in Johannesburg 2002. MAIN FEATURES: Several approaches exist to describe sustainability of chemistry. However, commonly agreed criteria are still missing. There is no doubt that products of modern chemistry help to achieve important goals of sustainability and that significant improvements have occurred regarding direct releases from production sites, but several facts demonstrate that chemistry is far from being sustainable. Still too many chemicals exhibit hazardous characteristics and pose a risk to health and environment. Too many resources are needed to produce chemicals and finished products. RESULTS AND CONCLUSION: Therefore, a strategy for sustainability of chemistry should be developed which comprises the following main elements: 1. Sustainable chemicals: sustainable chemical management includes a regulatory framework which makes no difference between new and existing chemicals, contains efficient information flow through the supply chain which allows users to handle chemicals safely and offers an authorisation procedure and/or an efficient restriction procedure for substances of high concern. This regulatory scheme should promote the development of inherently safe chemicals. 2. Sustainable chemical production: Sustainable chemical production needs the development and implementation of emerging alternative techniques like selective catalysis, biotechnology in order to release less CO2 and less toxic by-products, to save energy and to achieve higher yields. Information exchange on best available techniques (BAT) and best environmental practices (BEP) may help to promote changes towards more sustainability. 3. Sustainable products: An integrated product policy which provides a framework for sustainable products promotes the development of products with a long-term use phase, low resource demand in production and use, low emission of hazardous substances and properties suitable for reuse and recycling. This may be promoted by eco-labelling, chemical leasing concepts and extended information measures to enhance the demand of consumers and various actors in the supply chain for sustainable products. RECOMMENDATION AND PERSPECTIVE: Important tools for the promotion of sustainable chemistry are the abolition of barriers for innovation in legislation and within the chemical industry, more transparency for all users of chemical products, a new focus on sustainability in education and research, and a new way of thinking in terms of sustainability.

Chemical Industry↗
PubMed1987

Executive Order No. 119 reorganizing the Ministry of Health, its attached agencies and for other purposes, 30 January 1987.

This Order reorganizes the Ministry of Health. The Ministry has the power to do the following, among other things: "a) define the national health policy and formulate and implement a national health plan within the framework of the government's general policies and plans, and to present proposals to appropriate authorities on national issues which have health implications;" and "f) propagate health information and educate the population on important health, medical and environmental matters which have health implications." Among the staff support services to the Minister is the "Public Information and Health Education Service, which shall provide services related to formulating and implementing plans, programs, and projects for public education on health and for the timely and accurate public communication of Ministry policy on health issues." The Ministry also contains an Office for Public Health Services composed of ten staff services, among which are the following: "a) Maternal and Child Health Service, which shall formulate plans, policies, programs, standards and techniques relative to maternal and child health; provide consultative training and advisory services to implementing agencies; and conduct studies and research related to health services for mothers and children," and "c) Family Planning Service, which shall formulate plans, policies, programs, standards and techniques relative to family planning in the context of health and family welfare; provide consultative training and advisory services to implementing agencies; and conduct studies and research related to family planning."

Asia↗
PubMed1999

Idealist thought, social policy and the rediscovery of informal care.

Recent work in the history of welfare has suggested a need to reconsider the status of some conceptual frameworks within sociology and social policy studies regarding the meaning of 'social welfare' and the 'welfare state'. In this context, the present article argues in particular that the marked upswing of interest in informal care in the UK beginning in the 1970s reflected, at least in part, a reaction, itself not so far adequately understood, to some features of the work of Richard Titmuss and 'traditional social administration', work which, on examination, reveals a distinctive 'idealist' core, unsympathetic to research into familial patterns of caring. Similarities with 'classic' British idealism, broadly defined, at the end of the nineteenth and beginning of the twentieth centuries are reviewed. This idealist thought emerges too as unresponsive to informal care, even though contemporary non-idealist thought had discussed it. The article concludes that the (unacknowledged) persistence and influence of idealist modes of social thought diverted attention away from informal care; informal care was in fact not 'discovered' in the 1970s, it was rediscovered as idealist preconceptions about the nature of 'real' welfare were discarded. The sense of 'discovery' reflected prevailing and dubious historigraphical interpretations of the meaning of 'social welfare' and the status of the ('classic') 'welfare state'.

Attitude to Health↗
PubMed2006

Quality of acute stroke care improvement framework for the Paul Coverdell National Acute Stroke Registry: facilitating policy and system change at the hospital level.

The Paul Coverdell National Acute Stroke Registry prototypes baseline data collection demonstrated a significant gap in the use of evidenced-based interventions. Barriers to the use of these interventions can be characterized as relating to lack of knowledge, attitudes, and ineffective behaviors and systems. Quality improvement programs can address these issues by providing didactic presentations to disseminate the science and peer interactions to address the lack of belief in the evidence, guidelines, and likelihood of improved patient outcomes. Even with knowledge and intention to provide evidenced-based care, the absence of effective systems is a significant behavioral barrier. A program for quality improvement that includes multidisciplinary teams of clinical and quality improvement professionals has been successfully used to carry out redesign of stroke care delivery systems. Teams are given a methodology to set goals, test ideas for system redesign, and implement those changes that can be successfully adapted to the hospital's environment. Bringing teams from several hospitals together substantially accelerates the process by sharing examples of successful change and by providing strategies to support the behavior change necessary for the adoption of new systems. The participation of many hospitals also creates momentum for the adoption of change by demonstrating observable and successful improvement. Data collection and feedback are useful to demonstrate the need for change and evaluate the impact of system change, but improvement occurs very slowly without a quality improvement program. This quality improvement framework provides hospitals with the capacity and support to redesign systems, and has been shown to improve stroke care considerably, when coupled with an Internet-based decision support registry, and at a much more rapid pace than when hospitals use only the support registry.

Acute Disease↗
PubMed2006

The costs and benefits of reforestation in Liping County, Guizhou Province, China.

Reducing greenhouse gases in the atmosphere is becoming a pressing issue for the global community. Afforestation and reforestation are promoted worldwide as an effective means of sequestering carbon. For its national interest and global concerns, China has made great efforts to protect its existing forests and develop programs of afforestation and reforestation. Based on two surveys recently conducted in Liping County, Guizhou province, this paper investigates the economic changes associated with the implementation of the "Grain For Green" policy. Based on the analytical framework of benefit cost analysis, this paper concludes that the implementation of the reforestation of sloping agricultural land policy would not be possible if there were no government subsidies for the peasants. The short term economic returns of land and labour from forestation are substantially lower than those generated from grain or cash crop production on the steep slope lands. The government subsidies provide great economic incentives for peasants to take part in the project. The subsidies in fact have elevated peasant income in rural Liping. The estimated potential economic returns of plantations over the long run indicate that the removal of the government financial subsidies would not create an economic crisis for the peasants if the current market conditions continue.

Agriculture↗
PubMedDate not supplied

Mental health system and services in Albania.

AIMS: To describe the mental health system in Albania. METHODS: Data were gathered in 2003 and in 2004 using a new WHO instrument, World Health Organization Assessment Instrument for Mental health Systems (WHO-AIMS), designed for collecting essential information on the mental health system of low and middle income countries. It consists of 6 domains, 28 facets and 156 items. RESULTS: The information collected through WHO AIMS covered the key aspects of mental health system in Albania: the mental health policy and the legislative framework, the network of mental health services and the characteristics of the users, the role of the primary health care, the human resources, the public education and the links with other governmental sectors, monitoring and research. CONCLUSIONS: The data collection through WHO AIMS represented a needed step for a better in-depth knowledge of the system and for implementing actions to strengthen the system. Examples of planned actions were the improvement of the mental health component in primary care, a clear shift of resources from mental hospitals to community facilities, an increase of the outpatient care and an expansion of the mental health information system.

Albania↗
PubMed2000

Systematic reviews of injury-prevention strategies for occupational injuries: an overview.

BACKGROUND: Information on which strategies have been shown to be effective, which are ineffective, and which strategies have been inadequately evaluated is important for both public policy and future research. OBJECTIVE: The objective of this study was to provide systematic reviews of the literature on important strategies to prevent occupational, including agricultural, injuries. METHODS: The Injury Control Research Centers (ICRCs) funded by the National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention, and Centers for Agricultural Injury funded by the Division of Safety Research, the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, identified 12 important occupational and agricultural injury-prevention strategies or areas of research. Systematic reviews of the literature were conducted to identify relevant controlled trials and studies. These were critically reviewed and summarized. RESULTS: A total of 12 reviews were conducted on a range of topics in the occupational injury field. Few randomized controlled trials were found; most controlled studies were either comparisons over time and/or across different populations. In several areas we were limited to summarizing the descriptive literature. Nevertheless, summaries of these studies provide meaningful conclusions about the effectiveness of various interventions to decrease morbidity and mortality from selected occupational and agricultural injuries. CONCLUSIONS: A large body of literature on occupational, public health, or injury prevention interventions exists. The summary of this literature provides a framework to both direct policy and guide future research efforts.

Accidents, Occupational↗
PubMed2005

Conversational silence, coercion, equality: the role of language in influencing who gets identified as abused.

Various methods of ascertaining self-reported exposure to intimate partner violence (IPV) in health care and research settings have been evaluated to identify women who interpret themselves as abused for clinical and research intervention. However, few interpretive frameworks have been proposed to explain factors that may influence the success of this ascertainment process, including the contribution of language in facilitating women's interpretations of situations as abusive across social, cultural and historical contexts. This omission is substantial, given that IPV is context-specific, involving interaction between individuals of diverse linguistic and cultural backgrounds and their sociocultural environment. In the first part of this paper, we outline hermeneutics, one interpretive theoretical tradition to describe approaches to interpreting IPV. Hermeneutics is a linguistic philosophy that focuses on questions of how people understand spoken language, written text, and themselves through language across sociocultural environments. Hermeneutics acknowledges conditions and situations that facilitate opportunities for broad shared understanding and vocabularies about violence between communities, professionals and abused women, which in turn may reduce harm to women and negotiate action women may want to take in response to situations they interpret as abusive. In the second and third parts of the paper, we compare and contrast the strengths and limitations of three common approaches for asking women about IPV in health care and research settings, and outline a multi-dimensional IPV ascertainment tool that incorporates the three asking approaches to facilitate professionals bringing broad definitions of and vocabularies about abuse to encounters with women. This paper provides health care researchers, clinicians and policy makers with a framework for understanding the potential influence of language on women's interpretations of IPV, including the role of community and professional conversational silence, coercion and equality in influencing women's interpretations. We look at the influence of language about intimate partner violence in the United States on women's interpretations of abuse, although the basic constructs presented here could be applied in other countries and settings.

Coercion↗
PubMed1994

From population control to reproductive health: an emerging policy agenda.

This article reviews the background to the current debates between advocates of population control and reproductive health as frameworks for national and international health policies. Population control has been a dominant metaphor in international family planning programs since the 1960s. Population control has frequently meant pursuing a single-minded goal of fertility limitation, often without sufficient attention to the rights of family planning clients. This narrow focus has led to some coercive policies, numerous ethical violations, and ineffective family planning programs. In the last decade there has been the beginning of a policy shift, advocated by a growing number of activists and researchers in women's health, from population control to reproductive health. A reproductive health framework would provide a broader programmatic focus that could bring needed attention to such issues as sexually transmitted diseases, infertility, abortion, reproductive cancers and women's empowerment generally.

Female↗
PubMed2004

Impact, regulation and health policy implications of physician migration in OECD countries.

BACKGROUND: In the face of rising demand for medical services due to ageing populations, physician migration flows are increasingly affecting the supply of physicians in Organisation for Economic Co-operation and development (OECD) countries. This paper offers an integrated perspective on the impact of physician migration on home and host countries and discusses international regulation and policy approaches governing physician migration. METHODS: Information about migration flows, international regulation and policies governing physician migration were derived from two questionnaires sent to OECD countries, a secondary analysis of EUROSTAT Labour Force Surveys, a literature review and official policy documents of OECD countries. RESULTS: OECD countries increasingly perceive immigration of foreign physicians as a way of sustaining their physician workforce. As a result, countries have entered into international agreements regulating physician migration, although their success has been limited due to the imposition of licensing requirements and the protection of vested interests by domestic physicians. OECD countries have therefore adopted specific policies designed to stimulate the immigration of foreign physicians, whilst minimising its negative impact on the home country. Measures promoting immigration have included international recruitment campaigns, less strict immigration requirements and arrangements that foster shared learning between health care systems. Policies restricting the societal costs of physician emigration from developing countries such as good practice guidelines and taxes on host countries have not yet produced their expected effect or in some cases have not been established at all. CONCLUSIONS: Although OECD countries generally favour long-term policies of national self-sufficiency to sustain their physician workforce, such policies usually co-exist with short-term or medium-term policies to attract foreign physicians. As this is likely to continue, there is a need to create a global framework that enforces physician migration policies that confer benefits on home and host countries. In the long term, OECD countries need to put in place appropriate education and training policies rather than rely on physician migration to address their future needs.

Journal Article↗
PubMed1999

Continuing health care: the local development of policies and eligibility criteria.

In 1995 the Department of Health issued guidance on continuing health care following the health service commissioner's finding against Leeds Health Authority for failing to provide long-term care. Under this guidance, health authorities were required to agree continuing health care policies and eligibility criteria with fundholders and local authorities. This study sought to investigate the extent to which the drafting of local policies and criteria, within the framework of national guidance, led to consistency between health authorities. A structured content analysis was conducted of all the policies and eligibility criteria in three regions. In particular, it aimed to establish the comprehensiveness of local policies, the nature of local criteria, the consistency of each between authorities and with the guidance, the development of plans for reinvestment and the balance between institutional and domiciliary services. Only a minority of authorities were found to have identified investments in services, notwithstanding the requirement to do so in the guidance. In addition, most documents were not comprehensive in their coverage of client groups, with more information being provided about services for older people and those with mental health problems. Few policies contained action plans to translate general intentions about equity and consistency into practice. Eligibility criteria frequently took the form of descriptions of services and/or were so general that they would be difficult to apply in individual cases. Most documents contained no criteria for community health services. Whilst just over half of them included the aim of moving resources from acute to community sectors, they contained far more detail about institutionally based services and, for a number of reasons, appeared likely to reinforce the imbalance towards the latter. The documents analysed were part of an evolutionary process of understanding the contribution of effective continuing care to managing pressures on acute beds. Their impact on patients and their families must, however, await the findings from subsequent stages of this research.

Journal Article↗
PubMedDate not supplied

The new cell culture smallpox vaccine should be offered to the general population.

A series of major factors must be weighed in deciding whether or not, and to what extent, a particular country should consider pre-exposure vaccination for smallpox. These include the risk of a bioterrorist attack using smallpox, the risk of secondary spread from another country, the risks and benefits of vaccination, the effectivenes s of vaccination pre- and post-exposure, the prevalence of immunocompromised persons, the capacity of the medical care delivery system and the wealth of a nation. We review here the issues and variables relevant for policy making, propose a framework for country-specific decision making and suggest the World Health Organization has a key role to play, particularly with regard to lower-income countries. In doing so, we support the proposition.

Bioterrorism↗