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At least 541 records · Page 30Linked to original sources
PubMed1996

Laryngeal framework surgery for voice improvement.

Dysphonias resulting from incomplete glottis closure or inadequate vocal fold tension are eligible for phonosurgical correction. Many different phonosurgical techniques have been used for these indications, but the disadvantages associated with augmentation of the vocal folds by means of intracordal injections and the favourable reports concerning laryngeal framework surgery, have lead to a change in treatment policy in many centers. Most phonosurgeons presently advocate laryngeal framework surgery as the first treatment of choice. For correction of incomplete glottis closure usually thyroplasty type 1 and arytenoid adduction techniques are used. For correction of vocal fold tension cricothyroid approximation and thyroplasty type 3 can be used. Often combinations of different techniques are required to achieve the best result. It is therefore essential to perform these procedures under local anaesthesia, so that the voice can be monitored during the surgery and so that the surgery can be tailored to the patient's voice, 119 patients underwent laryngeal framework surgery, 85 of them for correction of incomplete glottis closure, which in 75 patients was due to unilateral vocal fold immobility. The results in this group were good also in long term follow-up. Complications were few and insignificant. For 30 patients, mostly transsexuals, the aim of surgery was to obtain a higher vocal pitch. This was successful in most patients, but 4 patients had cartilage fracture at the time of surgery as a result of the extreme cricothyroid approximation required. In all cases adequate repair could be obtained without further sequellae.

Glottis↗
PubMed1990

Finding audiences, changing beliefs: the structure of research use in Canadian health policy.

The impact of research information depends on its ability to change beliefs or policy assumptions within the relevant audiences. As a hybrid of American and British systems, Canada's chosen decision-making structure for policy-making and its legislative framework for health insurance make these audiences unclear and not readily accessible. This factor and historical characteristics of the research community which made them only partially responsive to the values of decisionmakers provide an explanation for the limited past use of research information in Canadian health policy. More recently, improved responsiveness by researchers and an emerging definition of the audiences by legislative policymakers are bringing about a gradual increase in the potential impact of research at the levels of administrative and clinical policy. Because of continuing decision-making constraints on legislative policy, however, impact at this level is predicted to remain diffuse, with only cautious acceptance of the changes in beliefs implied by research.

Attitude to Health↗
PubMed1996

Media advocacy: a strategy for advancing policy and promoting health.

The purpose of media advocacy is to promote public health goals by using the media to strategically apply pressure for policy change. It provides a framework for moving the public health discussion from a primary focus on the health behavior of individuals to the behavior of the policymakers whose decisions structure the environment in which people act. It addresses the power gap rather than just the information gap. Media advocacy focuses on public policy rather than personal behavior. This article uses two case studies to illustrate key aspects of media advocacy. The first is a 5-year statewide violence prevention initiative for young people in California. The second focuses on the activities of a mothers' group working to improve public housing. The "new public health," with its focus on participation, policy development, and political processes, could benefit from incorporating media advocacy.

Adolescent↗
PubMed1997

Policy research for disease prevention: challenges and practical recommendations.

Policy approaches to health promotion and disease prevention hold great potential, as several community-based projects have illustrated. Policy interventions, despite their wide-spread use, frequently lack a systematic framework for implementation and evaluation. The authors propose a four-stage framework for the formation and evaluation of public health policy. The stages are identification of health risks and preventive options; intervention development; policy development; and policy enactment and assurance. A strong focus on evaluation is included within the framework. In addition, a series of practical implications and recommendations are given under the broad headings of evaluation issues and linkages. It is hoped that the issues described will lead to more systematic implementation and evaluation of public health policy measures.

Health Policy↗
PubMed2001

Bayesian value-of-information analysis. An application to a policy model of Alzheimer's disease.

A framework is presented that distinguishes the conceptually separate decisions of which treatment strategy is optimal from the question of whether more information is required to inform this choice in the future. The authors argue that the choice of treatment strategy should be based on expected utility, and the only valid reason to characterize the uncertainty surrounding outcomes of interest is to establish the value of acquiring additional information. A Bayesian decision theoretic approach is demonstrated through a probabilistic analysis of a published policy model of Alzheimer's disease. The expected value of perfect information is estimated for the decision to adopt a new pharmaceutical for the population of patients with Alzheimer's disease in the United States. This provides an upper bound on the value of additional research. The value of information is also estimated for each of the model inputs. This analysis can focus future research by identifying those parameters where more precise estimates would be most valuable and indicating whether an experimental design would be required. We also discuss how this type of analysis can also be used to design experimental research efficiently (identifying optimal sample size and optimal sample allocation) based on the marginal cost and marginal benefit of sample information. Value-of-information analysis can provide a measure of the expected payoff from proposed research, which can be used to set priorities in research and development. It can also inform an efficient regulatory framework for new healthcare technologies: an analysis of the value of information would define when a claim for a new technology should be deemed substantiated and when evidence should be considered competent and reliable when it is not cost-effective to gather any more information.

Alzheimer Disease↗
PubMed2001

The concept of priority as it relates to a community mental health team.

This article illustrates how a concept clarification exercise can provide evidence to inform local policy development. Based on the framework developed in Walker and Avant's (1995) concept clarification theory, the concept of priority is examined in the context of a team of community mental health nurses. Themes of risk, multidisciplinary working, resources, and nursing role are identified as key areas for consideration, and the difficulties existing between government policy directives towards the severely mentally ill and health promotion are discussed. The article highlights how nursing theory can integrate the concept analysis of priority in planning client care. This is presented using Peplau's (1952) model as a guide to further enhance meaning of generated priorities to nursing practice.

Community Health Nursing↗
PubMed2004

Selecting agri-environmental indicators to facilitate monitoring and assessment of EU agri-environmental measures effectiveness.

Since its introduction in the early 1960s, the EU Common Agricultural Policy (CAP) has demonstrated a capacity to adapt and change in the face of new challenges. The reformed CAP, under AGENDA 2000, encourages more environmentally friendly farming practices. In the context of their rural development plans, Member States are required to link policies on agriculture with protection of the environment and to ensure that farmers meet environmental standards. Additionally, Member States should maintain and restore the quality of both their aquatic and adjacent terrestrial ecosystems according to the Directive 2000/60/EU, 'Establishing a framework for Community Action in the field of Water Policy'. Within this framework, agri-environmental indicators play an important role in planning and implementing CAP guidelines. However, selection and use of the proper indicators remains unresolved, considering that ecosystem processes are complex and interactions in most cases not obvious. This paper proposes a methodology for assessing the environmental state and impacts of current land use and management when implementing agri-environmental measures of CAP. The proposed methodology includes a modified Driving forces-Pressures-Impacts-Responses (DPSIR) framework, identification of Zones of Specific Functional Interest (ZSFI), and criteria for selecting agri-environmental indicators, which assess the functional performance of each zone and meet existing legislation. The Mygdonia Watershed (Greece) is an example where through use of both the appropriate Minimum Data Set of agri-environmental indicators at the identified zones and the proposed modified DPSIR, the functioning performance of each ZSFI can be assessed to evaluate the applied agri-environmental measures.

Agriculture↗
PubMed1994

Reducing violent injuries: priorities for pediatrician advocacy.

A basic framework for developing an advocacy plan must systematically break down the large task of policy development implementation into manageable components. The basic framework described in detail in this paper includes three steps: Setting policy objectives by narrowing the scope of policy, by reviewing policy options, and by examining options against selected criteria. Developing strategies for educating the public and for approaching legislative/regulatory bodies. Evaluating the effectiveness of the advocacy action plan as a process and as an agent for change. To illustrate the variety of ways in which pediatricians can be involved in the policy process to reduce violent injuries among children and adolescents, we apply this systematic approach to three priority areas. Prohibiting the use of corporal punishment in schools is intended to curb the institutionalized legitimacy of violence that has been associated with future use of violence. Efforts to remove handguns from the environments of children and adolescents are aimed at reducing the numbers of firearm injuries inflicted upon and by minors. Comprehensive treatment of adolescent victims of assault is intended to decrease the reoccurrence of violent injuries.

Adolescent↗
PubMed2002

Implications of agricultural and wildlife policy on management and eradication of bovine tuberculosis and brucellosis in free-ranging wood bison of northern Canada.

Although disease is often an important factor in the population dynamics of wild ungulates, it is largely the threat-both real and perceived-that sylvatic disease reservoirs pose to the health status of commercial livestock or game farm industry that has led governments to establish policy and legislation for disease management, trade, and movement. With respect to bovine tuberculosis and brucellosis in wildlife, policies are largely borrowed from the existing regulatory framework for domestic livestock. In this paper, we review how general policy goals for managing these reportable diseases in domestic livestock have also affected conservation and management of bison in Canada. We argue that there is a need to better integrate conservation biology with agricultural livestock policy to develop management options and better address the unique conservation challenges that diseased free-ranging bison populations present.

Agriculture↗
PubMed1987

Provision of immunisation--the Gazankulu experience.

Following the outbreak of poliomyelitis in Gazankulu in 1982, the immunisation services in Gazankulu were thoroughly examined. As a result of this, a comprehensive immunisation policy for Gazankulu was accepted in November 1986. The broad aim of the policy is to provide effective immunisation to all Gazankulu residents against tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles. A specific objective is that by the end of 1987, 85% of under-5s should have been vaccinated against these six diseases and by the end of 1990 this percentage should be 97%. The detailed strategies to reach these objectives are highlighted. Within the framework of the objectives, the policy allows different areas to formulate individual strategies. Programme monitoring and community involvement are two crucial aspects of the policy and these are discussed in detail. The early successes and difficulities in implementing this policy are discussed.

Delivery of Health Care↗
PubMed1992

The development of policy on denizens in Denmark.

"This article offers an analysis of Danish migration policy from 1960-90. The framework employed is the Swedish sociologist Thomas Hammar's concentric 'gate' model and his concept of 'denizens'. Non-Danish citizens' access to Danish society is regulated by 'gates' and security and rights increase in proportion with the number of 'gates' passed, culminating in naturalisation and full social, legal and political rights. After an initial profile of the various groups of foreigners living in Denmark, I discuss the development of policy measures regulating immigration with particular reference to the 'Law for Foreigners'. Finally I turn to the critical issue of policy on denizens."

Demography↗
PubMed1999

The new NIH and FDA medical research policies: targeting gender, promoting justice.

The National Institutes of Health (NIH) and Food and Drug Administration (FDA) have both recently revised their policies regarding the inclusion of women in clinical trials. Pressured by women's health activists and members of Congress, the NIH has vastly improved its policies; it now requires that women and minorities the included in clinical trials and that an analysis of gender and racial differences be performed. The FDA policy states that women and men should be included in clinical trials if both would receive the drug when marketed and that it expects a gender analysis to be performed. The FDA also lifted its 1977 ban on including women of childbearing potential in the early phases of drug studies. Analyzing these NIH and FDA policies according to a gender justice framework, I find that the NIH has moved significantly toward the institution of gender justice as it applies to medical research policies and that the FDA has taken only small steps toward this goal and lags behind the NIH.

Clinical Trials as Topic↗
PubMed1997

Critique of the National Cancer Institute of Canada's framework for cancer control.

This paper offers a critique of the National Cancer Institute of Canada's (NCIC) framework for cancer control. The critique has been prepared by researchers who used the framework to review the literature in 5 substantive areas. These reviews, published in the current and previous issues of CPC, were designed to begin to outline a research agenda for the Sociobehavioural Cancer Research Network. In this paper, the authors reflect on the strengths and limitations of the framework. Perceived strengths are that the framework (a) facilitates systematic thinking about research options and priorities, (b) helps foster clear communication, (c) links science and practice, (d) may assist grant review panels to place proposed studies in context and (e) emphasizes important values. Perceived concerns include the following: (a) potential users are not familiar with the framework, (b) lack of clarity of definitions and classification criteria, (c) the utility of the framework is not immediately self-evident to potential users, (d) the framework lacks emphasis on environmental and policy interventions and (e) it is not clear how the values espoused are to be integrated with other dimensions of the framework. The concerns were seen as remediable. In short, the framework was seen to be valuable in its current form; refinement may enhance its value.

Canada↗
PubMed2006

Disease risk analysis: a tool for primate conservation planning and decision making.

Concern about emerging and re-emerging diseases plays an increasing role in conservation and management of both captive and free-ranging nonhuman primates (NHPs). Managers and policy makers must formulate conservation plans in an arena plagued by uncertainty, complexity, emotion, and politics. The risk analysis paradigm provides a framework that brings together scientists and policy experts to make better decisions for both people and animals. Risk analysis is a multidisciplinary, science-based process that provides an organized and logical approach for incorporating scientific information into policy development in the real world. By blending four specific goal-oriented stages-hazard identification, risk assessment, risk management, and risk communication-one can logically assess the probability that an adverse event, such as the introduction of an emerging disease into a naïve population, will occur. The following is a review of this process as it pertains to NHP conservation and risks associated with infectious diseases.

Animals↗
PubMedDate not supplied

Breast cancer in limited-resource countries: health care systems and public policy.

As the largest cancer killer of women around the globe, breast cancer adversely impacts countries at all levels of economic development. Despite major advances in the early detection, diagnosis, and treatment of breast cancer, health care ministries face multitiered challenges to create and support health care programs that can improve breast cancer outcomes. In addition to the financial and organizational problems inherent in any health care system, breast health programs are hindered by a lack of recognition of cancer as a public health priority, trained health care personnel shortages and migration, public and health care provider educational deficits, and social barriers that impede patient entry into early detection and cancer treatment programs. No perfect health care system exists, even in the wealthiest countries. Based on inevitable economic and practical constraints, all health care systems are compelled to make trade-offs among four factors: access to care, scope of service, quality of care, and cost containment. Given these trade-offs, guidelines can define stratified approaches by which economically realistic incremental improvements can be sequentially implemented within the context of resource constraints to improve breast health care. Disease-specific "vertical" programs warrant "horizontal" integration with existing health care systems in limited-resource countries. The Breast Health Global Initiative (BHGI) Health Care Systems and Public Policy Panel defined a stratified framework outlining recommended breast health care interventions for each of four incremental levels of resources (basic, limited, enhanced, and maximal). Reallocation of existing resources and integration of a breast health care program with existing programs and infrastructure can potentially improve outcomes in a cost-sensitive manner. This adaptable framework can be used as a tool by policymakers for program planning and research design to make best use of available resources to improve breast health care in a given limited-resource setting.

Breast Neoplasms↗
PubMed2005

An empirical assessment of high-performing medical groups: results from a national study.

The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performing medical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.

Benchmarking↗
PubMed2005

"Harnessing genomics to improve health in Africa" - an executive course to support genomics policy.

BACKGROUND: Africa in the twenty-first century is faced with a heavy burden of disease, combined with ill-equipped medical systems and underdeveloped technological capacity. A major challenge for the international community is to bring scientific and technological advances like genomics to bear on the health priorities of poorer countries. The New Partnership for Africa's Development has identified science and technology as a key platform for Africa's renewal. Recognizing the timeliness of this issue, the African Centre for Technology Studies and the University of Toronto Joint Centre for Bioethics co-organized a course on Genomics and Public Health Policy in Nairobi, Kenya, the first of a series of similar courses to take place in the developing world. This article presents the findings and recommendations that emerged from this process, recommendations which suggest that a regional approach to developing sound science and technology policies is the key to harnessing genome-related biotechnology to improve health and contribute to human development in Africa. METHODS: The objectives of the course were to familiarize participants with the current status and implications of genomics for health in Africa; to provide frameworks for analyzing and debating the policy and ethical questions; and to begin developing a network across different sectors by sharing perspectives and building relationships. To achieve these goals the course brought together a diverse group of stakeholders from academic research centres, the media, non-governmental, voluntary and legal organizations to stimulate multi-sectoral debate around issues of policy. Topics included scientific advances in genomics innovation systems and business models, international regulatory frameworks, as well as ethical and legal issues. RESULTS: Seven main recommendations emerged: establish a network for sustained dialogue among participants; identify champions among politicians; use the New Plan for African Development (NEPAD) as entry point onto political agenda; commission an African capacity survey in genomics-related R&D to determine areas of strength; undertake a detailed study of R&D models with demonstrated success in the developing world, i.e. China, India, Cuba, Brazil; establish seven regional research centres of excellence; and, create sustainable financing mechanisms. A concrete outcome of this intensive five-day course was the establishment of the African Genome Policy Forum, a multi-stakeholder forum to foster further discussion on policy. CONCLUSION: With African leaders engaged in the New Partnership for Africa's Development, science and technology is well poised to play a valuable role in Africa's renewal, by contributing to economic development and to improved health. Africa's first course on Genomics and Public Health Policy aspired to contribute to the effort to bring this issue to the forefront of the policy debate, focusing on genomics through the lens of public health. The process that has led to this course has served as a model for three subsequent courses (in India, Venezuela and Oman), and the establishment of similar regional networks on genomics and policy, which could form the basis for inter-regional dialogue in the future.

Editorial↗
PubMed1999

Fortress South Africa and the deconstruction of apartheid's migration regime.

South Africa's new democratic government inherited a system of cross-border migration management rooted in the abusive practices of the past. Under apartheid, employers such as mining companies and White farmers, were exempted from normal immigration legislation. The result was legislation and practices that are in direct conflict with the new government's commitment to transparency, equality, accountability, and fundamental human rights. The practices permitted by this system have continued after 1994. This paper documents the continuities in international migration policy and practice between the old and new South Africa and highlights the dilemmas which the government faces in transforming inherited policy. The paper critically analyzes the regulatory framework of the bilateral labor agreements and the Aliens Control Act. The paper then highlights policy proposals that contravene the discourse of the fortress and assesses, pessimistically, the likelihood of their implementation before the 1999 elections.

Africa↗