[Global fight against suicide. 13 targets in the national program].
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A computed tomographic image transfer system ('Image Link') was used to link scanners within the Oxford region, UK, to the regional neurosurgical service. 100 consecutive neurosurgical referrals were examined by this system; 43% of the emergency referrals did not require transfer, 31% were transferred electively, and 26% urgently. Most of the patients defined as potentially hazardous for transfer (10/11) did not require neurosurgical intervention. The delay by the use of the system was negligible and early detection of intracranial haematoma contributed to good outcome in some head injured patients. Overall, 3,170 miles of ambulance journey were avoided. Use of image link has led to substantial improvements in management of neurosurgical emergency referrals, cost-effectiveness of neurosurgical and ambulance facilities, and interhospital communication between doctors.
In 1951 the Centers for Disease Control and Prevention created the Epidemic Intelligence Service to provide training and epidemiologic service on the model of a clinical residency program. By January 2001, an additional 28 applied epidemiology and training programs (AETPs) had been implemented around the globe (with over 945 graduates and 420 persons currently in training). Field Epidemiology Training Programs and Public Health Schools Without Walls are the most common models. Applied epidemiologists, or field epidemiologists, use science as the basis for intervention programs designed to improve public health. AETPs train people by providing them with health competencies through providing service to public health intervention programs and strengthening health systems. AETPs are relatively expensive to create and maintain, but they are highly sustainable and can produce immediate benefits. Of the 19 programs that began before 1997, 18 (95%) continue to produce graduates. The Training Programs in Epidemiology for Public Health Interventions Network was organized in 1997 to provide support, peer review, and quality assurance for AETPs. In 2001, new programs are planned or in development in India, Argentina, China, and Russia.
As public health by its very nature is multi-disciplinary, it may benefit individual programs to formulate a regional network, joining researchers and academics across programs. This approach may afford extended benefits, such as the establishment of regional health surveillance systems and collaborative funding initiatives. To explore this potential, member institutions comprising the Asia-Pacific Academic Consortium for Public Health provided data to form an aggregate profile of cross-institutional expertise and resources, which was presented to Health Specialists at the Asian Development Bank. The study provided a foundation for a planned regional network. A four-pronged approach was proffered detailing concurrent aspects of development: 1) network formation and expansion, 2) research coordination, 3) cross-institutional communication and instruction, and 4) promotion of self-sufficiency. The proposed plan affords the groundwork for an improved approach to public health research and practice that builds upon the established Consortium, and encourages new horizons. Regionalization is an increasing phenomenon world wide, and should be furthered as a concept for improved public health intervention and control.
Establishing strong partnerships with physicians, concentrating on the improvement of health rather than the treatment of illness, and moving patients efficiently through a continuum of care are just some of the keys to successfully managing in managed care.
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Health care for children with chronic illnesses is significantly more expensive than for the average child. Children with chronic illnesses are especially vulnerable in a competitive health care environment because of the higher ongoing cost associated with treating their illnesses and the inherent pressures to reduce services to manage within the capitated rate. To minimize the adverse impact a competitive market could have on these children, a "carve-out" for specific medical conditions is discussed. A capitation pricing system that reflects their higher costs is proposed, as well as a delivery system that is focused on their needs.
The international programs of the National Library of Medicine may vary in mechanism, but all share the common objective of improved medical research, education, and practice. They are a natural extension of domestic responsibilities and represent a sharing of time, talent, and resources. The programs may be service-oriented, cooperative efforts based on the computerized information storage and retrieval system (MEDLARS), or establishment of regional medical library programs. Policy and operational aspects are presented.
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