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At least 613 records · Page 34Linked to original sources
PubMed1989

The relevance of socioeconomic and health policy issues to clinical research. The case of MRI and neuroradiology.

Magnetic resonance imaging (MRI) is a high-cost, new technology with great potential for improving patient care. The lack of a coherent public policy for MRI, or its predecessor computed tomography (CT), has caused considerable problems. Lack of an enunciated public policy has led to inconsistent reimbursement and reimbursement levels that develop in haphazard ways. Furthermore, diffusion has been unpredictable and has led to geographical excesses and deficiencies. Technology assessments of MRI, although numerous, have used inconsistent criteria to rate MRI's clinical efficacy. The lack of methodologically sound studies of MRI severely hampered early evaluation. This article examines these problems and suggests that the medical profession take a stronger leadership role in developing policies for expensive, promising new diagnostic technologies. The profession should promote, demand, and perform rigorous clinical evaluations of new technologies, and help develop a consensus regarding the criteria for what constitutes a clinically valuable advance in diagnostic technology.

Costs and Cost Analysis↗
PubMed2005

Improving research transfer in the addictions field: a perspective from Canada.

This paper discusses how to enhance the research-to-practice exchange in the addictions field, while maintaining a balance with the demands and complexities of program delivery and policy development. It outlines the evolution of the concept of evidence-based practice, discusses the practical limitations and ways to improve transferring research to practice, and provides examples of research transfer activities in Canada. Practical limitations to research transfer include individual, organizational, and community factors. A strategic approach to research transfer includes addressing these limitations by combining dissemination activities with interventions such as individual instruction and incentives; building relationships among researchers, practitioners, and populations served; and obtaining commitments at a systemic level from funding bodies and research organizations to support research transfer. The potential is noted for the concept of workforce development to facilitate research transfer at organizational levels. The conclusion shown in this paper is that the tools and concept of evidence-based practice can lead the way to strengthening addictions programs and policies, and the development of a conceptual model for addiction research transfer in Canada would be a useful next step.

Behavior, Addictive↗
PubMed2003

Providing treatment to prisoners with mental disorders: development of a policy. Selective literature review and expert consultation exercise.

BACKGROUND: Mental disorder is more prevalent among people in prison than in the general population. Prisoners who require transfer to psychiatric hospitals for treatment face long delays. Doctors working in prisons regularly face ethical and legal dilemmas posed by prisoners with mental illness. AIMS: To develop a policy for providing treatment under the common law to prisoners with mental disorders who lack treatment decision-making capacity, while arrangements are made to transfer them to hospital. METHOD: The policy was developed through literature review and consultation with the Faculty of Law at Southampton University and health care staff at Winchester prison in the UK. RESULTS: The policy provides guidelines for establishing decision-making capacity, standards for documentation, and guidelines for implementation based on the Mental Health Act Code of Practice, other best-practice guidelines and case law. CONCLUSIONS: It can be argued that case law allows more-extensive treatment to be provided in the best interests of the incompetent prisoner, beyond emergency situations. The policy has ethical implications and its use should be carefully monitored.

Decision Making↗
PubMedDate not supplied

Cancer policy framework for: public health assessment of carcinogens in the environment.

Cancer remains at the forefront of public health concerns in the United States and throughout the world. Over the past 20 years a wide range of federal agencies and other organizations have been involved in developing policy statements, classification strategies, and assessment methods to address carcinogenesis and health risks. Each of these documents was developed in response to issues confronted by those organizations in pursuing their mission, often as a direct function of legislative mandates. In pursuing its mandated responsibilities, the Agency for Toxic Substances and Disease Registry (ATSDR) must address public health concerns associated with exposure to carcinogens in the context of all available relevant information. This information includes both technical data as well as science policy positions adopted by the range of organizations with programs germane to the assessment and/or regulation of carcinogens. Because of distinct differences in perspective, practice, and policy dictated by the mandated activities of these organizations and the rapidly evolving understanding of carcinogenesis, apparently divergent positions may be reflected in their conclusions. The differences outlined above, coupled with requests from the public, other agencies, and the private sector for a statement reflecting the Agency's position on science and science policy issues related to cancer, prompted the development of this policy. This document is intended to serve as a framework to guide the Agency in its programs and actions regarding carcinogens and to harmonize such efforts with those of other federal agencies and relevant organizations. This framework reflects an assessment of current practice within the Agency and defines the appropriate roles of conclusions derived by other groups, professional judgment, and emerging scientific principles in ATSDR's public health assessments of exposures to carcinogens. This Cancer Policy Framework is not intended to encompass the development of operational guidelines per se, although the Agency recognizes the utility of such efforts. A central theme of this Cancer Policy Framework is the use of risk analysis as an organizing construct based on sound biomedical and other scientific judgment to define plausible exposure ranges of concern rather than single numerical conclusions that may convey an artificial sense of precision. The development and use of innovative tools for exposure and dose response assessment (with particular emphasis on molecular epidemiology) are also endorsed.

Carcinogens, Environmental↗
PubMedDate not supplied

The impact of development and population policies on fertility in India.

This article examines the impact of development and population policies on fertility decline and regional variations in India during the 1970s. Indicators of development at the household level include female literacy and education, infant mortality, and poverty; at the village level they include availability of such social services as schools, medical facilities, and transportation and communication facilities. Multiple regression analysis of data aggregated at the state level demonstrates that conditions conducive to fertility decline include high adult female literacy and low infant mortality as indicators of social development, and high contraceptive use and, to a lesser extent, high female age at marriage as proximate determinants of fertility. There are reasons to believe that India's national family planning program contributed to the decline in fertility observed since the 1960s. The pace of fertility decline in the future will depend upon the pace of infant mortality decline, enhancement in female education, and improvements in family planning programs.

Birth Rate↗
PubMed1998

Syringe exchange in Canada: good but not enough to stem the HIV tide.

This article provides a historical perspective on the development of syringe exchange in Canada, the Canadian legal and policy context, evaluation and monitoring strategies, and current challenges facing HIV prevention efforts among injecting drug users. Despite the fact that it is legal to sell, exchange, or provide an IDU with a syringe and there are no laws in Canada requiring a physician's prescription to justify possession of a syringe, policy development and programming have not been adequate to hold HIV at bay in several cities across the country. Although there have been concerted efforts by syringe and needle exchange programs to increase the supply of injecting equipment, HIV prevalence continues to rise, provoking a rethinking of the role of syringe exchange. In a coordinated strategy for HIV prevention among drug users in Canada, needle and syringe exchange is not itself in question; however, ghettoization and needle quota systems may have had an adverse impact on prevention programming. A national action plan has been developed which aims to decentralize both methadone maintenance and syringe and needle exchange programs, increase access to detoxification and treatment modalities, and advocate for changes in the criminal justice system and law enforcement practices.

Canada↗
PubMed1994

The hazard of starting smoking: estimates from a split population duration model.

Understanding the determinants of the hazard of starting smoking is of great importance in developing policy to reduce the number of smokers. This paper develops a split population duration model of the decision to start smoking. Using data from the 1978 and 1979 Smoking Supplements to the National Health Interview Survey, we find some evidence that lifetime educational attainment, gender, and race are important determinants of both whether and when the smoking habit is initiated. The study finds no evidence that higher cigarette prices would have a significant impact on teenage decisions to pick up the smoking habit.

Adolescent↗
PubMed2003

Constraints on women's intersectoral health partnerships: lessons from Canada.

Issues that constrain women's organizations from developing partnerships that promote women's health through health policy development and implementation are discussed in terms of lessons drawn from 3 studies. Key issues are the values underlying notions of partnership and participation, communication across sectors, different worldviews, and the resource limitations of feminist organizations. By attending to constraints and learning from successes and failures, women's organizations will be able to promote women's health through intersectoral partnering. The health sector and health professionals need to respond to the constraints in order to benefit from the expertise that resides within women's organizations.

Canada↗
PubMed1998

Regulatory barriers to pain management.

OBJECTIVES: To provide an overview of relevant federal and state policies, as well as recommendations for identifying and addressing barriers to the treatment of cancer and non-cancer pain. DATA SOURCES: Review of federal and state statutes and medical board guidelines. CONCLUSIONS: There has been an increase in pain-related policies since the mid 1980s, with recent years showing a significant amount of policy development and adoption. However, a variety of laws and policies contain provisions that have the potential to discourage the use of opioid analgesics for the relief of pain. IMPLICATIONS FOR NURSING PRACTICE: The evaluation and treatment of patients with cancer and non-cancer pain can be enhanced by a knowledge of the specific restrictions of controlled substances statutes and practice guidelines. In this way, there will be less chance for nurses to practice outside established legal parameters.

Drug and Narcotic Control↗
PubMed2002

Cross-sector working: speech and language therapists in education.

Current policies and practices concerning speech and language therapy provision in schools are reviewed and issues which remain to be addressed are considered A general move to cross-sector approaches has resulted in a move to indirect therapy through assistants, and the effectiveness of this requires to be established. Funding streams for therapy differ across the UK, and despite extensive research and policy development remain somewhat unclear and vulnerable. The implications for policies on 'joined up thinking" are considered.

Allied Health Personnel↗
PubMed2004

Australia and New Zealand Health Policy: a new journal.

Australia and New Zealand Health Policy is a new journal which aims to promote debate and understanding about contemporary health policy developments in Australia and New Zealand. Although there are other international journals focussing on health policy, there are no Australian or New Zealand journals with this focus.One of the aims of Australia and New Zealand Health Policy is to focus on contemporary critiques and contemporary developments. Accordingly an e-journal format is particularly appropriate. Australian and New Zealand Health Policy is an open access journal which means that all articles will be freely and universally accessible online which, amongst other things, means that all articles will be freely and universally accessible online without any barriers to access, which increases their visibility.

Journal Article↗
PubMed2004

The HIV/AIDS epidemic in China: history, current strategies and future challenges.

This article reviews the epidemic of HIV infection and AIDS, the Chinese national policy development in response to the epidemic, and disparities between policies and the need for AIDS prevention in China. The HIV epidemic in China has gone through three phases, and it is now at the rapid expansion phase. Since 1988, HIV/AIDS has been addressed from a legal perspective, but in the early stages laws and regulations actually hindered HIV control efforts. Since 1995 efforts have been made to improve policy decisions. Two major strategic plans were issued in 1998 and 2001, with increased government funding for implementation. Although the challenges facing HIV/AIDs control in China are many, the Chinese government is making a stronger commitment for implementing effective AIDS control measures in the country.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Changing patterns of drug use among US military recruits before and after enlistment.

OBJECTIVES: The US armed forces adopted "zero tolerance" policies concerning illicit drug use in 1980 and later developed policies to discourage tobacco and alcohol abuse. This article examines drug use among young active-duty recruits both before and after enlistment, compared with nonmilitary age-mates, and documents historical shifts in such drug use across 2 decades. METHODS: Analyses employed longitudinal panel data from 20 nationally representative samples of high school seniors (cohorts of 1976-1995), each surveyed just before graduation and again within 2 years. Separate analyses for men (n = 12,082) and women (n = 15,345) contrasted those who entered military service, college, and civilian employment. RESULTS: Illicit drug use declined more among young military recruits than among their civilian counterparts. Analyses of male recruits at multiple time periods showed (1) declines in the prevalence of marijuana use and cocaine use after the initiation of routine military drug testing and (2) lower proportions of smokers of half a pack or more of cigarettes per day who entered service after the initiation of tobacco bans during basic training. CONCLUSIONS: Recent military drug policies appear to deter illicit drug use among enlistees and discourage some smokers from enlisting.

Adult↗
PubMed1987

The role of the hospital in the health policy of the German Social Democratic movement before World War I.

In this article, the author aims to contrast the traditional architecture-oriented history of hospitals with an empirical sociohistorical approach. The main topic discussed is the hospital's role in health policy as seen by German Social Democrats in the late 19th and early 20th centuries. Social democratic hospital policy developed as a compromise between two extreme positions: the party theoretician's abstract ideals on the one side and the rank and file's pragmatic view on the other. Thus, the social history of the hospital can illustrate how, around the turn of the century, the political labor movement in Germany shifted from radical revolutionary aims to pragmatic social reform in everyday political practice. At the same time, the hospital underwent a fundamental social change from a charity institution to a municipal center of modern medical care. This implies that any static or one-sided interpretation of the hospital's history and sociology is inadequate: its social role constantly changes according to broader social change and different interests of social groups and organizations. As for the social history of medicine in general, modern medicine's development can not be adequately understood from the narrow perspective of medical institutions themselves. It has to be seen in the broader context of socioeconomic and sociocultural development.

Berlin↗
PubMed1978

Contextual influences on personnel policies and programs: an explanatory model.

There has been a general absence of research to explain why personnel policies develop in organizations. This article has two objectives: (a) development of a theoretically relevant scheme for clustering personnel policies for analytic purposes, and (b) presentation of an explanatory model suggesting how contextual influences shape these policies.

Humans↗
PubMed2003

Managing medical workforces: from relative stability to disequilibrium in the UK NHS.

The management of the medical workforce, in particular the market for physicians, is costly and complex. For decades this process has been dominated by largely mechanistic forecasting (e.g., fixed doctor-population ratios), which ignored economic determinants. Internationally, and specifically in the UK, such practices achieved some success in producing modest cyclical shortages and surpluses in the past. However with large increases in UK health care funding, together with the international recognition of significant practice, activity and outcome variations in health care, this approach is now inadequate. With physician shortages emerging internationally, the impact of incentives (both financial and non-financial) on skill-mix (are nurses cost effective substitutes or complements for physicians?), activity (can distribution means be shifted and variation reduced?) and outcomes (can survival duration and quality of life of survival be improved?) is now central to policy development. Such issues create nice challenges for researchers and policy makers.

Budgets↗
PubMed1994

[Breast cancer in the man: a report of 30 patients].

A retrospective review of male patients suffering from breast cancer seen over an 18-year period was carried out at the Department of Clinical Oncology of the University Hospital of Graz. Thirty evaluable cases were analysed. Eight patients had Stage I, 11 had Stage II, 8 had Stage III, and 3 had Stage IV disease. Local control was achieved in the majority, 29/30 (97%), by either surgery alone or combined surgery and radiation therapy. Local recurrence developed in 2 (7%) patients. Further 7 (23%) patients developed distant metastases and were treated in accordance with policies developed for the appropriate stage of the disease in females, with hormonal manipulation for hormone receptor-positive and -unknown patients and chemotherapy for hormone receptor-negative patients. The corrected five-year survival (Kaplan-Meier) is 83% for the entire group, 100% for patients with Stage I disease, 86% in Stage II, and 67% in Stage III and IV disease, respectively. This corresponds well with the results in recently published series. Stage of disease at initial presentation was a significant factor determining survival in our investigation. Our own data as well as recent data from literature suggest that with respect to TNM Stages in mammary carcinoma, there is no prognostic difference between men and women. To what extent improved local control by adequate local therapy or systemic adjuvant treatment modalities may improve overall survival remains to be discussed.

Adult↗