PAXUS expands Australasian health sector capability.
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Commerce↗
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[The occupational health physician in the public health structure].
The paper deals with the relationship between duties and professional responsibility of the Occupational Health Physician in the Local Health Units. The Local Health operating in the field of Health protection in the workplace must guarantee: - generally acceptable management both qualitatively and quantitatively as regards knowledge and actions in the respective territories; up-dating of the information system in order to plan and check actions according to the degree and extent of risks in all possible working environments: industry and agriculture, service industry, construction industry, ect., and according to the health status of the working population. - unequivocal, timely and scientifically correct information of the public. The Health Protection in the Workplace Units should be responsible for these duties, transforming them into objective planning choices and setting up operative models of action based on typically interdisciplinary activities and tasks. In our opinion, health practice in community service should be mainly of an epidemiological and organisational nature rather than diagnostic and clinical. The main activities are therefore: - control and coordination of periodical and prescribed health examinations: the protocols must be suitable for and consistent with the risks involved and deontological and legal requirements must be respected. - establishment via epidemiological investigations of the health status of the workers in a community; this can also be achieved by means of direct health investigations (by industrial sector, by risk). - Training and information, health education.
Clinical Competence↗
What does primary health care cost and can we afford to find out? Rationale and methodology for a cost analysis of the Diepkloof Community Health Centre, Soweto.
Accurate information on the costs of providing primary health care (PHC) services is now an urgent priority for health policy makers and planners, if the Government's stated commitment to an adequate PHC system is to be realised. Cost information is also a critical management tool for both public and private sector providers. In this context, the inability of public sector PHC providers to generate accurate cost accounting information is a serious shortcoming. In an attempt to address this lack of local PHC cost data, a detailed analysis of the costs of PHC services was undertaken at the Diepkloof Community Health Centre (DK) in Soweto during 1990. The study aimed to assess the cost of each service provided at DK and where possible, to identify areas of inefficiency. This paper is the first of two that report the findings of this study. It briefly describes the methodology employed and presents the major results. These raise several important management issues. Most importantly, the study suggests that there is excess capacity in the administrative and in several of the clinical areas of this community health centre; this implies that the average cost per service could be reduced in several areas. Certain services, such as home visits, are particularly expensive and require careful evaluation. The policy implications of this analysis are also examined. The high cost of several services implies that extension of this type of PHC service to all urban and rural areas is likely to be unaffordable.(ABSTRACT TRUNCATED AT 250 WORDS)
Community Health Services↗
Sign language Web pages.
The WORLD WIDE WEB has changed the way people interact. It has also become an important equalizer of information access for many social sectors. However, for many people, including some sign language users, Web accessing can be difficult. For some, it not only presents another barrier to overcome but has left them without cultural equality. The present article describes a system that allows sign language-only Web pages to be created and linked through a video-based technique called sign-linking. In two studies, 14 Deaf participants examined two iterations of signlinked Web pages to gauge the usability and learnability of a signing Web page interface. The first study indicated that signing Web pages were usable by sign language users but that some interface features required improvement. The second study showed increased usability for those features; users consequently couldnavigate sign language information with ease and pleasure.
Adolescent↗
[From occupational medicine to community health in French-speaking Africa].
The Laval University has been involved in many French-speaking African countries for teaching and intervention programs in occupational health and safety. In Algeria and Zaire, seminars for public and occupational health physicians have been aimed at allowing participants to gain the skills, knowledge and attitudes required to implement medico-environmental surveillance programs in industry. These teaching programs were presented in a wider perspective of occupational health services. As defined by the International Labor Organisation (ILO), these services should identify occupational risk factors, conceive and implement occupational prevention programs, realize health surveillance activities, monitor health statistics, promote adaptation of work to workers and rehabilitation of disabled workers, realize information and formation programs and, finally, organize first-aid activities. In Zaire, the program was aimed at integrating the occupational health approach in a more global perspective of community health, which means that the participants were able, at the end of the programs, to identify and analyse the main health problems of a given population and to plan, implement, manage and evaluate the health programs required to meet the health needs of the population. Those aspects were considered important, given that 98% of the active manpower in Africa belongs to industrial sectors which are not covered by occupational medicine legislation, that is the agricultural and informal production sectors. These approaches should help reach the World Health Organisation (WHO) goal set for all countries: "Health for all, by the year 2000".
Algeria↗
Introducing economic evaluation as a policy tool in Korea: will decision makers get quality information? : a critical review of published Korean economic evaluations.
Interest in the use of economic evaluations in Korea as an aid for healthcare decision makers has been growing rapidly since the financial crisis of the Korean National Health Insurance fund and the separation in 2000 of the roles of prescribing and dispensing drugs. The Korean Health Insurance Review Agency (HIRA) is considering making it mandatory for pharmaceutical companies to submit the results of an economic evaluation when demanding reimbursement of new pharmaceuticals. The usefulness of the results of economic evaluations depends highly on the quality of the studies. The purpose of this paper, therefore, is to provide a critical review of economic evaluations of healthcare technologies published in the Korean context. Our results show that many studies did not meet international standards. Study designs were suboptimal, study perspectives and types were often stated incompletely, time periods were often too short, and outcome measures were often less than ideal. In addition, some articles did not distinguish between measurement and valuation of resource use. Capital, overhead and productivity costs were often omitted. Only half of the studies performed sensitivity analyses. In order to further rationalise resource allocation in the Korean healthcare sector, the quality of the information provided through economic evaluations needs to improve. Developing clear guidelines and educating and training researchers in performing economic evaluations is necessary.
Cost-Benefit Analysis↗
Realizing the benefits of executive information systems.
Over the last several years, the literature on EISs (executive information systems) in all business sectors--including health care--has been focused on the design and implementation of these new systems. However, little attention has been given to identifying the wide range of direct and indirect benefits that occur after an EIS is successfully installed. This paper discusses in qualitative terms these tangible and intangible benefits and the factors that impact their realization and maximization. The paper is based on findings the authors have gained as a result of installing EISs in the past two years.
Communication↗
Breast implants: a survey of cosmetic clinics.
The quality of information available to prospective cosmetic breast implant recipients in the private sector was assessed. Sixteen women telephoned 14 clinics requesting written information about breast implants and their safety. The information received varied enormously in quality. Of the purely cosmetic clinics offering information, it was generally of better quality and more consistent than private hospitals where accredited plastic surgeons operate. In the current climate of consumer choice and negative attention given to silicone breast implants by the media, more comprehensive information should be readily available to guide potential patients.
Breast Implants↗
Managing external resources in the health sector: are there lessons for SWAps (sector-wide approaches)?
Drawing on the case studies presented in this issue, from Bangladesh, Cambodia, Mozambique, Zambia and South Africa, and examples from other countries, this paper asks what general conclusions can be drawn about the management of external resources, and specifically what lessons could inform the future implementation of sector-wide approaches (SWAps) in the health sector. Factors constraining the management of aid by ministries of health are grouped under three themes: context and timing, institutional capacities and the interplay of power and influence in negotiations over aid. Two factors, often underplayed, were found to be important in facilitating management of resources: the inter-relationship of formal and informal relationships, and the extent to which incremental changes are tolerated. The main conclusion is that coordination and management of external resources is inherently unstable, involving a changing group of actors, many of whom enjoy considerable autonomy, but who need each other to materialize their often somewhat different goals. Managing aid is not a linear process, but is subject to set-backs and crises, although it can also produce positive spin-offs unexpectedly. It is highly dependent on institutional and systemic issues within both donor and recipient environments. In promoting sector-wide approaches the key will be to recognize context-specific conditions in each country, to find ways of building capacity in ministries of health to develop and own the future vision of the health sector, and to negotiate a realistic package that is explicit in its agreed objectives. The paper ends with identifying crucial actions that will enable ministries of health to take the lead role in developing and implementing SWAps.
Developing Countries↗
European Commission activities in eHealth.
Health-care is an information-intensive and knowledge-demanding sector, which is why eHealth solutions are so important in this field. The European Commission (EC) has been initiating and funding research and development activities regarding Information and Communication Technologies (ICT) for health, or "eHealth", since 1988. These programmes covered priority topics like electronic health-care records, regional and national health networks, telemedicine in homecare and care-at-the-point-of-need to support continuity of care concepts, systems to support people to stay healthy, and systems and tools to support health professionals to work more efficiently and safely on patients. During the 15-year span of the programmes, the European Union (EU) has contributed about 500 million Euro to approximately 400 R&D projects, support activities, best practice and studies covering technical, clinical, ethical, legal, organisational and market issues. eHealth has shown proven benefits in application fields like improved access to care, care at the point-of-need, citizen-centred care, improved quality and cost containment. Such applications were on show at the EU High Level eHealth Conferences in Brussels, Belgium, in 2003, and in Cork, Ireland, in 2004. eHealth is now on the governmental agenda of EU Member States to be implemented on a broader scale. In line with this development, the Commission has taken a number of policy initiatives. A European Union Action Plan for a European eHealth Area was published by the Commission in April 2004 and endorsed by the EU health ministers in June 2004. This means that, for the first time, Europe has a coherent agenda for the implementation of eHealth. This report will concentrate on eHealth activities initiated by the Information Society Directorate-General of the European Commission.
Europe↗
The management of health library outreach services: evaluation and reflection on lessons learned on the VIVOS project.
PURPOSE: The aim of the VIVOS project was to develop and evaluate methodologies, i.e., sets of methods, for determining the value and impact of "virtual outreach" information services in the health sector in the UK. METHODS: Five different projects were recruited initially, with another two added later. Methods were largely qualitative, with over 130 interviews conducted among health professionals, complemented by postal questionnaire surveys. RESULTS: Identified factors that affect the successful roll-out and continued development of the projects included the need for help-desk type services to provide sustained support for new users to the services. CONCLUSIONS: Follow-up of the projects eighteen months after the end of the VIVOS project revealed that the long-term impacts for the participating library managers included the benefits of using evidence on service outcomes, enhanced recognition locally, and greater confidence in evaluation.
Community-Institutional Relations↗
Targeting the fungal plasma membrane proton pump.
The need for new mechanistic classes of broad spectrum antifungal agents has prompted development of the membrane sector and ectodomain of the plasma membrane proton pumping ATPase as an antifungal target. The fungal proton pump is a highly abundant, essential enzyme in Saccharomyces cerevisiae. It belongs to the family of P-type ATPases, a class of enzymes that includes the Na+,K(+)-ATPase and the gastric H+,K(+)-ATPase. These enzymes are cell surface therapeutic targets for the cardiac glycosides and several anti-ulcer drugs, respectively. The effects of acid-activated omeprazole show that extensive inhibition of the S. cerevisiae ATPase is fungicidal. Fungal proton pumps possess elements within their transmembrane loops that distinguish them from other P-type ATPases. These loops, such as the conformationally sensitive transmembrane loop 1+2, can attenuate the activity of the enzyme. Expression in S. cerevisiae of fully functional chimeric ATPases that contain a foreign target comprising transmembrane loops 1+2 and/or 3+4 from the fungal pathogen Candida albicans suggests that these loops operate as a domain. The chimera containing C. albicans transmembrane loops 1+2 and 3+4 provides a prototype for mutational analysis of the target region and the screening of inhibitors directed against opportunistic fungal pathogens. Panels of mutants with modified ATPase regulation or with altered cell surface cysteine residues are also described. Information about the ATPase membrane sector and ectodomain has been integrated into a model of this region.
Amino Acid Sequence↗
Implications of oncogenomics for cancer research and clinical oncology.
The explosion of information generated by large-scale functional genomics technologies has resulted in an exponential increase in the number of potential genes and proteins available for pharmaceutical and diagnostic research development. In order to tap this potential, the primary challenge is to develop a strategy to effectively integrate and extract meaning from the human genomic sequence information that has been generated since the start of the Human Genome Project. This article deals with the strategies being applied by academics and by the biotechnology sector to sort and triage this information with the ultimate goal of identifying future therapeutic targets for cancer and other diseases.
Animals↗
Community care: the independent sector.
The independent sector, which consists of the voluntary and private sectors, is a vital element in supporting older people in the community. The voluntary sector, coordinated by the Council for Voluntary Service and the National Council for Voluntary Organisations, provides a variety of services, including practical help, reassurance and companionship, and advice, information, campaigning, and advocacy. The private sector owns all of the nursing homes and most of the residential homes and is gradually becoming more involved with the provision of services to help support older people in their own homes. With this increase in size and importance of the independent sector over recent years, there is now a real need for greater communication between the private, voluntary, and statutory agencies in any one region. In some areas, forums made up of representatives of these various sectors meet to discuss relevant issues and construct local policies, thus allowing a more coordinated approach to the delivery of services.
Aged↗
Strategic uses of information technology in health care: a state-of-the-art survey.
The general perception that the use of information technology (IT) in health care is ten to fifteen years behind IT in other industrial sectors such as banking, manufacturing, and airline is rapidly changing. Health care providers, faced with an unprecedented era of competition and managed care, are now exploring the opportunities for using IT to improve the quality while simultaneously reducing the cost of health care. A revolution is taking place in the health care industry, with IT playing an increasingly important role in its delivery. In recent years, for example, the industry spent approximately $12 billion to $14 billion a year on IT. Further exponential growth is expected as the health care industry implements electronic medical records, upgrades hospital information systems, sets up intranets for sharing information among key stakeholders, and uses public networks, such as the Internet, for distributing health-related information and for providing remote diagnostics. Along with these drastic changes and the new approach to health care, the field of health/medical informatics and telematics has also experienced significant growth in the last few years. This article identifies and surveys the critical information technologies that are being adopted to provide strategic benefits to the various health care constituencies including hospitals and health maintenance organizations (HMOs).
Canada↗
Analysis of accident inequality of the Spanish fishing fleet.
There is at present a clear tendency to consider safety as a vital factor in the running of a country's fishing sector. However, the planning of the necessary resources and their adequate distribution according to the sector's needs is only possible if detailed information is available about the degree of concentration of the accidentality of that sector. In this context, the aim of this work is two-fold: firstly, to formalise a methodology for the fishing sector of a country which allows the inequality in the concentration of accidents to be analysed; and secondly, to apply this methodology to the Spanish fishing fleet for the period 1994-2002. Thus, indices are built by regions and by types of vessel for two variables: fishermen and vessels. Results are obtained both for the inequality in the concentration of accidents and their associated Lorenz curves and for the rates and elasticities of fishing sector accidents.
Accidents, Occupational↗
Information systems for community health: are we addressing the right strategy?
Computerised information systems for community health services have evolved with advances in information technology (IT) in Australia and overseas. However, there is evidence from other sectors for the need to distinguish between an information systems (IS) strategy and an IT strategy. This paper uses case studies of computerised information systems developed in New South Wales to identify issues that lead to success and failure. These issues show that many of the shortcomings can be attributed to a poor IS strategy. The paper discusses the shortcomings of an IT-driven strategy. It argues that an IS strategy needs to be congruent with the organisational strategy for community health and that the system design should satisfy the information needs of service personnel if the information is to be used.
Australia↗
Estimation of animal-level prevalence from pooled samples in animal production.
Often, the prevalence of an infection in the animal-production sector is determined at the group level. The prevalence at animal level (p) gives more-precise information on the infection status of the sector. This paper shows that pooled-sample data together with mathematical models allow for estimation of p. For this, model assumptions have to be made on the variation of p between groups separated in space and/or time. Formulas were derived for four models that were based on different assumptions. Model 1 assumed that p has the same value for all groups. Models 2-4 assumed that some of the groups were not infected. In addition, model 2 assumed that p has the same value for all infected groups; model 3 assumed that for an infected group, p is equal to either p(1) or p(2); and model 4 assumed that p was Beta distributed among infected groups. The models were applied to data sets on Salmonella infection in broiler flocks, including serotype data dominated by S. Hadar and S. Paratyphi B, var. Java. Based on likelihood-ratio tests, models 3 and 4 consistently fitted significantly better to the data. The applicability of model 4 is numerically bounded, related to the shape of the Beta distribution of p. Model calculations show that flock-level prevalence of Salmonella is much higher after than before slaughter. This difference (which possibly is related to different types of samples) is much smaller at the animal level. An important result of the estimation of p is that it in turn allows for an estimation of the proportion of false-negative groups--which is important in estimating the effect of veterinary or public-health measures.
Animals↗