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From strategy to reality: 25 years of planning and progress in occupational injury research.

Injury as a major public health problem, although noted as early as the 1930s, was not widely accepted by the public health community until the 1980s. Over recent decades, there have been a number of strategic plans developed to prevent and control occupational injuries. These plans have been remarkably consistent in that many of the same recommendations surfaced despite different planners from different eras. The recommendations also generally align with the steps in the public health approach. Although recognition of the relevance of the public health approach to traumatic occupational injury came decades ago, significant barriers have inhibited its full implementation. Today, these barriers are being overcome, due to improved surveillance, increased collaborations among disciplines, increasing partnerships with industry, improved prevention evaluation methods, cost analysis models, and increasing funding. Of course, many of the experiences in the United States are paralleled in other countries in the Western world, and even in some developing countries. Substantial progress has been made in recent years in identifying problems and developing solutions, in addressing the recommendations of decades of planning, and of building the scientific foundation necessary to guide prevention. As a result, traumatic occupational injury research must begin to increase focus on bringing the public health process full circle, including the implementation and evaluation of preventive strategies and interventions. Now, the final steps of the process need our attention-evaluating the effectiveness of these solutions and then getting knowledge and products onto the shop floor, the construction site, and the farm, the convenience store, and the delivery truck; getting effective prevention into the workplace. Now is the time to close the loop, from science to prevention.

Humans↗

Population forecasts for South Pacific nations using autoregressive models, 1985-2000.

"This paper uses an autoregressive statistical model to forecast population for Fiji, Western Samoa, Tonga, Solomon Islands, and Vanuatu and compares these forecasts with those obtained from other methods. The growth rate of population is predicted to continue to fall in Fiji and Tonga, rise a little for Western Samoa, and rise considerably in Vanuatu and the Solomon Islands. The implications of the forecasts for recent government development plans are also discussed."

Demography↗

The Mutual Assistance Programme of the IUATLD. Development, contribution and significance.

The Mutual Assistance Programme of the IUATLD is aimed at trying to compensate for the neglect into which tuberculosis had fallen from the part of governments, teaching institutions and international agencies, and represents an innovative approach to promote solidarity between governments and voluntary organizations of low tuberculosis prevalence countries and those of high prevalence countries. The main objective has been to develop a system of delivery of treatment and diagnosis of tuberculosis that would be efficacious even under the difficult conditions of high prevalence of tuberculosis, low resources and/or socio-political disturbances. The system turned out not only to be efficacious in terms of cure rates and epidemiological impact but also to be efficient in terms of cost/benefit. The National Tuberculosis Programme's approach includes the application of short-course chemotherapy, the regular provision of drugs and products, a system of registers, forms and periodic reports, the assessment of the yield of case-finding and, most important of all, the analysis of the therapeutic results in successive cohorts of patients. Cure rates repeatedly reach around 85% in new cases and approximately 80% in retreatment cases, nationwide, in the countries where such programmes have been successively implemented. Each national programme has an important role of training and of capacity building. While serving the populations, the national programmes also provide the framework for relatively inexpensive operational research and, finally, the careful collection of data represents a basis--unique of its kind in the world--for the study of the clinical and epidemiological relationships between tuberculosis and HIV. The method has been endorsed by the WHO and has the support of the World Bank, the United Nations Development Plan and the main government Agencies for Development Cooperation. It is part of the new Global Strategy against Tuberculosis which is presently being developed under the WHO TB Unit. The other aspects of Mutual Assistance concern courses, consultation to programmes not directly sponsored by the IUATLD and publications.

Charities↗

[Development of human resources for working in environmental health].

This paper was presented as a reference document in the First Meeting of the PAHO/WHO Textbook Program Committee for the Teaching of Sanitary Engineering and Environmental Sciences, held in Santo Domingo, Dominican Republic, from 24 to 26 November 1977. It analyzes the human resource development process in terms of the basic components: planning, development itself, and utilization. Its principal objectives are: to encourage the performance of studies and research on human resources in environmental health as sources of information for taking decisions, making policy, and drawing up training plans; to suggest ways of improving the quality of education and training services; to encourage the development of suitable techniques and methods for determining human resource needs; and to highlight some recent studies and publications on human resources in relation to environmental problems.

Allied Health Personnel↗

New issues, new options: a management perspective on population and family planning.

As population problems increasingly are seen in the context of socioeconomic development and as programs to reduce fertility become more diversified and multisectoral, issues facing program managers are changing. In addressing today's challenges in the areas of population policy and development planning, family planning program design, and problem-solving mechanisms, a variety of options can be considered. No blanket prescriptions can be made, but familiarity with some of the alternative and an understanding of their political and administrative implications may be helpful to managers, not only of population programs but in related development field as well.

Family Planning Services↗

The taxol supply crisis. New NCI policies for handling the large-scale production of novel natural product anticancer and anti-HIV agents.

Over the past 30 years, the National Cancer Institute has been involved in the preclinical and/or clinical evaluation of the majority of those agents approved for the treatment of cancer. Many of the new agents under consideration in the NCI program are either natural products or derivatives of natural product leads, and of critical importance to their development is the issue of drug supply. In responding to the drug supply crisis which emerged with the demonstration of the clinical efficacy of taxol, the NCI has identified several important lessons for those interested in natural product drug discovery and development. As a result, the NCI has developed plans to avert similar supply crisis in the future by initiating exploratory research projects for large-scale production of promising agents at the earliest possible point following the demonstration of confirmed antitumor activity. These plans, together with a review of the development of taxol, are presented in this paper.

Antineoplastic Agents↗

From the cradle to enteral autonomy: the role of autologous gastrointestinal reconstruction.

The short bowel state is treatable, with acceptable long-term quality of life. Management during the first 6-12 months of life is critical but, presently, frequently compromises long-term survival and prospects. At first presentation, primary caregivers, working with specialists at designated intestinal failure centers, should develop a structured individual-oriented management plan. Preservation of venous access, "hepatosparing" parenteral nutrition, and avoidance of liver sepsis are crucial to survival. Early surgery should be limited to conservation of autologous bowel, even short bowel lengths having great potential, and to facilitating natural intestinal adaptation. Bowel expansion may be relevant prior to delayed bowel reconstruction with single or combined techniques that include bowel lengthening and/or tailoring, reversed segments, and colon interposition. Bowel transplantation, as yet not recommended for primary management, offers survival and opportunity to those with no prospect of autologous bowel autonomy or following failed autologous gastrointestinal reconstruction. This paper reviews current surgery for the short bowel state and concludes that it is presently appropriate before bowel transplantation to offer autologous gastrointestinal reconstruction, with its prospect of enteral autonomy with quality life. It emphasizes the need for an individual-oriented management plan, developed jointly at the time of first presentation between the primary caregivers and a designated multidisciplinary intestinal failure center, to enhance the prospects for enteral autonomy preferably on autologous bowel. Autologous gastrointestinal reconstruction is in its infancy and requires resources, commitment, and research from dedicated bowel reconstructive surgeons toward a better opportunity for the child and family with short bowel.

Adaptation, Physiological↗

Provision of educationally-related services for children and adolescents with chronic diseases and disabling conditions. American Academy of Pediatrics. Committee on Children with Disabilities.

Children and adolescents with chronic diseases and disabling conditions often need related services. As medical home professionals, pediatricians can assist children, adolescents, and their families with the complex federal, state, and local laws, regulations, and systems associated with these services. Expanded roles for pediatricians in Individual Family Service Plan, Individualized Education Plan, and 504 Plan development and implementation are recommended. The complex range of federal, state, and local laws, regulations, and systems for special education and related services for children and adolescents in public schools is beyond the scope of this statement. Readers are referred to the policy statement "The Pediatrician's Role in Development and Implementation of an Individual Education Plan (IEP) and/or an Individual Family Services Plan"(1) by the American Academy of Pediatrics for additional background materials.

Adolescent↗

Using the State Plan Index to evaluate the quality of state plans to prevent obesity and other chronic diseases.

INTRODUCTION: Implicit in public health planning models is the assumption that good public health plans lead to good programs, and good programs lead to desired health outcomes. Despite considerable resources that are devoted to developing plans, public health agencies and organizations have lacked a tool for evaluating the finished product of their planning efforts -- the written plan itself -- as an important indicator of progress. To address the need for an instrument to assess the quality of state plans designed to prevent and control chronic diseases, we created and tested the State Plan Index and used it to evaluate the quality of nine state plans aimed at preventing and reducing obesity. METHODS: The State Plan Index was developed under the auspices of the Centers for Disease Control and Prevention (CDC) in collaboration with public health experts in federal, state, and academic settings. The State Plan Index included 55 items related to plan quality arranged into nine components. Each item was rated on a Likert scale from 0 to 5, with 5 being the highest rating. Each plan also received a separate overall plan quality score using the same scale. Each state plan was evaluated by four or five raters using the State Plan Index. For each plan, the 55 items were averaged to calculate an item average score, and a subscore was calculated for each State Plan Index component. Finally, five states also self-rated their own plans (self score). RESULTS: The mean item average score for all plans was 2.4 out of 5.0. The range of item average scores was 1.0 to 3.0. The component of the State Plan Index with the highest mean component score (3.3) was Presentation of Epidemiologic Data on Disease Burden. The components with the lowest component scores were Resources for Plan Implementation (0.7); Integration of Obesity Efforts with Other Chronic Disease Efforts (1.7); and Program Evaluation (2.0). Plan quality was rated higher when based on the single overall plan quality score assigned by raters. In addition, self scores were consistently and substantially higher than rater-assigned scores. CONCLUSION: Evaluation of plans early in the life of programs can be used to strengthen existing programs and to guide programs newly engaged in chronic disease prevention planning. The CDC has used the State Plan Index evaluation results to guide technical assistance, plan training sessions, and enhance communication with state staff about plan content, quality, and public health approach. Some state program directors self-evaluated their obesity draft plan and used the evaluation results to strengthen their planning process and to guide plan revisions. Other states have adapted the State Plan Index as a framework for new planning efforts to prevent obesity as well as other chronic diseases.

Centers for Disease Control and Prevention, U.S.↗

Issues in medical staff planning: past, present, and future.

More and more hospitals are preparing and utilizing medical staff development plans. This article discusses how the nature and purposes of hospital medical staff planning have evolved over time, the increasing impact of this activity upon physicians, and the new issues raised by current trends in medical staff planning.

Data Collection↗

Valuing research in clinical practice: a basis for developing a strategic plan for nursing research.

With a view to developing a strategic plan for nursing research in a clinical practice setting, a survey was conducted to examine nurses' attitudes towards research as a part of their work. The 348 nurse respondents represented various nursing roles: staff nurses, head nurses, clinical nurse specialists, nurse educators, hospice nurses, expanded-role nurses, and an enterostomal therapist. They were classified into two groups, staff nurses and leadership nurses. The subjects reported that they valued research highly and that they believed the nursing division was supportive of research activities. Few were actually involved in conducting research; the nurses reported a lack of confidence in their ability to participate in designing and conducting studies. Most staff nurses were not using research in their work, while the majority of leadership nurses were. Factors that explain both research use by nurses and their participation in designing and conducting research differed for the two groups.

Adult↗

The Human Settlements Authority Act, 1988 (No. 2 of 1988), 4 June 1986.

This Act establishes in Swaziland the Human Settlements Authority, whose members are appointed by the Minister responsible for human settlements. The Authority shall "1) assist the Government in formulating policy relating to human settlements and uphold and give effect to such policy; 2) ensure the orderly development of existing and future urban and rural settlements; 3) establish a finance mechanism for ensuring the supply and maintenance of improved shelter and infrastructure throughout Swaziland, which shall include a system of revenue recovery; 4) prepare appropriate standards for the provision of land, shelter and infrastructure by both private and public developers; 5) regulate real estate transactions including the standardization of lease agreements, rent control and sale of land and buildings; 6) encourage and support research in appropriate methods of providing affordable shelter and infrastructure; and 7) perform all other acts or things as are required by this Act." Under the Act, no person shall establish a human settlement, housing scheme, or private housing scheme without the written permission of the Authority. Further provisions of the Act deal with the membership and meetings of the Authority, the granting of permission for human settlements, and human settlement development plans, among other things. On 4 June 1986, the Government of Swaziland also enacted the National Housing Board Act, 1988 (No. 3 of 1988). This Act establishes a National Housing Board, subject to the provisions of the Human Settlements Act, 1988, to "provide affordable housing generally in Swaziland and take over such housing schemes as the Government may determine." Further provisions of the Act deal with the functions, membership, finances, staffing, assets, and administration of the Board. See Swaziland Government Gazette, Extraordinary, Vol. 26, No. 581, 2 March 1988, pp. S6-S11.

Africa↗

The health maintenance organization delivery system. A national study of attitudes of HMO project directors on HMO issues.

A national survey of health maintenance organization project directors' attitudes on HMO delivery issues was conducted to gather data about HMO planning development and delivery areas. Questionnaire results revealed characteristics of the HMO project director, sponsoring institution, and developmental stage. Seven HMO issues (Prepayment Mechanism, Quality of Care, Degree of Federal Participation) Public and Private Funding, Physicians' Attitudes toward HMO, and Consumer Recruitment) were identified to measure the attitudes of directors. As a whole, responses were in the positive range. Scale 1 (Prepayment Mechanism) and Scale 2 (Quality of Care) received the lowest mean scores and were in the moderate agreement range. Scale 3 (Degree of Federal Regulation) and Scale 5 (Public and Private Funding) had the highest mean scores and fell between slight agreement and disagreement. Further research has been noted in various administrative features and issue areas of HMO. Most crucial is the outcome of HMO legislation which has a bearing on the policy and program of the HMO delivery system. On the basis of what appears to be a representative sample of directors of DHEW-funded HMO Planning and Development Projects, the study has assessed attitudes on important issues relevant to HMOs and determined areas of greatest agreement and disagreement.

Administrative Personnel↗

Development of a nutritional care plan for diabetic patients.

A nutritional care plan, encompassing all aspects of nutritional assessment, education, and follow-up was designed and implemented at the Victoria General Hospital in Halifax, Nova Scotia. The care plan was developed in response to the results of an audit on nutritional care of diabetic patients. It was designed to assure referral of all diabetic patients to clinical dietitians, set standards for care and its documentation, provide a teaching tool, and enhance communication between inpatient and outpatient nutrition services. The care plan was developed by the authors in committee and approved by the clinical dietitians and the medical staff at the Victoria General Hospital. The care plan format is described in detail. It has been in effect since March, 1982 with positive feedback reported by clinical dietitians. Reevaluation of care, charting, and referrals to outpatient nutrition services are planned. Additional care plans on other nutritional topics are planned for the future.

Diet, Diabetic↗

Developing an abstract and plan for presenting at education programs.

Presenters at the Society of Gastroenterology Nurses and Associates education programs are now being asked to submit abstracts on the proposed topic for presentation. In this article the author discusses the steps in planning and developing a presentation as well as submitting an abstract for consideration.

Abstracting and Indexing↗

Growth determinants in the core-periphery of Korea.

"This article describes the emergent spatial dispersion pattern of the urban system of the Republic of Korea, where the government has instituted a strong decentralization policy. Intraregional decentralization is underway within the core area, while intraregional polarization towards larger regional centers is evident in periphery areas. Through the use of step-wise regression analysis, determinants of the differential growth rates of urban centers in the core and periphery are identified. The different spatial development processes operating in the core and periphery have implications for growth pole theory and regional development planning."

Asia↗