Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Policy Making”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources
PubMed2006

Technology assessment and knowledge brokering: the case of assisted reproduction in The Netherlands.

OBJECTIVES: Even when policy makers show interest and evidence-informed and convincing HTA studies are available, use of assessment products is not guaranteed. In this article, we report our experience with knowledge brokering to foster evidence-informed policy making on cost-effective treatment and reimbursement of assisted reproduction in The Netherlands. METHODS: From earlier work in the field of knowledge brokering, we foresaw the need for a deliberative strategy to manage the inherent tension between scientific rigor demanded by researchers and responsiveness to real-time needs demanded by policy makers. Therefore, we structured the process in three distinct steps: (i) agreement about the main messages from the research, (ii) analysis of the policy context and of the meaning of the main messages for the actors involved, and (iii) an invitational meeting to make recommendations for action. RESULTS: One of the recommendations that would require changes in ministerial policy was followed up instantly, whereas the other recommendation is still under debate. The Dutch Society of Obstetrics and Gynecology activated the revision of two guidelines. The patient organization uses the new scientific insights in informing members and the public. Closing the loop, The Netherlands Organisation for Health Research and Development (ZonMw) funded research to close knowledge gaps that became apparent in the process. CONCLUSIONS: Knowledge brokering is a promising approach to bring HTA into practice. We conclude that the methodologies to feed research results into the policy process are still in an incipient stage and need further development.

Cost-Benefit Analysis↗
PubMed1996

Behavioural feedback to risk variation ensues from unsatisfied appetency.

For a long time, but particularly since the last two decades, the phenomenon of behavioural feedback to risk variation, especially to highway safety measures, has been the subject of numerous papers and debates. It has been advanced that human behaviour ensues from the interaction between two motivational systems: (1) appetency, governed by a homeostasic mechanism, wherein the individual seeks to satisfy needs, and (2) aversion, guided by the principle of zero aversion, whereby the individual seeks to avoid aversive stimuli. When an individual considers the possibility of undertaking an action, he weighs the advantages (appetency) and the disavantages (aversion). If the appetency proves to be stronger than the aversion, the action is completed and ipso facto, the individual accepts the risk associated with it. In this article, it is suggested that the behavioural feedback following a variation in the risk (aversion) ensues from unsatisfied appetency. If the unsatisfied appetency is nil (the individual is already satisfied), a drop in the aversive constraint (e.g. lowered risk of an accident) will not cause any behavioural feedback. On the other hand, if there is an unsatisfied appetency (the individual is not fully satisfied), a drop in the aversive constraint will bring about behavioural feedback in proportion to the level of unsatisfied appetency. Cases in which behavioural feedback is likely to arise and the implications for public policy-making are briefly discussed.

Accidents, Traffic↗
PubMed1991

Decision making in dentistry. Part II: Clinical applications of decision methods.

The study of clinical decision making provides a common model on which to base dental practice and thus promotes standardization of care and treatment. Decision analysis can assist in identifying missing data in clinical problems and thus generate clinically relevant research agendas. Part II reviews the current literature focusing on three areas of decision making in dentistry: diagnosis, treatment planning, and disease prediction. The growing body of literature indicates that wide variation exists among the treatment plans made by dentists. Considerable bias arises from many sources of uncertainty in decision making, including the limitations of human memory and judgment. Literature pertaining to computer application of decision analysis in dentistry and to policy making are reviewed.

Decision Making↗
PubMed1992

Women and access to health care.

This paper is concerned with access to health care for women in developing countries, with specific reference to Latin American and Caribbean countries. It reviews the available literature on the concept of access as it relates to other variables such as accountability, affordability and acceptability of health services, taking into consideration the effects of the generalized socio-economic crisis that has affected most countries during the last decade, as well as equity objectives. Various approaches to defining variables affecting access to health care appear in the literature reviewed. While some of them indicate that ability to pay for services act as a major determinant of access to health care, others point to behavioral issues related to motivation, health seeking behavior or perception of illness as a deterrent to women in the low socioeconomic strata, while others indicate that sociocultural issues, such as values, education, religion or demographic variables related to age, influence access to health care. The paper concludes with some comments on policies and strategies for securing access to health and healthcare, indicating the need to move away from traditional solutions including framing gender-based health differences in status and access adequately, promoting and strengthening social participation of women in policy making.

Americas↗
PubMed2004

Proxy and surrogate consent in geriatric neuropsychiatric research: update and recommendations.

OBJECTIVE: The ethics of involving decisionally incapable adults in research will continue to grow in importance as more research is conducted to address the problems of decisionally impaired persons, especially elderly persons. The authors provide an updated discussion, critique, and recommendations regarding the need for clear legal and regulatory policy on this issue. METHOD: The authors summarize and build on discussions of a workshop on proxy and surrogate consent in geriatric neuropsychiatric research sponsored by the Aging Research Consortium of the National Institute of Mental Health. They incorporate the views of various stakeholders present at the workshop as well as review recent federal and state initiatives, recent empirical research and media reports, and various commission reports and relevant regulations. RESULTS: Despite a wave of initiatives in the late 1990s to clarify policy, surrogate consent for research continues to be a murky legal area and incapable subjects in the United States still lack clear regulatory protection. There is evidence that conservative risk management strategies by institutional review boards and their institutions may severely restrict research with decisionally impaired subjects. A passive approach to this problem may no longer be feasible. A recent federal advisory report on human research protections and legislative initiatives in some states could begin to provide a blueprint for future policy making. Interim recommendations for various stakeholders are given. CONCLUSIONS: It is imperative that the scientific community, patients and their advocates, and policy makers at all levels establish a constructive dialogue to clarify ethical and legal standards in the area of proxy and surrogate consent for research.

Adult↗
PubMedDate not supplied

Promoting private health insurance in Australia.

Health insurance policy in Australia has been distinguished by considerable instability over the past five years. This paper reviews the rationale and emerging evidence on three major policy initiatives--a move to allow selective contracting, the introduction of a 30 percent government subsidy for private health insurance, and the abolition of pure community rating. Policy making on private health insurance has been characterized by insufficient attention to research that might provide a stronger evidence basis for policy reforms.

Adolescent↗
PubMed2004

Town-level characteristics and smoking policy adoption in Massachusetts: are local restaurant smoking regulations fostering disparities in health protection?

OBJECTIVES: We identified and quantified differences in sociodemographic characteristics of communities relative to the strength of local restaurant smoking regulations in Massachusetts. METHODS: We examined the relationship between the strength of the 351 local restaurant smoking regulations in Massachusetts and a number of town-level characteristics, using a multinomial logistic regression model. RESULTS: Characteristics important to the adoption of stronger restaurant smoking regulations included higher education and per capita income, geographic region, voter support for a state cigarette tax initiative, board of health funding to promote clean indoor air policy making, and the presence of a bordering town with a strong regulation. CONCLUSIONS: The current pattern of smoke-free restaurant policy enactment fosters socioeconomic and geographic disparities in health protection, undermining an important national health goal.

Financing, Government↗
PubMed1983

New federalism and health policy.

The making of health policy in the United States is a complex process that involves the private and public sectors, including multiple levels of government. Five characteristics of the policy process are identified, which establish the means by which policies are formulated and which affect the nature of the policies that emerge. These characteristics include (1) the relationship of the government to the private sector; (2) the distribution of authority and responsibility within a federal system of government; (3) the relationship between policy formation and implementation; (4) a pluralistic ideology as the basis of politics; and (5) incrementalism as the strategy for reform. The article focuses on the impact on health policy of the distribution of authority and responsibility within the federal system, particularly the impact of new federalism policies as they emerged during the past decade. The effects of dual federalism, cooperative federalism, creative federalism, and new federalism are examined in relation to health policies. The article concludes with an examination of the challenge to long-established values and health policies posed by new federalism.

Government↗
PubMed2004

[The International Union for Health Promotion and Education's Global Programme on Health Promotion Effectiveness].

The Global Programme on Health Promotion Effectiveness (GPHPE) is a multi-partner initiative, coordinated by the International Union for Health Promotion and Education (IUHPE) in collaboration with the World Health Organization, and supported by a number of partners from across the world. The GPHPE aims to raise standards of health promoting policy-making and practice worldwide by: reviewing evidence of effectiveness in terms of health, social, economic and political impact; translating evidence to policy makers, teachers, practitioners, researchers; stimulating debate on the nature of evidence of effectiveness. The principal challenge for the GPHPE is to develop a sustainable approach with adaptations suitable to different regional needs, whilst maintaining the high quality for which the European work that triggered the programme is recognised. Although varied, the regional activities are all clearly designed to contribute to the global body of knowledge that the GPHPE aims to build. The article presents the origins of the GPHPE, its operational structure and zooms in on some of the specific activities of the European Region.

Europe↗
PubMed2005

HIV vaccine research--South Africa's ethical-legal framework and its ability to promote the welfare of trial participants.

An effective ethical-legal framework for the conduct of research is critical. We describe five essential components of such a system, review the extent to which these components have been realised in South Africa, present brief implications for the ethical conduct of clinical trials of HIV vaccines in South Africa and make recommendations. The components of an effective ethical-legal system that we propose are the existence of scientific ethical and policy-making structures that regulate research; research ethics committees (RECs) that ethically review research; national ethical guidelines and standards; laws protecting research participants; and mechanisms to enforce and monitor legal rights and ethical standards. We conclude that the ethical-legal framework has, for the most part, the necessary institutions, and certain necessary guidelines but does not have many of the laws needed to protect and promote the rights of persons participating in research, including HIV vaccine trials. Recommendations made include advocacy measures to finalise and implement legislation, development of regulations, analysis and comparison of ethical guidelines, and the development of measures to monitor ethical-legal rights at trial sites.

AIDS Vaccines↗
PubMedDate not supplied

Severely and persistently mentally ill substance abusers: clinical and policy issues.

Communities that are struggling to provide effective treatment for the challenging population of severely mentally ill clients who use alcohol and drugs have a growing research base on which to make policy decisions. Integrating outpatient treatment for mental health and addictive disorders appears to be more effective than treatment in two separate systems. Integrated treatment at a single site allows for individualizing treatment priorities without fragmenting care. Harm reduction approaches provide a low threshold entry, which can be followed by interventions to enhance motivation. Managing patient benefits to discourage drug use reduces the likelihood of their becoming homeless, hospitalized or incarcerated. Inadequate treatment capacity plays a large role in the growing number of disturbed clients who end up in the criminal justice system. Effective community treatment requires vigorous collaboration between care providers. Ultimately, professional training programs need to produce clinicians who are competent and comfortable addressing alcohol and other drug use to implement effective treatment systems.

Attitude of Health Personnel↗
PubMed2002

Nurses as equals in the multidisciplinary team.

For many years nurses have had a high profile both nationally and internationally, but in the past most nurses played only a supporting role. Although the doctor is still recognized as the leader of the clinical team, nurses have become recognized as professionals in their own right, carrying responsibility for their own actions. The clinical and managerial judgement of nurses is respected and increasingly they are given the authority to make policy decisions within a team. However, nurses must take personal responsibility for developing their own leadership and boardroom skills to enable them to make an equal contribution. In this article I reflect on how Professor Michael Hull valued the role of nurses as equal members of the clinical team. In the Centre for Reproductive Medicine in Bristol he paved the way towards making nurses equal. He encouraged nurses to learn and use their knowledge and this in turn developed self-esteem and confidence, which not only made nurses equal but also made them feel equal.

Civil Rights↗
PubMed2005

Requiring belt use as part of a school parking permit program: does it increase students' belt use?

OBJECTIVE: Teenagers have very high motor vehicle crash rates, and their use of seat belts is generally lower than that of adults. A potential school-based strategy to increase teenagers' belt use is a policy making parking privileges contingent on belt use by student drivers and their passengers. This study evaluated the effects of implementing a school belt policy. METHODS: The effects of a belt policy were evaluated during the 2003-2004 school year at high schools in two states: Connecticut, a state with a primary enforcement belt law and high belt use rates, and Mississippi, a state with a secondary enforcement law and generally low use rates. Both schools enforced the policy, and violations resulted in a graduated set of penalties leading to the potential loss of parking privileges. Baseline and post-policy belt use rates were obtained from observation surveys of student drivers and their teenage passengers coming to and from school. Changes in belt use were examined relative to belt use trends at comparison schools without a belt policy. Implementation of the policies also was monitored. RESULTS: In Mississippi, among students arriving at school in the morning, driver belt use increased from 42% before the policy to 67% about 6 months after; passenger belt use increased from 16% to 61%, although sample sizes were small. These increases were significantly larger than expected, based on belt use trends at the comparison school in Mississippi. In Connecticut, where 86% of drivers and 79% of their passengers already were belted prior to the policy, there was no significant change. Both schools publicized and monitored the belt policy, and most enforcement occurred in the morning as students arrived at school. CONCLUSIONS: Based on a small-scale application of a belt policy at two schools in different states, a school belt policy may have stronger effects in states where belt use is low. Strong penalties and enforcement are essential elements of an effective policy. Adequate resources and commitment are needed for schools to implement and monitor the type of strong policy needed to sustain high belt use rates. Replication of this study in additional schools appears warranted.

Adolescent↗
PubMed2004

The contribution of research to Australian policy responses to heroin dependence 1990-2001: a personal retrospection.

Periodic public concern about heroin use has been a major driver of Australian drug policy in the four decades since heroin use was first reported. The number of heroin-dependent people in Australia has increased from several hundreds in the late 1960s to around 100,000 by the end of the 1990s. In this paper I do the following: (1) describe collaborative research on heroin dependence that was undertaken between 1991 and 2001 by researchers at the National Drug and Alcohol Research Centre; (2) discuss the contribution that this research may have made to the formulation of policies towards the treatment of heroin dependence during a period when the policy debate crystallized around the issue of whether or not Australia should conduct a controlled trial of heroin prescription; and (3) reflect on the relationships between research and policy-making in the addictions field, specifically on the roles of investigator-initiated and commissioned research, the interface between researchers, funders and policy-makers; and the need to be realistic about the likely impact of research on policy and practice.

Australia↗
PubMed2006

The politics of sexual orientation issues in American schools.

Schools are increasingly expected to address the needs of gay, lesbian, bisexual, and transgender students. However, the controversial nature of sexual orientation programs and policies makes this a politically sensitive undertaking. This empirical study analyzes the extent to which public school districts across the United States have implemented policy recommendations and describes, according to 4 theoretical policy models, factors that influence their ability to do so. The survey found that most districts have not institutionalized recommended policies or programs. Recommendations for school health professionals based on factors found to be significantly associated with the implementation of programs are discussed.

Adolescent↗
PubMed2006

Searching for social capital: historical perspectives on health, poverty and culture.

Social capital has been seen as having a positive effect on health, and the concept of social capital has been viewed as of central importance to debates about healthy, sustainable communities. More generally, behaviour and its relationship with health has become much more central to policy-making, as illustrated in the Choosing Health White Paper (2005), and the concept of social capital has been one influence on the concept of social exclusion. Robert Putnam's arguments, both those expressed in Making Democracy Work (1993) and the revised version seen in Bowling Alone (2000) have been taken up by numerous social scientists and policy-makers. But despite the explicitly historical perspective that Putnam employs in Bowling Alone in particular, the history of social capital remains rather neglected in the available literature. This article is concerned with providing a historical perspective on social capital, especially the ways in which social investigators have viewed the relationships between health, poverty and behaviour. The article puts social capital alongside that of 'underclass' concepts such as the culture of poverty thesis, and examines how the latter has been invented and reinvented in the U.K. and the U.S.A. over the last 120 years. It argues that there are important similarities between the culture of poverty and social capital, but also significant differences, and these have implications for current policy initiatives. One way of analysing concepts like social capital and social exclusion more rigorously is by locating them within this longer-term history of social investigation, in which debates about health, poverty, and culture have been of

Community Health Planning↗
PubMedDate not supplied

Occupational health in Central America.

The 12.4 million economically active population (EAP) of the seven Central American countries includes a large informal sector. Social security covers only 14-60%. No surveillance of occupational safety and health (OSH) hazards or accidents exists. Extrapolating the incidence of occupational accidents among insured Costa Rican workers to the Central American EAP yields two million accidents yearly, still a gross underestimate. Occupational diseases are underreported, misdiagnosed, and not recognized as such. A number of regional OSH programs aim at modernization of the labor administrations and address the formal sector, in particular textile maquila, in connection with free trade agreements. The weak role of the ministries of health is expected to strengthen under the Pan American Health Organization OSH program. Employers largely influence new policies. Workers' influence on OSH policies has been weak, with only about 10% unionization rate and scarce resources and OSH knowledge. Informal workers, however, are getting organized. OSH research is underdeveloped and not linked to policy making. Construction, agriculture, and general un/underemployment are considered priorities for intervention. The informal sector needs to be included in national and regional OSH policies. Regional collaboration and international development support are of strategic importance to achieve sustainable improvement in OSH.

Accidents, Occupational↗
PubMed2003

[Overwork and its health effects--current status and future approach regarding Karoshi].

The word karoshi, i.e. death due to overwork, is not defined for medical diagnosis, but in Japan it means cases of compensation awarded by reason of fatal occupational diseases, particularly ischemic heart diseases and cerebrovascular diseases which are recognized as caused by a heavy workload. Current studies have shown that 1) almost definitely there is evidence of an association between overwork and cardiovascular diseases and the risk factors were found, 2) no reports have been published on evidence of a causal relationship between overwork and fatal effects even though the possibility remains, and 3) the adverse health effects can vary according to workers' characteristics such as gender, age, stress coping and perception. Recently there has been an increase in the proportion of compensated cases versus claims from 3.1% in the 1988 fiscal year to 20.7% in the 2001 fiscal year. This may be related to the deregulation of criteria for compensation, or nintei-kijun. The period of determination of overwork for victims has been extended to a maximum of six months in the newest criteria set in 2001, up from only one week in the criteria set in 1987. According to sociological analysis, long working hours in Japan are related not only to the structure of the working-time system but also the sociocultural background of labor. In 2002, the Japanese government provided the first countermeasures for the prevention of karoshi for all employees stating that they should not work more than 45 h overtime per month and that government intervention in the form of administrative guidance to employees and their employers should be conducted if overtime exceeds 100 h per month. It is a population strategy targeting all workers equally, not just a high-risk strategy targeting only those with some risk factors, and is expected to provide more fruitful results with flexibility, i.e. differentially reinforced management for older workers and those working under highly stressful conditions with harmonization of the production cycle in the workplace. Occupational health professionals such as occupational health physicians and nurses will play a key role in making break-throughs to solve various problems related to karoshi, which may then result in further investigations to provide scientific evidence for policy making.

Cardiovascular Diseases↗