[Further improvement of occupational medicine dispensary care--a priority task in the health protection of workers].
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Environmental Exposure↗
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Results for “Health Priorities”
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.
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[Prostate cancer screening (II): is prostate cancer a public health problem? Update of incidence and mortality figures in France from 1982 to 1990].
OBJECTIVE: To describe the epidemiological situation of prostatic cancer in France on the basis on a large population sample. MATERIAL AND METHODS: This study uses incidence data derived from French cancer registers, and mortality data obtained from death certificates. Crude rates and rates standardized for the world population are calculated. The variation of these rates is analysed by a log-linear model (adjusted for age, department and period). RESULTS: The incidence of prostatic cancer in France in 1990 was 200 to 300/100,000 between the ages of 60 and 70 years and more than 600/100,000 after the age of 70 years. 73% of cases were diagnosed after the age of 70 years. The incidence increased annually by 8.76% between 1982 and 1990. An estimated 22,600 cases were diagnosed in France in 1990. The increased incidence of localized or local stages is due to the use of diagnostic tests (PSA and ultrasound-guided biopsies), as this increase accelerated after 1987. The crude mortality rate was 33.4/100,000 (384/100,000 between the ages of 75 and 85 years). It increased by 2.56% per annum from 1982 to 1990, but essentially for men over the age of 75 years. CONCLUSION: These findings tend to make prostatic cancer a public health priority, but this affirmation must be moderated by the fact that this disease has a low impact on loss of life expectancy.
Age Distribution↗
Research priorities in mental health, Part 2: an evaluationof the current research effort against stakeholders' priorities.
OBJECTIVE: To examine the current distribution of mental health research in Australia and compare this with the priorities of various stakeholder groups. METHOD: A content analysis was carried out on a year's worth of published articles and a year's worth of competitive research grants. A questionnaire for stakeholders was developed in which respondents were asked to rate priorities for research using the same categories. Questionnaires were sent to mental health researchers,members of panels that evaluate mental health research grant applications,general practitioners, psychiatrists, clinical psychologists, mental health nurses, mental health consumer and carer advocates, and members of the National Mental Health Working Group. RESULTS: Different groups of stakeholders tended to have differing perspectives on research priorities, with some major differences between committees that evaluate research grants and consumer and carer groups. Different stakeholder groups also tended to obtain their information about research from different sources. However, there were also a number of areas of agreement. When different research topics are considered,the following tended to be under-researched: affective disorders,suicide, primary care and community settings, prevention and promotion,evaluation of services, Aboriginal and Torres Strait Islander peoples,and socially and economically disadvantaged people. CONCLUSIONS: It is of concern that committees that evaluate research are guided by different values from consumers and carers in setting priorities. Nevertheless, there is consensus across stakeholder groups that a number of areas should be a high priority.
Analysis of Variance↗
Brundtland sets out priorities at annual World Health Assembly.
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Health Priorities↗
Cardiovascular health--a workplace priority.
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Cardiovascular Diseases↗
Global control of sexually transmitted infections.
Sexually transmitted infections other than HIV are important global health issues. They have, however, been neglected as a public-health priority and control efforts continue to fail. Sexually transmitted infections, by their nature, affect individuals, who are part of partnerships and larger sexual networks, and in turn populations. We propose a framework of individual, partnership, and population levels for examining the effects of sexually transmitted infections and interventions to control them. At the individual level we have a range of effective diagnostic tests, treatments, and vaccines. These options are unavailable or inaccessible in many resource-poor settings, where syndromic management remains the core intervention for individual case management. At the partnership level, partner notification and antenatal syphilis screening have the potential to prevent infection and re-infection. Interventions delivered to whole populations, or groups in whom the risks of infection and onward transmission are very high, have the greatest potential effect. Improvements to the infrastructure of treatment services can reduce the incidence of syphilis and gonorrhoea or urethritis. Strong evidence for the effectiveness of most other interventions on population-level outcomes is, however, scarce. Effective action requires a multifaceted approach including better basic epidemiological and surveillance data, high quality evidence about effectiveness of individual interventions and programmes, better methods to get effective interventions onto the policy agenda, and better advocacy and more commitment to get them implemented properly. We must not allow stigma, prejudice, and moral opposition to obstruct the goals of infectious disease control.
Contact Tracing↗
Beyond the physical examination: the nurse practitioner's role in adolescent risk reduction and resiliency building in a school-based health center.
School-based health centers in high schools provide a unique setting in which to deliver risk-reduction and resilience-building services to adolescents. The traditional health care system operating in the United States focuses on the treatment of illness and disease rather than on preventing problems originating from health risk behaviors. Nurse practitioners can promote healthy behavior in adolescents through linkages to parents, schools, and community organizations; by conducting individual risk assessments; and by providing health education and access to creative health programs that build resilience and promote protective factors. With a focus on wellness, nurse practitioners as advanced practice nurses and specialists in disease prevention and health promotion can establish students' health priorities in the context of the primary health care they deliver on a daily basis.
Adolescent↗
Ten priorities for women's health.
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Black or African American↗
[Waiting list guarantee between medicine and bureaucracy].
The traditional autonomy of the health professions is being eroded by external bureaucratic regulations of health care services, implemented to control costs and secure equitable access to services. This is an international trend. The guaranteed maximum waiting time in Norway is an example of such regulations. Introduced in 1990 and revised in 1997, it regulates the maximum waiting time for hospital admittance for patients who meet certain criteria. The regulation limits physicians' scope for setting priorities according to traditional criteria such as disease severity and admittance on a first come, first served basis. At issue here is whether the waiting time guarantee is compatible with established professional norms for setting priorities. We explored this issue of regulation versus professional norms through a postal survey among 152 physicians and nurses in charge of allocating patients to waiting lists. The results indicate that most respondents do not think that the reform has led to more equitable priorities. Health professionals seem to follow professional norms more than externally imposed rules. Difficulties in interpreting the rules and infringements of the guarantee in respondents' departments led to negative attitudes towards the guarantee. Physicians were more negative than nurses in their attitudes.
Attitude of Health Personnel↗
[Neonatal screening for metabolic diseases--a task without priority in the Norwegian health policy?].
The Norwegian national screening programme for early diagnosis of phenylketonuria and congenital hypothyroidism was established in 1978-79. The organization and implementation of the programme is based on a marginal cost policy profile and has kept almost the same structure throughout the period of national neonatal screening. We focus on practical measures aimed at increasing the quality of the programme, and suggest a health political reconsideration of public preference and financial support for neonatal screening in Norway.
Congenital Hypothyroidism↗
[Prevention priorities in mental health in Geneva: a study using the Delphi technic].
A Delphi technique was used to determine priorities for mental health prevention in Geneva. The study comprised two rounds of postal questionnaires targeted at 58 participants concerned and/or interested by mental health through their association or their work. From the responses given in the first round mental health problems were listed, essentially health problems (65%) and service problems (11%) and less frequently resources problems (< 1%). Consensus produced in the second round indicated that 3 problems were priorities for the development of preventive measures: depression, alcohol abuse, maltraitance and sexual abuse. Using the Delphi technique, a qualitative method corresponding to a subjective consensus issued from a group of experts, priorities for mental health prevention were identified in Geneva, in 1995.
Adolescent↗
Reaching common ground: a patient-family-based conceptual framework of quality EOL care.
Improvement in the quality of end-of-life (EOL) care is a priority health care issue since serious deficiencies in quality of care have been reported across care settings. Increasing pressure is now focused on Canadian health care organizations to be accountable for the quality of palliative and EOL care delivered. Numerous domains of quality EOL care upon which to create accountability frameworks are now published, with some derived from the patient/family perspective. There is a need to reach common ground on the domains of quality EOL care valued by patients and families in order to develop consistent performance measures and set priorities for health care improvement. This paper describes a meta-synthesis study to develop a common conceptual framework of quality EOL care integrating attributes of quality valued by patients and their families.
Attitude to Death↗
Responding to health changes: a case study of dental health conditions and systems in Japan and Australia.
This paper presents an analysis of the main policy and organisational issues confronting dental health systems in Japan and Australia. Using the changes in the epidemiology of dental disease (the oral disease which still affects much of public dental health planning) as evidence of fundamental differences in the dental health systems of the two countries, the analysis seeks to illuminate, first, the structures and processes in both nations to review and implement changes to educational practices and workforce planning and, second, the constraints on each nation's capability to respond quickly and appropriately to the changing dental health needs. It is argued that Japan's ability to rapidly change its oral health outcomes, its dental educational system and its traditional workforce structure and service-mix, is more constrained than appears to be the case in the Australian dental system. The major barriers to Japan's ability to change appear to lie in both its traditional cultural decision-making processes and in a series of specific health and educational structures which place high reliance on a private educational system for health providers, a national insurance system which rewards treatment under a fee-for-service reimbursement scheme and the lack of a formal, transparent, infra-structure for planning health priorities. Barriers to Australia achieving culturally appropriate oral health outcomes for the next century appear more related to whether national unity in goal setting and implementation strategies can be achieved. The constraints in Australia are related to its federal system and to the low priority given to financing public dental services.
Adolescent↗
Priorities in occupational health research: a Delphi study in The Netherlands.
OBJECTIVES: To achieve a coherent programme of topics for research in occupational health and safety, with well founded priorities and to relate them to perceived gaps and needs in The Netherlands. METHODS: In the first phase of the study 33 key informants were interviewed. In the second phase questionnaires were sent to 150 Dutch experts (including the key informants). Four groups were recruited, originating from: occupational health and safety services; scientific research institutes; governmental and other administrative bodies; and companies. Using the Delphi technique, the experts were asked to prioritize several topics, which were placed under different headings. In the third phase five workshops were organised to elaborate on the highly prioritized topics. RESULTS: The response rates were 86% for the first and 81% for the second questionnaire. In the second round consistency was reached and consensus proved to be satisfactory; so that the Delphi process was stopped. There were surprisingly few differences in opinion between the four groups. The most important heading was "design/implementation/evaluation of measures", in which the topic cost-benefit analysis of measures had the highest score. "Assessment of relations between exposure and effect" was the second most important heading. Under this heading, topics on work stress were generally judged to be more important than topics on safety and biological, chemical, and physical hazards. The headings "occupational rehabilitation/sociomedical guidance" and "occupational health care/occupational health services" had about the sam priority, closely following the heading "assessment of relations between exposure and effect". CONCLUSIONS: The general agreement on priorities should provide a sufficiently broad basis for decision makers to initiate a long term programme for occupational health research and development in The Netherlands.
Delphi Technique↗
[Quality of care in chronic obstructive pulmonary disease].
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has been a public health priority for many years and many recommendations have been published on its detection and management. STATE OF THE ART: Many studies have shown that practice remains sub-optimal, at both diagnostic and therapeutic levels, in the stable state and during exacerbations. There are multiple factors responsible including the recommendations themselves (method of development, format, distribution and implementation) and persisting grey areas in the literature upon which they are based. PERSPECTIVE: To improve this situation it will be necessary to clarify the place of various treatment options during the evolution of the disease, to define the best organisational care pathways and to produce precise and didactic guidelines that will be widely distributed and implemented. CONCLUSIONS: Real progress can be anticipated in view of the increasing quality of the guidelines and the clinical trials upon which they are based.
Critical Pathways↗
[Maternal mortality in Guinea: magnitude and perspectives].
In recent years maternal mortality in developing countries has become a public health priority for international organizations. However, measuring the true magnitude of this problem is the subject of much methodological debate. In less than a century, the rate of maternal mortality in most industrialized countries has decreased one hundred-fold. In contrast, the rate remains very high in most developing countries, particularly in Africa. In this article based on the studies conducted in Guinea we review various operational proposals which may contribute to improving maternal health and reducing maternal morbidity and mortality, with particular reference to the work of the French speaking organization "Santé Maternelle Internationale".
Adolescent↗
Human immunodeficiency virus infection and AIDS in east Africa: challenges and possibilities for prevention and control.
Human immunodeficiency infection and AIDS are a major recent microbial infection in east Africa with serious health and socioeconomic impacts in the region. At present HIV infection and AIDS account for more than 50% of adult medical admissions into some of the national and provincial hospitals as well as for 10-15% of paediatric admissions. AIDS is also at present the commonest cause of death among those aged 15-45 years. Tuberculosis, a closely associated disease to HIV infection, has increased more than three fold in some countries in the region. The prevalence of HIV infection currently ranges from 10-30% among adults in urban areas and from less than 1% to 25% in adults in rural areas; since this prevalence is still rising, the full impact of the AIDS problem in east Africa is yet to be realised. This is different from the situation in many developed countries where AIDS is no longer a priority health issue and where peak prevalences of the infection have been reached. The differences in HIV prevalences between east Africa and developed countries are due to poverty, ignorance, high prevalence of other STDs and associated cultural and traditional practices which prevail and facilitate HIV transmission in the region. While more than 80% of HIV infection in east Africa is transmitted through heterosexual intercourse, 5-15% of cases are perinatally transmitted and the remaining cases are transmitted through blood and blood products. While a lot of scientific advances have been made in immunopathology of AIDS, diagnostics and in social behavioural studies, we are still a long way towards getting curative therapy and or effective preventive vaccines. Recent discovery that use of zidovudine can significantly reduce perinatal HIV transmission is an additional breakthrough. While knowledge and tools for preventing HIV transmission are available in the world, prospects for AIDS control in east Africa appear gloomy unless major efforts are made in the reduction of poverty, ignorance and in the control of other common sexually transmitted diseases.
Adolescent↗
Emergence of cardiovascular diseases in developing countries.
Developing countries are subject to the same risks that have contributed to the high incidence of cardiovascular diseases in the already developed countries. Improvements in life expectancy at birth lead to predictable shifts in the cause-of-death structure over time. The stage at which cardiovascular diseases may be considered to be 'actively emerging' corresponds to a life expectancy level between 50 and 60 years and, at this level, cardiovascular disease mortality accounts for 15-25% of all deaths. The average life expectancy at birth in developing countries for the year 2000 is projected to be 60 years or more and it may be expected that by that time cardiovascular diseases would be actively emerging or established in virtually every country. In many developing countries today, life-style pattern that is associated with high rates of coronary heart disease is not yet widespread and it is therefore logical that a strategy of prevention should include efforts to inhibit the entrenchment and spread of unhealthy life-styles in the community (i.e., primordial prevention). At the country level, cardiovascular disease prevention and control cannot be considered in isolation and must be related to prevailing national health priorities and competing claims from other sectors of development. In poorer countries where life expectancy is below 50 years primordial prevention activities are likely to be restricted--perhaps to smoking and hypertension control. In middle-income countries a broader based approach to primordial prevention is feasible and is more likely to be acceptable.
Cardiovascular Diseases↗