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PubMed2001

[Declared diseases, observed diseases and health priorities in a Benin rural district].

A project of a humanitarian action was preceded by a health diagnosis of a population in the rural district Bonou in Bénin. A diagnosis of perception was set up by the interviews among the population and the local health professionals. That diagnosis was completed by an objectified diagnosis originating from the analysis of 460 consultations performed in Bénin end 1998- beginning 1999. The cross-sorting between the diagnosis of perception and the objectified diagnosis pointed out four public health problems: malaria, bronchial asthma, infectious diarrhoeas and Buruli ulcer with respective prevalences of 9%, 6%, 3% and 0.9%. The prevalence of bronchial asthma fluctuates from 4% in dry areas to 8% in wet areas (Chi 2 = 3.50; p = 0.06). The role of house dust mites is suspected because of those ecological arguments to which is added clinical reasoning. Bronchial asthma was chosen as a priority health problem because of the feasibility and acceptance of a survey which aims at pointing out the allergic etiology. The confirmation of that etiology will enable in that case the decrease of the allergenic pressure, particularly well adapted solution in the Southern countries. Therefore a humanitarian action is foreseen to apprehend the etiologies of bronchial asthma in the rural district Bonou in Bénin in 2000.

Adolescent↗
PubMed1992

Hazardous-waste sites: priority health conditions and research strategies--United States.

Uncontrolled disposal sites containing hazardous waste and other contaminants have created national environmental problems (1). Because of potential health problems associated with the more than 33,000 hazardous-waste sites in the United States, the Agency for Toxic Substances and Disease Registry (ATSDR)--as part of its federally legislated mandate--has developed a list of seven priority health conditions (PHCs) to 1) assist in evaluating potential health risks to persons living near these sites and 2) determine program and applied human health research activities involving hazardous substances identified at the sites. This report summarizes the development and intended applications of the seven PHCs.

Environmental Exposure↗
PubMed2003

Women's health priorities and perceptions of care: a survey to identify opportunities for improving preventative health care delivery for older women.

BACKGROUND: women live longer than men but consistently report poorer health status and health-related quality of life. Information is scarce on what components of care women desire to help them meet the challenges of their later years. OBJECTIVES: to identify older women"s priorities for maintaining physical, emotional and social well-being in later years and to measure the extent to which women perceive that these priorities are being met by the health care system. METHODS: a cross-sectional survey of community-dwelling women aged 55-93 years old (n = 609, mean age 70). Women attendees of outpatient medical clinics were invited to fill out a written questionnaire on health priorities and perceptions of care. Mismatches between the care that women desired and the care they perceived to be receiving were identified. Predictors of unmet priorities were evaluated. SETTING: the Greater Montreal Area in Quebec, Canada. RESULTS: in general, respondents were more concerned about preventing disability than with developing certain diseases later in life. Women prioritised feeling validated in the health care relationship and having their health care provider see them as a whole person. Deficiencies in addressing memory loss, preserving mobility and function and treating urinary incontinence were highlighted. Women aged 75 years and older were less likely to perceive that their priorities were unmet compared to women aged 55-74 years (OR 0.571; 95% confidence interval 0.404-0.808), when adjusting for other socio-demographic and health variables. CONCLUSIONS: Opportunities exist to improve the preventive health care that women are receiving to promote healthy ageing. Women aged 55-74 should especially be targeted for interventions to prevent disability in later life.

Activities of Daily Living↗
PubMed2005

[Disability-adjusted life years: an instrument for defining public health priorities?].

BACKGROUND: The objective of this paper is the study of a health indicator allowing surveillance and evaluation of the overall health of the Paris population, and providing information to help prioritize possible choices among preventive and curative actions. Moreover, comparison between results obtained for Paris with a global health indicator, "Disability-adjusted life years" (DALYs) and available bibliographical data will enable clarifying some points about summary measures of health. METHODS: The method used is that of the Global Burden of Disease. It allows a ranking of diseases using an indicator called DALYs. This indicator integrates mortality and morbidity components by summing expected years of life lost due to premature mortality and calculated years of healthy life lost. DALYs were calculated using local mortality data and published regional disabilities tables from the World Health Organisation (WHO). RESULTS: There were a total of 242 061 DALYs for Paris for the year 1999. The six leading specific causes are: alcoholic psychosis and dependence (accounting for 6.5% of the total), lung cancers (5.7%), ischaemic hearth disease (4.8%), depression (4.4%), dementias (4.2%), and arthritis (3.9%). Men contributed the majority of DALYs for the first three. For four of the six leading causes, the majority of DALYs came from years lived with disability, rather than mortality. Only for lung cancer and ischaemic hearth disease was the majority of DALYs from years of life lost by mortality. CONCLUSION: The results for Paris are used to illustrate how DALYs can illuminate debates about public health priorities. Such data can inform the population about health condition and provide decision makers with global health indicators. The next step will be to estimate the DALYs from local morbidity data when available, and compare these results to those based on the World Health Organisation tables, which are not sensitive to local results other than those due to mortality. Future steps include further evaluation and development of this method for surveillance, assessment and evaluation of public health actions. However, some of the results obtained with this indicator underline the limits of this kind of analysis.

Adolescent↗
PubMed2000

A World Wide Web-based health resource. Survey of Missouri school nurses to determine priority health information resources for SchoolhealthLink.

Two hundred ninety-two school nurses in Missouri participated in a mailed survey to aid in the design of SchoolhealthLink, a World Wide Web (WWW)-based information service for Missouri school nurses and children. The nurses identified specific health information resources likely to benefit school nurses and school children and prioritized these resources. The school nurses assigned high priority to 11 types of health information resources: individualized health care plans, emergency care plans, communicable disease control plans, acute illness, injuries, communicable diseases, hotline numbers, medications in schools, immunization protocols and standards, community-based health care resources, and Department of Elementary and Secondary Education regulations that affect school nurse practice. The four most common health problems school nurses identified were asthma, attention deficit disorder, diabetes, and head lice. SchoolhealthLink will provide a one-stop WWW-based resource for school nurses and school children.

Adult↗
PubMed1998

A health priorities model: application to mammography screening.

This study describes and empirically tests a health priorities model. This model predicts underuse of regular mammography screening among adult women within the larger health context in which such decisions are made. The model incorporates women's comparative illness threats, comparative importance of health behaviors, and demographic variables. A telephone survey was conducted with a sample of women (N = 887) older than 50, in 40 rural communities in the state of Washington. Logistic regression analyses showed that women who perceived themselves at low risk for getting breast cancer and/or who perceived another disease (i.e. heart attack) as an equal or greater threat than breast cancer were less likely to be regular screeners of mammography. In addition, women who perceived other health behaviors as more important than regular mammography screening were less likely to be regular screeners than those women who perceived regular mammography screening as more important. Current or anticipated health problems were not related to screening behavior. The results are discussed in light of the practical, theoretical, and empirical implications.

Aged↗
PubMedDate not supplied

[Organ transplantation as a health priority in developing countries].

The epidemiology profile of developing countries is in transition. While the prevalence of infectious and preventable diseases, malnutrition, and in general the health problems traditionally associated to the poor, is still high, the characteristic health profile of industrialized countries (i.e. chronic and degenerative diseases, accidents, violence, social pathology) is beginning to surface. This paper focuses on the need to consider organ transplantation as a health priority in developing countries, as an important element in the global strategy to cover both aspects of the health care demand.

Developing Countries↗
PubMed1997

Oral disease in Africa: a challenge to change oral health priorities.

Colonial and other unsustainable oral health strategies exported to Africa have failed to improve oral health in the region. An alternative way of interpreting and responding to the problems of oral health in Africa is presented. It begins with a systematic interpretation of the health information available, using the application of the basic epidemiological principle of defining a specific health problem by describing its prevalence, severity (morbidity, mortality) and age adjusted distribution in the population. African oral disease priorities determined in this way are shown to be fundamentally different from those perceived previously. It is recommended that this new approach be used in customising a viable set of oral health policies and intervention strategies for each individual African community.

Africa↗
PubMed1989

Trypanosomiasis: a public health priority in Cameroon.

From a historical standpoint and the present distribution of the disease, human trypanosomiasis, in spite of its comparatively low incidence, still remains a public health priority in Cameroon, requiring both national and international support for control measures. The geographical position of the country within the Glossina belt, certain cultural practices, agro-industrial activities, and an improving transport system are current factors favouring the spread of the disease. Similarly the changing pattern of the disease, ignorance and the lack of valid diagnostic and safe chemotherapeutic tools are some obstacles to current control measures.

Animals↗
PubMedDate not supplied

Identifying environmental health priorities for a whole nation: the use of principal environmental exposure pathways in the Philippines.

This paper presents a novel approach to establishing environmental health priorities for a large society, based upon the concept of principal environmental exposure pathways (PEEPs). Principal environmental exposure pathways extend the concept of a causal pathway backward from health outcome to exposure, then to the industrial, transportation, commercial, or living conditions that gave rise to the pollution of interest. In the Philippines, where the method was developed and used, five PEEPs were identified: an urban air-pollution pathway; a community water-supply pathway; an urban solid-waste pathway; a rural "point-source" pathway; and a pathway whereby fertilizers and pesticides affect food, worker health, and rural water supplies. Characterizing the PEEPs involved pinpointing the populations at risk necessary to estimate the burden of morbidity and mortality related to each as well as identifying the health outcomes that were experienced by those exposed along each pathway or that they could be expected to experience; determining where adequate health-outcome information was available or absent; where exposure sources were or were not adequately identified; where there were significant gaps in agency responsibilities; where new data flows were needed; and where things could have been improved by improving inter-agency cooperation. The most important success of the PEEP method was to reduce the "problem of everything" in a complex country of 65 million people to a small and manageable number of priority environmental exposures.

Air Pollution↗
PubMed2003

Bone and joint diseases around the world. France: rheumatoid polyarthritis, chronic juvenile idiopathic arthritis, and ankylosing spondylitis. A public health priority.

Since its creation, the Association française des Polyarthrites is doing everything possible to come to the aid of people with polyarthritic diseases and to help medical research make advances against this illness. Each year, with the help of sponsors, we organize a national information campaign with first-hand accounts and presentations by sufferers on radio and television stations, so that polyarthritis should be better understood by the general public. Last year, together with other associations, we asked the Minister of Health about the barriers to receiving innovative treatment for polyarthritis because of the cost. Because of this action, the Minister has made additional funds available so that more sufferers can benefit from new treatment. Recently, several associations dealing with chronic and serious inflammatory rheumatic illnesses who came together as an action group presented a text to the Minister of Health about the urgent need to make these illnesses a public health priority. Working sessions between the Minister, patient associations, and rheumatologists to consider how to implement a public health plan are in progress.

Arthritis, Juvenile↗
PubMed2000

[Critical analysis of health priorities determination in France].

Since the mid 1970's, reforms to the health care system were aimed at controlling expenditures. Furthermore, there was not much of a relationship between public health policies and expenditure control policies. The reforms of 1996 aimed to introduce a new paradigm. The French health care system, based until then upon the biomedical model, now must adopt public health tools: Definition of health objectives; Development of priorities; Evaluation; Allocation of resources based on needs; Public debates. The objective of this study is to evaluate the move toward defining priorities, three years after the introduction of this reform. The study focused on the type of priorities implemented (e.g. implicit or explicit priorities, access to health care services, or severity of health problems) and their links to the allocation of resources; and the practical development of priorities (e.g. political or technocratic procedure, the role of public debates). In France, priorities are defined by health problem and not by service. They are explicit, but the link to allocation of resources isn't clear. Despite a wide consultation, the system of defining priorities is more technocratic than political. Moreover, the system is more concerned with including health professionals (doctors, administrators) in this new approach to public health, than with taking public opinion into account.

Cost Control↗