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PubMed1979

[Occupational health as a priority].

The development of occupational health services in the Republic of South Africa has been limited by three factors. Firstly, occupational safety completely overshadowed occupational health. Secondly, about 8 state departments were active in its administration. Thirdly, occupational health was not interpreted as a preventable disease under the old Public Health Act No. 36 of 1919, and was hence excluded from the usual community health activities. The recommendations of the 1975 Commission of Inquiry that occupational health should fall under the scope of the Department of Health, and that the National Research Institute for Occupational Diseases should be transferred from the South African Medical Research Council to the Department of Health, have not yet been implemented. The advantages of such implementation and the estimated costs involved are discussed. A primary prerequisite is that all occupational diseases should be made notifiable diseases.

Occupational Health Services↗
PubMed1999

Effect of discussion and deliberation on the public's views of priority setting in health care: focus group study.

OBJECTIVE: To investigate the extent to which people change their views about priority setting in health care as a result of discussion and deliberation. DESIGN: A random sample of patients from two urban general practices was invited to attend two focus group meetings, a fortnight apart. SETTING: North Yorkshire Health Authority. SUBJECTS: 60 randomly chosen patients meeting in 10 groups of five to seven people. MAIN OUTCOME MEASURES: Differences between people's views at the start of the first meeting and at the end of the second meeting, after they have had an opportunity for discussion and deliberation, measured by questionnaires at the start of the first meeting and the end of the second meeting. RESULTS: Respondents became more reticent about the role that their views should play in determining priorities and more sympathetic to the role that healthcare managers play. About a half of respondents initially wanted to give lower priority to smokers, heavy drinkers, and illegal drug users, but after discussion many no longer wished to discriminate against these people. CONCLUSION: The public's views about setting priorities in health care are systematically different when they have been given an opportunity to discuss the issues. If the considered opinions of the general public are required, surveys that do not allow respondents time or opportunity for reflection may be of doubtful value.

Adolescent↗
PubMed1998

The use of societal criteria in priority setting for health technology assessment in The Netherlands. Initial experiences and future challenges.

Priority setting for the evaluation of health technologies in the Netherlands is exclusively based on the scientific merits of individual research proposals. This process has not resulted in satisfactory allocation of resources. Therefore, societal criteria for setting priorities for health technology assessment have been proposed as an adjunct to scientific criteria. These societal criteria include the burden of disease, uncertainty about the (cost-)effectiveness of the intervention at issue, the potential benefits of the research project, and its potential impact on health care. To realize the full potential of this model for priority setting, a number of methodological issues need to be addressed. Joint efforts of researchers and policy makers in this field are necessary for future progress.

Health Care Rationing↗
PubMedDate not supplied

Priority research for health for all.

A main aim of the European Nursing Conference in Vienna in June 1988 was to stimulate nurses into action to help realize WHO's ambitious targets for European countries by the year 2000. Nurses in the region, it is hoped, are now following up on the Conference declaration and recommendations (INR, Sept/Oct 1988, p. 130). As action requires knowledge, research has been afforded a top role in the health-for-all movement and nurses can make a valuable contribution. A review of the targets and some of the main research areas needed to achieve them are given below not only to assist researchers in the European Region and industrialized countries tries but also to alert nurse researchers in other lesser developed countries of research areas that may soon also become "high priority."

Global Health↗
PubMed2005

Intimate partner violence and disabilities among women attending family practice clinics.

PURPOSE: To estimate the frequency and type of disabilities preventing work among those experiencing intimate partner violence (IPV) compared with those never experiencing IPV. METHODS: We used a large cross-sectional survey of women, ages 18-65, attending family practice clinics from 1997 through 1998. Participation included a 5-10-minute in-clinic survey assessing IPV experience and a longer telephone survey assessing health status and chronic disabilities that prevented work outside the home or housework. RESULTS: Of 1,152 eligible women surveyed, 54% experienced some type of IPV, and 24% were currently in a violent relationship. Women who had ever experienced IPV were more than twice as likely to report a disability (adjusted odds ratio [aOR] = 2.2, 95% confidence interval [CI] 1.6, 3.0). The most commonly reported disabilities were those associated with heart or circulatory disease (4.9%), followed by back problems (3.5%), chronic pain (3.4%), arthritis (3.0%), nerve system damage (2.4%), asthma or another respiratory problem including emphysema (1.7%), and either depression (1.6%) or another mental illness (1.0%). Women ever experiencing IPV were more likely to report a disability due to generalized chronic pain (aOR = 2.5, 95% CI 1.5, 4.3) and mental illness (aOR = 4.5, 95% CI 1.5, 13.1). IPV-related injuries were associated in a dose-dependent manner with having any disability and with disability from chronic pain, asthma and other respiratory diseases, mental illness, and chronic diseases. CONCLUSIONS: Primary care-based efforts to screen for IPV and effectively intervene to reduce the impact of IPV on women's lives must be a public health priority to reduce the shortterm and long-term health effects, including disabilities.

Adult↗
PubMed2006

The burden of disease and injury in Serbia.

BACKGROUND: In the last decade of the 20th century, a considerable effort has been put into the development of summary measures of population health that combine information on mortality and non-fatal health outcomes. We used the DALYs (Disability adjusted life years) method to assess the burden of disease and injury in the population of Serbia. METHODS: Our study, largely based on the methods developed for the Global burden of disease study, was conducted between October 2002 and September 2003. DALYs, stratified by gender and age, were calculated for 18 selected health conditions for the population of Serbia, Serbia and Montenegro for 2000. Years of life lost (YLL) were calculated using country mortality statistics, while years lived with disability (YLD) were calculated using different sources of information. Also, the YLD/YYL ratio and age-adjusted rates of DALYs were calculated. RESULTS: Ischaemic heart disease, cerebrovascular diseases, lung cancer, unipolar depressive disorders, and diabetes mellitus were responsible for almost two-thirds (70%) of the total burden of 18 selected disorders in Serbia 2000. The leading five causes for males were ischaemic heart disease (26.1 DALY per 1000), stroke (17.9), lung cancer (12.7), road traffic accidents (6.5), and self-inflicted injuries (5.5). For females, the leading five causes were stroke (18.1 DALY per 1000), ischaemic heart disease (14.1), depression (8.7), breast cancer (6.1), and diabetes mellitus (5.2). CONCLUSIONS: The final results of the study have shown that the national health priority areas should cover cardiovascular diseases, cancers, and mental health.

Cost of Illness↗
PubMed1995

Community empowerment in rural health care.

The Healthy Communities 2000 mandate calls for public health leaders to involve community members in setting health priorities and implementing programs in response to the national health objectives for the year 2000 (American Public Health Association, 1991). This paper describes community involvement through a community empowerment nursing intervention and evaluates its application in a rural community. A community health nursing project (AHCPR, Grant No. HS06801) with three interventions, one of which was community empowerment, was designed to address the health needs of small, rural, underserved, primarily Mexican American communities in Arizona. Community empowerment in this project was based on the community-development approach to community organization, and involved community health nurses and lay health workers, called promotoras, who are key persons in community development. The implementation of two health fairs, one the result of the community-empowerment intervention, is described and evaluated in relation to community health. The community-empowerment intervention was based on community participation and responsibility, hallmarks of the second health fair, reflecting lay expertise and cooperation among various levels of the community. Successes and limitations of the health fairs provide feedback for developing a community-empowerment intervention.

Arizona↗
PubMed2002

Genital ulcers, stigma, HIV, and STI control in sub-Saharan Africa.

HIV associated stigma is still prevalent throughout Africa despite the spread of the epidemic. Stigma is also attached to sexually transmitted infections (STIs). Despite the importance of STIs, particularly genital ulceration in facilitating heterosexual HIV transmission, policymakers continue to focus mainly on other priorities. It would appear that this lack of public health initiative in tackling genital ulcers is itself an example of stigmatisation. Possible explanations for this include geographical variation in the data and a perception that genital ulcers are not a topic that can be discussed freely and openly. HIV policymakers in countries worst affected by HIV in Africa should examine their own opinions for bias when determining public health priorities for HIV prevention. The importance of genital ulcers should be reassessed and publicised.

Africa South of the Sahara↗
PubMed2006

Study protocol--diabetes and related conditions in urban indigenous people in the Darwin, Australia region: aims, methods and participation in the DRUID Study.

BACKGROUND: Diabetes mellitus is a serious and increasing health problem in Australia and is a designated national health priority. Diabetes and related conditions represent an even greater health burden among Indigenous Australians (Aborigines and Torres Strait Islanders), but there are critical gaps in knowledge relating to the incidence and prevalence, aetiology, and prevention of diabetes in this group, including a lack of information on the burden of disease among Indigenous people in urban areas. The DRUID Study (Diabetes and Related conditions in Urban Indigenous people in the Darwin region) was designed to address this knowledge gap. METHODS/DESIGN: The study was conducted in a specified geographic area in and around Darwin, Australia. Eligible participants underwent a health examination, including collection of blood and urine samples, clinical and anthropometric measurements, and administration of questionnaires, with an additional assessment for people with diabetes. The study was designed to incorporate local Indigenous leadership, facilitate community engagement, and provide employment and training opportunities for local Indigenous people. A variety of recruitment methods were used. A total of 1,004 eligible people gave consent and provided at least one measurement. When compared with census data for the Indigenous population living in the study area, there was a marked under-representation of males, but no substantial differences in age, place of residence, Indigenous group, or household income. Early participants were more likely than later participants to have previously diagnosed diabetes. DISCUSSION: Despite lower than anticipated recruitment, this is, to our knowledge, the largest study ever conducted on the health of Indigenous Australians living in urban areas, a group which comprises the majority of Australia's Indigenous population but about whose health and wellbeing relatively little is known. The study is well-placed to provide new information that can be used by policy makers and service providers to improve the delivery of services and programs that affect the health of Indigenous people. It also represents a valuable opportunity to establish an urban Indigenous cohort study, provided participants can be followed successfully over time.

Adolescent↗
PubMed1996

An evaluation of precaution-based approaches as EMF policy tools in community environments.

This paper explores the use of precaution-based approaches as policy tools when responding to concerns about power-frequency electric and magnetic fields (EMF) in community environments. The combination of public concern and scientific uncertainty about potential health impacts from exposure to EMF challenges society to adopt EMF policies that balance the benefits of electric power against the possibility that some aspect of the use of electricity may be harmful. Inappropriate policy responses can undermine the economics of society's use of electricity and have other adverse consequences on public health. These adverse consequences result from the inappropriate diversion of scarce public and private resources. Precaution-based approaches are rooted in individual concepts of common sense and can be an effective component of a comprehensive set of EMF policy options. Precaution-based approaches do not replace science-based policy options and should only be used when the available science-based guidelines are not applicable. The application of these approaches should balance the real and expected costs and benefits of taking or not taking action. Given our current scientific knowledge, actions taken to reduce EMF exposure should necessarily be low cost because the expected benefits are uncertain. Society also needs to avoid adopting EMF policies that could incur high costs from distorting resources from other, more important, personal and public health priorities.

Community Health Services↗
PubMed1991

The role of clinical epidemiology in establishing essential national health research capabilities in developing countries.

Health research directly relevant to the needs of the people of developing countries is essential for equity in development as well as for improving health planning and management. the international Commission on Health Research for Development has stressed the need to strengthen the capacity of developing countries, no matter how poor, to carry out essential national health research (ENHR). Clinical epidemiologists in developing countries can significantly contribute to the manpower available for ENHR. They play a major role in the provision and practice of appropriate health care by contributing to the critical assessment of priority health problems and by carrying out scientific evaluation of new and conventional intervention tools. In clinical epidemiology units in developing countries, transdisciplinary collaboration with social scientists and health economics has enhanced the capacity to do research that would influence decision-making and health policy, even as links with ministries of health and other ENHR-committed networks are being strengthened. The potential for carrying out ENHR will be multiplied as national and regional training centers for clinical epidemiology in selected developing countries are established.

Delivery of Health Care↗
PubMed1986

[Estimation of the impact of the principal diseases in rural Mali].

The authors assess the health impact of major diseases in the circles of Kita, Bafoulabé and Kenieba (Western Mali) by measuring, for each of them, the number of healthy days of life lost through illness, disability and death. Malaria, birth diseases, infant gastro-enteritis and pneumopathies, measles, malnutrition and hemoglobinopathies account for 58.1% of healthy life lost due to all studied diseases. Parasitic diseases (except malaria), tuberculosis, leprosy are less important than usually said; on the contrary, the impact of hepatic, cardiovascular, and eyes diseases is great. In developing countries assessing the number of healthy days lost by the community due to different diseases is usefull to choose the health priorities and to compare the cost/effectiveness ratio of different health programs.

Adult↗
PubMedDate not supplied

Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention.

Achieving and maintaining high rates of screening mammography are major public health priorities. This report examines data from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention on the utilization of mammography among women ages 40-75. Results show that progress is being made in some areas--57.7 percent of women "ever had" a mammogram; 50.3 percent, in previous 2 years. However, those not having repeated regular screening appear to be a sizable proportion. Only 28.6 percent of women ages 40-75 had been both screened on the recommended age-specific schedule and expressed an intention to continue screening; another 29.2 percent indicated no intention to have a mammogram in the near future. Income, clinical breast examination, and Pap (Papanicolaou's) test, having no regular source of care, region of the country and residential variables, smoking status, not exercising, not knowing how to do breast self-examination, and race were among the variables having the strongest associations with mammography status. Several groups in the population therefore remain at risk of not receiving regular screening. The combination of mammography status to date and future intention to have the examination provides an important perspective on efforts to reach public health screening objectives and appears to provide a strategy for targeting interventions.

Adult↗
PubMed1984

Oral health status and traditions in the Philippines.

With an annual population growth of 2.71 per cent per year the government is harnessing all available resources so that every Filipino can enjoy a decent way of life. Since the majority of the population is in the rural areas, priority health services are directed towards this particular segment. Because of meagre income among the rural population all health services are given free, except for major operations, medicines and dental procedures such as the construction of partial and full dentures, porcelain restorations, root canal therapy and major oral surgery. Older people in the rural areas still adhere to their beliefs and traditions to alleviate the pain of toothache, particularly in the areas which cannot be reached by dentists. Because their fees are minimal the services of quack doctors/dentists and faith healers are still sought. In the Philippines, although dental health services have been given a low priority by the government, preventive dental health programmes are being implemented throughout the country. These include mouthrinsing with sodium fluoride solutions, supervised toothbrushing with fluoride toothpaste and the use of fluoride-containing varnish and fluoride tablets. Water fluoridation exists in two pilot areas and there is an intensive dental health education campaign. Indigenous health workers augment the inadequate dental manpower in attempting to attain and maintain the global indicator for oral health, which is 3 DMFT on average for age 12 years old.

Adolescent↗
PubMed2000

The impact of school-organized sport activities on the priority youth health-risk behaviors.

PURPOSE: To evaluate the impact of school-organized sport activities on the priority youth health-risk behaviors.METHODS: Data were taken from The 1997 National School-based Youth Risk Behavior Survey. Measures of prevalence rates in six categories of priority health-risk behaviors defined by Centers for Disease Control and Prevention were performed between participants and non-participants in school-organized sport activities. Then multiple logistic regression analyses were used to assess the association between participation in school-organized sport activities and the priority health-risk behaviors.RESULTS: Overall, 49.5% of students nationwide participated in school-organized sport activities in 1997. The major behavioral factors that proved statistically significant in predicting participation in school-organized activities in the logistic regression model were non-use of seatbelt, non-use of helmet, and use of chewing tobacco. Behavioral factors that were inversely related to participation in school-organized activities were smoking cigarettes, using different kinds of drugs, using condoms, carrying weapons, eating vegetables, and attempting suicide.CONCLUSIONS: Based on the nationally representative data, participation in school-organized sport activities was positively associated with many desirable health behaviors. However, a challenge for us will be not only to promote youth participation in school-organized sport activities, but also to address some co-existing behavioral problems that may lead to non-intentional injury and use of chewing tobacco.

Journal Article↗
PubMed2005

Uruguay on the world stage: how child health became an international priority.

The evolution of international health has typically been assessed from the standpoint of central institutions (international health organizations, foundations, and development agencies) or of one-way diffusion and influence from developed to developing countries. To deepen understanding of how the international health agenda is shaped, I examined the little-known case of Uruguay and its pioneering role in advancing and institutionalizing child health as an international priority between 1890 and 1950. The emergence of Uruguay as a node of international health may be explained through the country's early gauging of its public health progress, its borrowing and adaptation of methods developed overseas, and its broadcasting of its own innovations and shortcomings.

Adolescent↗