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PubMed2002

Fluoridation at fifty: what have we learned?

The question posed by the title of this article encompasses more than just the law and science applied to fluoridation. A review of the history and present status of fluoridation policy development and implementation makes it quickly apparent that the lessons learned are applicable to a wide range of public health policy and that the public health community needs to be very concerned about the status and trends of legal precedent. Indeed, in the context of recent U. S. Supreme Court decisions, the need for a comprehensive and coordinated effort to educate the public, legislators, and jurists about the safety and efficacy of community water fluoridation is clear. Two fundamental issues are at the core of this article: (1) the use of science in formulating and defending public health policy, and (2) how to connect scientific fact with the legal process in connection with the actual circumstances regarding a community's health status. The opening section of this article presents an analysis of fluoridation's great success in preventing dental caries over the past 50 years, along with a discussion of current data scientifically demonstrating that fluoride is safe when properly utilized. A second section provides an overview of one state's legislative experience in mandating fluoridation and the political challenges encountered. A final section discusses the legal issues associated with fluoridation, including the bases of legal challenges to public laws mandating it.

Dental Caries↗
PubMed2005

The health status of southern children: a neglected regional disparity.

PURPOSE: Great variations exist in child health outcomes among states in the United States, with southern states consistently ranked among the lowest in the country. Investigation of the geographical distribution of children's health status and the regional factors contributing to these outcomes has been neglected. We attempted to identify the degree to which region of residence may be linked to health outcomes for children with the specific aim of determining whether living in the southern region of the United States is adversely associated with children's health status. METHODS: A child health index (CHI) that ranked each state in the United States was computed by using state-specific composite scores generated from outcome measures for a number of indicators of child health. Five indicators for physical health were chosen (percent low birth weight infants, infant mortality rate, child death rate, teen death rate, and teen birth rates) based on their historic and routine use to define health outcomes in children. Indicators were calculated as rates or percentages. Standard scores were calculated for each state for each health indicator by subtracting the mean of the measures for all states from the observed measure for each state. Indicators related to social and economic status were considered to be variables that impact physical health, as opposed to indicators of physical health, and therefore were not used to generate the composite child health score. These variables were subsequently examined in this study as potential confounding variables. Mapping was used to redefine regional groupings of states, and parametric tests (2-sample t test, analysis of means, and analysis-of-variance F tests) were used to compare the means of the CHI scores for the regional groupings and test for statistical significance. Multiple-regression analysis computed the relationship of region, social and economic indicators, and race to the CHI. Simple linear-regression analyses were used to assess the individual effect of each indicator. RESULTS: A geographic region of contiguous states, characterized by their poor child health outcomes relative to other states and regions of the United States, exists within the "Deep South" (Mississippi, Louisiana, Arkansas, Tennessee, Alabama, Georgia, North Carolina, South Carolina, and Florida). This Deep-South region is statistically different in CHI scores from the US Census Bureau-defined grouping of states in the South. The mean of CHI scores for the Deep-South region was >1 SD below the mean of CHI scores for all states. In contrast, the CHI score means for each of the other 3 regions were all above the overall mean of CHI scores for all states. Regression analysis showed that living in the Deep-South region is a stronger predictor of poor child health outcomes than other consistently collected and reported variables commonly used to predict children's health. CONCLUSIONS: The findings of this study indicate that region of residence in the United States is statistically related to important measures of children's health and may be among the most powerful predictors of child health outcomes and disparities. This clarification of the poorer health status of children living in the Deep South through spatial analysis is an essential first step for developing a better understanding of variations in the health of children. Similar to early epidemiology work linking geographic boundaries to disease, discovering the mechanisms/pathways/causes by which region influences health outcomes is a critical step in addressing disparities and inequities in child health and one that is an important and fertile area for future research. The reasons for these disparities may be complex and synergistically related to various economic, political, social, cultural, and perhaps even environmental (physical) factors in the region. This research will require the use and development of new approaches and applications of spatial analysis to develop insights into the societal, environmental, and historical determinants of child health that have been neglected in previous child health outcomes and policy research. The public policy implications of the findings in this study are substantial. Few, if any, policies identify these children as a high-risk group on the basis of their region of residence. A better understanding of the depth and breadth of disparities in health, education, and other social outcomes among and within regions of the United States is necessary for the generation of policies that enable policy makers to address and mitigate the factors that influence these disparities. Defining and clarifying the regional boundaries is also necessary to better inform public policy decisions related to resource allocation and the prevention and/or mitigation of the effects of region on child health. The identification of the Deep South as a clearly defined subregion of the Census Bureau's regional definition of the South suggests the need to use more culturally and socially relevant boundaries than the Census Bureau regions when analyzing regional data for policy development.

Adolescent↗
PubMed1993

A measure of growth. A system's corporate ethics committee assesses its accomplishments and future direction.

In 1992 the Sisters of Mercy Health System (SMHS) Corporate Ethics Committee (CEC) developed a three-step evaluative process of the system's ethics programs. The evaluation consisted of a retrospective review of the minutes of CEC meetings since the committee's inception, an oral evaluation with current CEC members, and a written assessment of the committee's performance by current and former members. In the open discussion, 86 percent of participants indicated that the system needs the CEC because it facilitates in-depth examination of ethical issues and provides important research and consulting services to the system executive. Respondents completing the written evaluation indicated that the CEC's dominant strength is the diversity of its membership, which includes trustees, physicians, ethicists, nurses, administrators, managers, and chaplains. More than 57 percent of respondents reported the CEC has achieved all six of its goals, which included education, articulation, decision making, policy development, program development, and evaluation. A review of the CEC evaluation suggests that the committee has moved beyond the development stage and entered a period of active growth. CEC members have made great strides in educating themselves, and the committee must now consider whether to broaden its focus by developing its knowledge base and skills for bioethical education and policy recommendations. The CEC is currently testing an ethical decision-making model it recently developed.

Bioethical Issues↗
PubMedDate not supplied

The UK, health and peace-building: the mysterious disappearance of Health as a Bridge for Peace.

The problem of how to build peace in post-conflict societies continues to loom large for governments and development agencies worldwide. This article examines the involvement of the UK development community in the creation of the World Health Organization's 'Health as a Bridge for Peace' (HBP) programme. It argues that the new development policy context brought in by the United Kingdom Labour administration in 1997 appeared to provide fertile ground for health-sector initiatives such as these to become an important part of the UK's peace-building strategy, but that HBP in fact failed to take root. The role of individuals, the changing departmental focus of the Department for International Development (DFID), its relationship with WHO, and the absence of persuasive evidence for the efficacy of HBP are highlighted as being crucial in explaining the policy's mysterious disappearance.

Global Health↗
PubMed2001

The environmental impact of water markets: an Australian case-study.

Water markets are developing as part of a Council of Australian Governments initiative to promote an efficient use of Australia's water resources. The consequences of these policies on river health is yet to be fully understood, but recognised as having significant interrelationships which need to be explored. This paper examines the consequences of introducing trade and allocating water for environmental use in the Border Rivers region of Queensland. The results of this study suggest that: (1) trade in water entitlements is likely to increase the differential between extractive demand and historical flow regimes as extractive water-use concentrates on the most profitable crops, and (2) water markets are likely to limit the effectiveness of water policies aimed at restoring natural flow regimes. As a result, trade-offs between environmental needs and income from extractive use will need to be determined. This work is important and timely in water-policy development demonstrating the linkages and trade-offs between ecological and economic objectives.

Commerce↗
PubMed1987

The Soviet settlement system--current issues and future prospects.

"A survey of current urban issues and trends in the Soviet Union sets the stage for an analysis of the problems of the urban system of the USSR and discussion of recent efforts at planning and policy development for a national settlement system. The General Scheme of Settlement, issued in 1975 and revised in 1982 to guide the development of such a national system, is examined as is the ensuing debate between two opposing schools of thought as to the best approach for restructuring the urban system."

Demography↗
PubMed2002

Accounting for unemployment among people with mental illness.

Persons diagnosed with a serious mental illness experience significantly high rates of unemployment compared with the general population. The explanations for this situation have included a focus on the symptoms associated with these disorders, a focus on the lack of effective vocational rehabilitation programs for this population, and, most recently, a focus on employer discrimination and the financial disincentives to employment in various public policies. The authors of this manuscript review the evolution in thought pertaining to the labor market experiences of persons with a serious mental illness and propose as an additional set of factors that should be considered, those labor market liabilities that this population shares with others without disabilities who experience similar employment histories. The authors conclude that the inclusion of these factors in our understanding of issues that persons with serious mental illness face in the competitive labor market will likely lead to a further evolution in program and policy development.

Persons with Disabilities↗
PubMed2003

Pregnancy during residency: a literature review.

PURPOSE: It is estimated that by 2010 30% of U.S. physicians will be women. Pregnancy during residency can and does happen in all programs, and continues to provide problems for many. The author reviews the issues surrounding pregnancy during residency by evaluating published commentaries and research reports. METHOD: A literature search was conducted using Medline (January 1984-October 2001). Published articles were categorized as research or commentary. Research reports were sorted by content and summarized under three headings: mother and infant health, sources of stress and support for the pregnant resident, and reactions of colleagues to the pregnant resident. RESULTS: A total of 27 research reports were located; two additional reports published before 1984 were added because they complemented included studies. The majority of the studies in this review used retrospective self-report questionnaires, mostly completed by female residents and physicians. All reports suggested an increased risk of complications, especially adverse late-pregnancy events, for pregnant physicians. Pregnant residents found the physical demands of residency and lack of support from fellow residents and their departments most stressful. Anger and resentment toward the pregnant resident were common among not-pregnant residents, feelings particularly associated with expectations of increased workload. Individual maternity/parental leave policies were inconsistent. Policy development is discussed. CONCLUSIONS: The studies in this review supported planning for residents' pregnancies, and the author advocates clear maternity/parental leave policies. The author comments on the use of existing data to make common sense changes and on the need for further studies to help clarify the issues and evaluate program changes.

Adaptation, Psychological↗
PubMed2004

Overcoming the hurdles to providing urban health care in the 21st century.

The delivery of health care services to urban populations in the United States is a system of rapidly increasing complexity. With the emergence of superspecialized physicians, a scientific approach to disease management has received great emphasis. Those providing health care at the population level may also apply this evidence-based approach. Analysis of the process of health care delivery in its entirety is complicated, confusing, and may be fraught with bias. In this article, a powerful instrument for providing a scientific approach to urban health care health policy development is introduced. This tool allows for analysis and assessment of hurdles to health care delivery to urban populations by dividing the process into elements of "administration," "provision," and "utilization" (APU). This APU triangle model, while intuitive, also allows a more definitive analysis by parts than would be possible to make of the whole. Using this model, the authors explore some of the hurdles faced by each element as well as some potential solutions. Although this model is presented in the context of urban hurdles to health care, it is equally applicable to rural environments or other service-delivery systems. In conclusion, this article discusses the emergence of the role of the public health department as the facilitator and manager between sectors of the community not traditionally connected in a collaborative health care model. Thus, the urban public health department coordinates efforts to surmount the hurdles and provides the venue for analysis, development, and employment of successful strategies.

Cities↗
PubMed1990

AIDS and state developmental disability agencies: a national survey.

A survey of state developmental disability agencies was undertaken in October 1987 regarding AIDS policy development, education, and training and service provision. Of 44 states responding to the 27-item questionnaire, only 21 had formal AIDS policies. Policies varied considerably from state to state. Twenty-five of the responding states include information on AIDS in their staff training curriculum, with such training more likely to be provided to institutional staff than to community-based staff. Only 10 states reported AIDS prevention to be part of their client training programs, with training more likely to be found in institutional settings. Eleven states reported HIV positive cases, with such cases found more often in institutions than in community settings. Several states reported some type of segregation of HIV positive individuals. Policies, educational programming, and services to meet the special needs of persons with developmental disabilities are called for.

Acquired Immunodeficiency Syndrome↗
PubMed2000

The role of the nurse in developing cancer screening programs.

PURPOSE/OBJECTIVE: To describe and provide an overview of the role that nurses can play in developing cancer screening programs. DATA SOURCES: Published articles, book chapters, and clinical experience. DATA SYNTHESIS: Many approaches and considerations are available for developing cancer screening programs. Planning considerations include needs assessment, patient-education strategies, funding, recruitment issues, follow-up strategies, staffing, policy development, and evaluation. An understanding of these considerations may lead to more effective cancer screening programs. CONCLUSIONS: Nurses can play an integral role in the development and management of cancer screening programs. Careful program planning may enhance this process. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need to consider a wide range of issues when developing cancer screening programs, including the purpose of the program, how the program will be implemented, the population being served, and the potential impact on individuals being served.

Financial Support↗
PubMed1996

Tobacco and the developing world.

Tobacco consumption is increasing in developing countries, which will bear the brunt of the tobacco epidemic in the 21st century. If current smoking patterns continue, 7 of the world's 10 million annual deaths from tobacco in 2025 will occur in developing countries. Compared with developed countries, more men and fewer women currently smoke in developing countries, but smoking among girls and women is increasing. While indigenous tobacco production and consumption remain a major problem, of particular concern is the penetration by the transnational tobacco companies, bringing with them denial of the health evidence, sophisticated advertising and promotion, threats of trade sanctions based on tobacco trade, and opposition to tobacco control measures, in particular promotional bans and tobacco tax policy. Developing countries must urgently devise and implement national tobacco control policies, but many governments have little experience in the new noncommunicable disease epidemic or in countering the transnational tobacco companies.

Advertising↗
PubMedDate not supplied

The prospects for using (Q)SARs in a changing political environment--high expectations and a key role for the European Commission's joint research centre.

Recent policy developments in the European union (EU) and within the Organisation for Economic Cooperation and Development (OECD) have placed increased emphasis on the use of structure-activity relationships (SARs) and quantitative structure-activity relationships (QSARs), collectively referred to as (Q)SARs, within various regulatory programmes for the assessment of chemicals and products. The most significant example within the EU is the European commission's proposal (of 29 October 2003) to introduce a new system for managing chemicals (called REACH), which calls for an increased use of (Q)SARs and other non-animal methods, especially for the assessment of low production volume chemicals. Another development within the EU is the Seventh Amendment to the Cosmetics Directive, which foresees the phasing out of animal testing on cosmetics, combined with the imposition of marketing bans on cosmetics that have been tested on animals after certain deadlines. At the same time, the Existing Chemicals programme within the OECD is investigating ways of increasing the use of chemical category approaches, which depend heavily on the use of (Q)SARs, activity-activity relationships and read-across. Such developments are placing an enormous challenge on industry, regulatory bodies, and on the European commission's Joint Research Centre (JRC), which is responsible for providing independent scientific advice to policy makers in the European Commission and the Member States. This paper reviews the different scientific and regulatory purposes for which reliable (Q)SARs could be used, and describes the current work of the JRC in providing scientific support for the development, validation and implementation of (Q)SARs.

Animal Experimentation↗
PubMed2004

Spatial pattern of private health care provision in Ujjain, India: a provider survey processed and analysed with a Geographical Information System.

In developing countries like India, official information on private health care providers is scanty. This is an obstacle for effective health care planning and policy development. In this paper, we present a project aimed to enumerate, characterise and digitally map all private providers (PPs) using Geographical Information System (GIS) in a rural district in India. A team of surveyors carried out a census of private providers in the district. This data was combined with official data on geophysical characteristics and infrastructure, demographic situation and location of settlements and public health care providers. This study highlights the need to consider PPs in health policy making in India. The survey identified about 2000 additional PPs over and above those listed with the health authorities. About half practised modern medicine (Allopathy) while the rest practised other types of formal medical systems (Ayurveda or Homeopathy) or informal therapeutic systems. Individuals with no formal health care training constituted the majority of PPs. Formally trained doctors were highly concentrated in urban areas while trained non-doctors and untrained PPs dominated in the rural areas. The study shows how GIS can be used to create an improved basis for health services research. In the future, the digitised map will be used as a sampling frame and point of reference for studies on quality and utilisation of PPs in Ujjain district. However, the utility for health care planning is less clear. GIS has limitations in countries like India due to lack of valid routine data to enter into GIS as well as to competing demand for health care resources.

Data Collection↗
PubMed1997

Latex allergy.

An overview of latex allergy, including methods for preventing reactions and reducing exposure to latex, is provided. Latex allergy is a serious medical problem for an increasing number of patients and health care workers. From an institutional perspective, several precautionary procedures need to be followed to ensure safe care for patients and to protect employees from unnecessary latex exposure. These include establishing a multidisciplinary committee to develop policies and procedures; identifying products containing latex; identifying latex-sensitive patients and employees as well as those at high risk of developing the sensitivity; implementing precautions against allergic reactions to latex; educating personnel and patients on latex allergy; and reviewing quality assurance data to continually improve precautionary procedures. Pharmacists should be involved in developing and implementing these procedures. In particular, they can play a major role in the education of health professionals and patients. There is a strong need for more information on latex sensitivity, especially in the areas of epidemiology, product development, and effectiveness of procedures. Each institution, including its pharmacists, must evaluate the available information about latex sensitivity and determine appropriate actions.

Allergens↗
PubMed1999

Quality assurance in dental education.

This paper proposes the development and world-wide use of an electronic dental curriculum which will ensure quality assurance in dental education, in the broadest sense, through the continuous updating of its content and linkages to contemporary resources and databases. This curriculum will need to be reinforced onsite by knowledgeable faculty in the context of patient care delivery with the highest of standards. Two rationales are presented to support the world-wide curriculum concept: one is related to the sophisticated knowledge of science, particularly the biological sciences and its transfer to the oral care environment; the second is related to the progressive role which current developments in information technology allow us to take in the delivery of the curriculum. The paper also addresses the important issue of policy development that will be necessary to ensure continued quality assurance through assessment of this curriculum. We propose to use on a worldwide basis, the system piloted by DENTED, the thematic network project "achieving convergence in standards of output of European Dental Education". The paper concludes by suggesting the next steps for assessing the efficacy of a world-wide electronic curriculum in dental education, supporting development and determining who might maintain this curriculum.

Curriculum↗
PubMedDate not supplied

An association's campaign to influence policy.

When an opportunity was opened to make its voice heard in the arenas of political action and policy development, the New York State Nurses Association (NYSNA), a member of the American Nurses Association, began to implement strategies to achieve its policy goals. Below, the strategies it used to influence the policymakers on issues important to professional nursing.

Health Policy↗