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PubMed2000

[Obesity in the child].

The prevalence of childhood obesity increases dramatically in all industrialized countries. As in adults, it is defined by an increase in fat mass. The United States seem to be facing the most difficult situation. However, rapid changes in the way of life leads to consider that, in a near future, as much as 25% of the children in Europe could be concerned as well. A new epidemiological tool designed by the International Obesity Task Force takes as reference criteria the body mass index and will allow comparisons between countries as well as it will take into account the physiological variations of fat mass during growth. GENETICS AND ENVIRONMENT: A NEW PUZZLE: Inactivity seems to account as much as increased or unbalanced food intakes. While genetics account for a part of the disease at the population level, its role remains unclear in individuals. Most complications occur early in life, in a silent and progressive way. All these aspects do not only open fields of research but also provide new understanding and therapeutic basis for clinicians. PREVENTION: A PUBLIC HEALTH PRIORITY: Prevention has become a priority which should be based on early individual surveillance and Health Policy programs based on "National Recommendations for the diagnosis, prevention and treatment of obesity". All professionals dealing in one way or another with children lifestyle are concerned as well as do the families.

Adolescent↗
PubMedDate not supplied

[The integrated management of childhood illness: Haiti's example].

Child health in developing countries is a public health priority both at the national and international level. The World Health Organization, UNICEF and other technical partners have developed The Integrated Management of Childhood Illness (IMCI) strategy to reduce child mortality and improve child health and development through a holistic approach. By the end of 2002, 109 countries among which 17 in the region of the Americas and Caribbean had adopted and implemented this strategy,. In this region, Haiti presents the highest mortality rate for under-fives. Every year, more than 138,000 children die of diseases such as malaria, pneumonia, diarrhea, measles and perinatal complications. Malnutrition contributes to a high percentage of these deaths. It is recognised that the mortality due to these diseases can be prevented. To fight this burden, Haiti officially adopted the IMCI strategy in 1997. The objectives of this paper are, after a general overview of the IMCI strategy, to describe Haiti's child health and analyse the achievements of the first steps of implementing the IMCI strategy in Haiti. The methodology used was a standardised literature review and a qualitative survey based on semi-structured interviews of national and local health authorities involved in the implementation of the IMCI strategy in Haiti. Main results show a limited impact of the first and second phase of implementation in the country. The key factors for this have been limited economical and human resources. A unequal distribution of existing resources between the different IMCI strategy components especially community and family practices, has limited adequate coverage. Isolated actions in favour of child health as well as a lack of co-ordinated interventions between the various actors have been among the barriers for an adequate implementation of this strategy. We recognise that the approach used here is not a formal evaluation on the implementation of IMCI in Haiti. Nevertheless, we hope this article will contribute to draw the attention of national and international public health decision-makers on the difficulties of implementing this strategy in Haiti and in this way, improve child health in the country.

Child↗
PubMed2006

[Adolescent health: collaborative effort between school health services, medical practitioners and adolescents or specialized clinics].

Adolescents have complex health needs, that require consistent answers between the health and education sectors. This article describes the existing structures and collaborations in Geneva, between medical practitioners, specialized clinics and school health. School health doesn't make any routine health screening, but strengthens its role for guidance of adolescents. Priority health activities for school health include protection of victims of abuse, integration of youth living with a chronic condition, and mediation for students with repeated absences. In any of these cases, collaboration between health services and school health services is essential. In the case of drug abuse, collaboration with teachers is necessary.

Adolescent↗
PubMed1986

Psychological care of the chronically physically ill.

Disease prevalence and health priorities have changed, with increasing emphasis on chronic degenerative problems. Health care for the chronically physically ill needs to focus on realistic and often modest goals. This article presents the case for greater consideration of psychological factors, and outlines an example of a system of psychological care.

Adaptation, Psychological↗
PubMedDate not supplied

Assessing the public's health: community diagnosis in North Carolina.

The community diagnosis process in North Carolina has evolved over a period of years. It began in 1974 and gained great impetus during and after 1983. It serves to address the "true" health problems of the State's citizenry through the identification and communication of these problems from the local level to the State. In this "bottom-up" planning process, conducted biennially, the State health department prepares 100 county-specific health data books and an accompanying guide that advise local health department personnel on the concepts, methods, and materials of community diagnosis. The data books and guides are presented at a series of workshops to county health department personnel who subsequently analyze the data in the light of their local situations and report back to the State their county's priority health problems and strategies for solving them. This county information is then used by the State health director to determine funding requests to the legislature. In the end, it is hoped that the products of this process serve the ultimate goal of allocating resources according to priorities to meet the documented health needs of North Carolinians. "The Future of Public Health," authored by a committee of the Institute of Medicine, defines a health planning and leadership role for a local health authority that is fundamental to the protection of the community's health. Community diagnosis provides for the kind of needs assessment that is crucial to that role.

Community Health Services↗
PubMed2006

Priority setting of health interventions: the need for multi-criteria decision analysis.

Priority setting of health interventions is often ad-hoc and resources are not used to an optimal extent. Underlying problem is that multiple criteria play a role and decisions are complex. Interventions may be chosen to maximize general population health, to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to respond to life-threatening situations, all with respect to practical and budgetary constraints. This is the type of problem that policy makers are typically bad at solving rationally, unaided. They tend to use heuristic or intuitive approaches to simplify complexity, and in the process, important information is ignored. Next, policy makers may select interventions for only political motives. This indicates the need for rational and transparent approaches to priority setting. Over the past decades, a number of approaches have been developed, including evidence-based medicine, burden of disease analyses, cost-effectiveness analyses, and equity analyses. However, these approaches concentrate on single criteria only, whereas in reality, policy makers need to make choices taking into account multiple criteria simultaneously. Moreover, they do not cover all criteria that are relevant to policy makers. Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research. In other scientific disciplines, multi-criteria decision analysis is well developed, has gained widespread acceptance and is routinely used. This paper presents the main principles of multi-criteria decision analysis. There are only a very few applications to guide resource allocation decisions in health. We call for a shift away from present priority setting tools in health--that tend to focus on single criteria--towards transparent and systematic approaches that take into account all relevant criteria simultaneously.

Journal Article↗
PubMedDate not supplied

Childhood and teenage pregnancies.

Childhood and teenage pregnancy poses a significant social and health problem in the UK and it has implications for nurses across a wide range of disciplines. This article aims to raise awareness of the issue and help nurses to identify the risks of early sexual activity and pregnancy for young people. It includes the views of a group of first year, undergraduate nurses who took part in discussions on the topic while taking a module concerned with current health priorities.

Adolescent↗
PubMed1995

Patients' views of priority setting in health care: an interview survey in one practice.

OBJECTIVES: To explore the assumptions underlying consumers' responses to questions of resource priorities in the NHS. DESIGN: Qualitative analysis of semi-structured interviews with a heterogeneous sample of 16 patients drawn from a general practice. RESULTS: Interviewees were not persuaded that they had a legitimate role to play in the prioritisation of services. They supported the principle of equity and were reluctant to use their own personal needs as a basis for resource allocation; instead they argued from what they perceived to be the needs of others. CONCLUSIONS: Paradoxically, surveys of consumers' views on health care priorities probably do not elicit the personal ideas of respondents but tap into a more general ideological position closer to an earlier collectivist notion of health care.

Adult↗
PubMedDate not supplied

Adolescents and sexually transmitted diseases: diagnosis, developmental issues, and prevention.

Sexually transmitted diseases (STDs) continue to be a public health priority; adolescents are the highest risk group for nearly all STDs. Health care providers play an important role in addressing the problem of STDs among teenagers. This article reviews diagnostic approaches, developmental aspects of adolescents, and prevention efforts. Findings related to the STD epidemic in adolescents and the theoretic and pragmatic issues regarding prevention efforts, are presented.

Adolescent↗
PubMed2003

Decentralisation and its implications for reproductive health: the Philippines experience.

Decentralisation is one of the most common health sector reforms initiated in developing countries in the 1980-90s. Although decentralisation is often politically driven, it can significantly improve health sector performance. However, the early phase of the Philippines experience indicates that decentralisation in and of itself does not always improve the efficiency, equity and effectiveness of the health sector. Instead, it can exacerbate inequities, weaken local commitment to priority health issues and decrease the efficiency and effectiveness of service delivery by disrupting the referral chain. Such effects pose a particularly serious threat to accessibility and delivery of reproductive health services, some of which (e.g. family planning) are controversial and thus susceptible to local pressures, and others of which (e.g. emergency obstetric care) require a functioning and effective health system. Moreover, those undertaking decentralisation need to take account of the impacts of non-health factors as well as other reforms that interact with decentralisation to affect accessibility, affordability and quality of services, including for reproductive health. The Philippines experience also demonstrates that authority should be shared between the centre and local units in order to achieve national health objectives and respond to local health needs. Adjustments must be made during implementation to correct for both emerging and pre-existing problems.

Decision Making, Organizational↗
PubMed2000

Community attitudes to pregnancy, anaemia, iron and folate supplementation in urban and rural Lagos, south-western Nigeria.

OBJECTIVE: To identify community perspectives and attitudes to pregnancy, anaemia, iron and folate supplements during pregnancy in Lagos, south-western Nigeria. DESIGN: Qualitative using focus group discussions, observational data and in-depth interviews. SETTING: Amukoko, a peri-urban slum area and Ibese a rural coastal area in Lagos, south-western Nigeria. PARTICIPANTS: 23 pregnant women and two health-care providers. FINDINGS: Maternal anaemia is not perceived as a priority health problem by pregnant women. Knowledge of the signs and symptoms of anaemia is limited among rural pregnant women. The recognition of maternal complications associated with anaemia is low among pregnant women and some health-care providers. Severe blood loss at or after delivery is sometimes attributed to the excessive use of iron and folate supplements. Sustaining the motivation to continue taking iron tablets and communicating the benefits of iron supplementation which could encourage compliance was also lacking. IMPLICATIONS FOR PRACTICE: An understanding of the local beliefs, attitudes and practices regarding pregnancy is needed to design more effective methods of health education for pregnant women and to provide maternal services which are 'culturally acceptable'.

Adult↗
PubMed2004

Introducing the Learning Practice--I. The characteristics of Learning Organizations in Primary Care.

RATIONALE, AIMS AND OBJECTIVES: This paper is the first of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. Here we introduce the notion of the Learning Practice (LP) and outline the characteristics and nature of an LP, exploring cultural and structural factors in detail. METHODS: Drawing upon both theoretical concepts and empirical research into LOs in health care settings, the format, focus and feasibility of an LP is explored. RESULTS AND CONCLUSIONS: Characteristics of LPs include flatter team-based structures that prioritize learning and empowered change, involve staff and are open to suggestions and innovation. Potential benefits include: timely changes in service provision that are realistic, acceptable, sustainable, and owned at practitioner level; smoother interprofessional working; and fast flowing informal communication backed up by records of key decisions to facilitate permanent learning. Critical comment on potential pitfalls and practical difficulties highlights features of the present system that hinder development: tightly defined roles; political behaviours and individual-oriented support systems; plus the ongoing difficulties involved in tolerating errors (whilst people learn). This paper contributes to the wider quality improvement debate in the area in three main ways. First, by locating Government's desires to create health systems capable of learning within the theoretical and empirical evidence on LOs. Second, it suggests what an LP could be like and how its culture and structures might benefit both staff and patients in addition to meeting externally driven reforms and health priorities. Third, it extends the application of LO concepts to the health care sector locating the principles in bottom-up change.

Diffusion of Innovation↗
PubMed2006

Mapping indicators of sexually transmitted infection services in the South African public health sector.

BACKGROUND: Prevention and early treatment of sexually transmitted infections (STIs) is a high public health priority in South Africa. In 2002 a national survey of public health care (PHC) facilities was conducted to develop measurable indicators for monitoring and evaluation of the National STI programme. In this paper we present maps of key indicators obtained from the survey, and discuss their programmatic implications. We also address some methodological issues that arise in the context of producing appropriate maps. METHODS: A national sample, stratified by subdistrict/municipality, of 962 PHC facilities was randomly selected. In each facility the senior nurse was telephonically contacted and interviewed to answer questions related to the implementation of STI prevention and management from a structured questionnaire. Responses were validated through a second phone call, and inconsistencies recorded. The following key variables were mapped: stock-outs of drugs and condoms, knowledge of correct treatment procedures, consistent record keeping, number of STI clients seen per month per 1000 adult population, number of condoms distributed per adult male, and number of trained nurses per 1000 population. Using conditional autoregressive models and Markov Chain Monte Carlo (MCMC) simulation, smoothed subdistrict level clinic responses were computed and 95% confidence limits estimated. RESULTS AND DISCUSSION: Drug stock-outs were reported by 13% [95% CI 10-15%] and condom stock-outs were reported by 4% [95% CI 2-5%] of facilities. Underlying geographical patterns of risk were more clearly observed when maps had been smoothed and were not dominated by sampling error. Smoothed maps show that there is a finite, low risk of drug stock-outs in all areas with higher risk regions more clearly identified. The maps of indicators of STI services at PHC facilities show that there are important differences in quality of service within South Africa and underscore the usefulness of facility level routine data both for local programme monitoring and planning and for providing a national "bird's eye view" of programme performance.

Adult↗
PubMed1997

Is research into ethnicity and health racist, unsound, or important science?

Much historical research on race, intelligence, and health was racist, unethical, and ineffective. The concepts of race and ethnicity are difficult to define but continue to be applied to the study of the health of immigrant and ethnic minority groups in the hope of advancing understanding of causes of disease. While a morass of associations has been generated, race and ethnicity in health research have seldom given fundamental new understanding of disease. Most such research is "black box epidemiology." Researchers have not overcome the many conceptual and technical problems of research into ethnicity and health. By emphasising the negative aspects of the health of ethnic minority groups, research may have damaged their social standing and deflected attention from their health priorities. Unless researchers recognise the difficulties with research into ethnicity and health and correct its weaknesses, 20th century research in this subject may suffer the same ignominious fate as that of race science in the 19th century.

Biomedical Research↗
PubMed1987

Imported malaria in the UK: advice given by general practitioners to British residents travelling to malaria endemic areas.

General practitioners are in a key position to provide advice to those travelling to malaria endemic areas. A study of at-risk travellers revealed that 54% visited their general practitioner before their intended trip overseas and of these 79% were given advice about antimalarial precautions. Of those advised 98% carried antimalarial tablets with them on their trip but only 46% had any knowledge of other methods of personal protection against malaria. Fewer non-white than white British residents received information from their general practitioners.It is suggested that general practitioners should be better informed about current malaria transmission and currently recommended chemoprophylactic drugs and dosages. It is also suggested that the major public health priority should be to stimulate a greater involvement of non-health service agencies in order to make the public aware of the risk of malaria and seek medical advice before travel.

Adolescent↗
PubMedDate not supplied

Identifying research priorities for the health care of children and adolescents.

In an effort to identify priority statements for research into the healthcare of children and adolescents a search of multiple research databases and the Internet was undertaken. There is a considerable body of literature outlining research priorities that are built around specific disorders or specialist services, which are not readily applicable to the general healthcare of children and adolescents. A few general statements of research priorities were identified, but these were mainly developed to inform research programs in the US. In addition there was little evidence that these agendas had incorporated the needs of the consumers of this healthcare namely, children and adolescents, and their families. Therefore, there is a need to address the needs of a broader community in regards to the research agenda for the healthcare of children and adolescents. The advantage of an agenda developed by multiple stakeholder groups is that it will have broader meaning to a wider community. However at this stage, there is no such statement that can readily inform a general program of reserch into the healthcare of children and adolescents.

Adolescent↗
PubMedDate not supplied

[Integration of the Expanded Program on Immunization into primary health care: examples of Benin and Guinea].

Since 1986, two West African countries have been delivering immunizations within the framework of reorganized peripheral health systems. This revitalization is based on strategies which are implemented by an increasing number of African countries under the name "Bamako Initiative". It aims at providing universal access to a minimum package of maternal and child health priority interventions starting with immunizations, pre and perinatal care, oral rehydration for diarrhoea, treatment of malaria and acute lower respiratory infections. Within this package, immunization has been given high priority. Several strategies aimed at improving immunization coverage have been implemented: services have been reorganized so that any child or woman making contact with the health system receives immunization if needed. Health information systems have been revised so as to allow for active individual follow up and better management of health centre resources. Health staff have been given training in management and a biannual monitoring/microplanning process at health centre level has been introduced. The goal of monitoring is to enable health personnel to identify the obstacles to attaining optimum coverages with the priority interventions and to select locally appropriate corrective strategies. Health centres have also been provided with a motorcycle allowing for regular outreach activities. To cover the running costs of the services (mainly restocking of drugs, running and maintenance of the cold chain and the motorbike, and staff incentives), financial contribution from local communities have been sought through a fee-for-treatment system. Prices have been set at an affordable level by limiting the number of drugs to a minimal list purchased under generic names by international tendering procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Benin↗