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PubMed2001

The application of ontologies and problem-solving methods for the development of shareable guidelines.

Recently, studies have shown the benefits of using clinical guidelines in the practice of medicine. Computer-based clinical guidelines are increasingly applied in diverse areas such as policy development, utilization management, education, conduct of clinical trials, and workflow facilitation. This paper discusses some of the representations suggested in literature, discusses their weak and strong points, and demonstrates and discusses a new approach that extends earlier developed formalisms by combining primitives, ontologies and the use of problem-solving methods (PSMs). The approach is supported by a framework that facilitates the entire guideline authoring process. The paper demonstrates this framework and presents examples of guidelines, PSMs and systems that were developed by means of this approach. The overall goal of this approach is to improve the acceptance of shareable guidelines and decision support systems in daily care by facilitating the guideline acquisition and execution phases.

Decision Support Systems, Clinical↗
PubMedDate not supplied

Advance directives: development, opposition, and criticism.

Since the PSDA became law on December 1, all Medicare and Medicaid health care providers are required to develop policies and procedures to comply with the law. The principles of autonomy and distributive justice are basic to the Act, and the social worker's vital role will continue to develop as the law is implemented.

Admitting Department, Hospital↗
PubMed1992

Washington State's Basic Health Plan: choices and challenges.

The current turbulence characterizing the health sector has engendered a limited number of state-level experiments to provide health services for the nation's 37 million uninsured. The issues and challenges generated by each program's design and implementation vary. By examining the experience of one such state program, the Washington Basic Health Plan, in some detail, this paper contributes to the policy debate regarding the possible range of solutions available to address the issue of "the uninsured." By analyzing the array of design choices available at the time the program was enacted, and why certain options were chosen rather than others, this paper points to the complex interaction of political dynamics, public policy development, and program implementation.

Health Policy↗
PubMed2002

Predicting weekly earning for consumers with severe disabilities: implications for welfare reform and vocational rehabilitation.

This 1999 research analyzed selected descriptive variables for consumers with significant disabilities, who were successfully employed. The goal was to investigate employment outcomes for consumers whose cases were closed as successfully employed. Human capital theory provided the theoretical underpinnings for evaluating the findings. This study empirically assessed factors which contributed to increased weekly earnings for consumers of state vocational rehabilitation services with severe disabilities. The variables included in this study were weekly earnings at closure, correlated with year last employed, highest grade completed, and birth year. The study found that 17.2% of variability in weekly earnings of the significantly disabled consumers can be predicted by these variables. Education, age, and work experience were found to be predictors of potential earning power. These findings can be used to provide the foundation for the development of reliable program evaluation as well as clinical interventions. This study links outcomes to the services provided. It further provides the data necessary to support policy development in the areas of rehabilitation and welfare reform.

Persons with Disabilities↗
PubMed1990

Preventing alcohol related birth damage: a review.

Since 1974 numerous clinical studies have made it clear that heavy alcohol consumption during pregnancy (in excess of 80 g or 8 units daily) can result in a child being born with a specific combination of physical and mental disabilities known as the Fetal Alcohol Syndrome. More moderate levels of intake (as little as 10 g of 1 unit daily) are associated with other fetal problems known as Fetal Alcohol Effects. The most common of these is growth retardation. Reduction of alcohol consumption is beneficial to pregnancy outcome. However, despite this great clinical and research interest within the field there has been comparatively little attention paid to researching possible preventative strategies and appropriate policy development. This paper first describes the size of the problem posed by drinking in pregnancy in the U.S.A. and the U.K., detailing the contrasting policy response on either side of the Atlantic. It examines the difficulties of formulating appropriate advice and then assesses the available research reports on preventative measures. The strategies described include general publicity and counselling for pregnant women. In addition, attention has been paid to the problems of dissemination by emphasising professional education. One major shortcoming is that most of these studies appear to have been carried out with little reference to existing knowledge on health education and promotion, or educational work in the antenatal or alcohol fields. In addition, little attention appears to have been paid to the characteristics of the groups at whom intervention might be targeted or the underlying social or psychological factors which maintain drinking in these groups. The second part of this paper, therefore, attempts to suggest appropriate avenues for developing preventative strategies by presenting a wide-ranging review with special reference to British experience. Particular attention is given to the issues of form and content of appropriate messages, targeting of risk populations, the venue for intervention, and media and the actual mechanisms involved in implementing the programme. We conclude that women should be advised to limit their alcohol consumption to no more than one unit a day when they are either pregnant or planning a pregnancy. We recommend that pregnant women should be asked about their alcohol and given appropriate advice during routine antenatal clinic visits. We suggest that the form of advice should be designed with the characteristics of the risk population in mind.(ABSTRACT TRUNCATED AT 400 WORDS)

Alcoholism↗
PubMedDate not supplied

Missed cancer screening opportunities among older women: A provider survey.

PURPOSE: Lack of physician recommendation is a major predictor of underutilization of breast and cervical cancer screening. The authors conducted a comprehensive two-part study of Florida primary care providers to determine which providers were not screening their older patients and why. This article reports on the study's quantitative survey component. DESCRIPTION OF STUDY: After an initial mailing of surveys to 2052 randomly sampled, licensed medical and osteopathic physicians, nurse practitioners, and certified nurse midwives, a follow-up mailing and phone calls resulted in 496 usable surveys. Outcome variables were whether or not primary care providers performed screening tests for their asymptomatic, women patients older than 50 years of age. Predictor variables included: age, race, gender, training, specialty, practice size, and location of the providers, and the percentage of older patients that they served. RESULTS: The best predictors of primary care providers not screening their asymptomatic women patients who were older than 50 years of age were providers also being older than 50, specializing in geriatrics or adult health, and working in a small or rural practice. An analysis of providers' responses to structured survey items related to their own and their patients' attitudes about screening indicated that providers often miss the opportunity to screen due to a combination of patient, provider, practice, and access barriers. CLINICAL IMPLICATIONS: The authors recommend that public health and primary care practitioners collaborate in developing strategies that address areas of potential change for overcoming these four barriers, while also considering the essential public health services of assessment, policy development, and assurance. These strategies should be designed to facilitate the breast and cervical cancer screening process for both providers and patients, so that providers feel more comfortable performing and recommending these important tests, particularly for underserved groups of older women.

Adult↗
PubMed1995

Environmental and policy approaches to cardiovascular disease prevention through physical activity: issues and opportunities.

The majority of Americans remain inactive despite evidence of significant health benefits from even moderately intense activity. Previous intervention efforts have generally focused on changing individual behavior. This article discusses the use of policy, legislative and regulatory, and environmental interventions in promoting physical activity to prevent cardiovascular disease (CVD) and other chronic diseases. The authors present evidence on the need, formulation, description, and effectiveness of policy and environmental intervention approaches. Types of approaches addressed to promote physical activity include federal, state, and local legislation and regulation, policy development and implementation, and environmental support. They also describe opportunities for state and local health departments to initiate and participate in environmental and policy approaches.

Cardiovascular Diseases↗
PubMed1998

How Australia came to have a National Women's Health Policy.

A National Women's Health Policy was launched in Australia in 1989, and Australia became the only country to have a comprehensive policy on women's health. The policy is intended to provide a framework for decision-making in both mainstream and separate women's health services. The author examines the forces and factors that led to the formulation and adoption of the policy, then addresses the question of why Australia is alone in choosing a national policy as a focus for women's health action. A number of key influences, either absent or weaker in comparable countries, worked together to facilitate policy development. The activities of women working in a number of arenas coincided with the election of relatively supportive governments, creation of women's policy machinery in bureaucracies, employment of feminists in key positions, and opportunities for policy expansion afforded by federalism. These influences, within the Australian ideological context of strong support for social liberalism, account for the country's distinctive policy position.

Australia↗
PubMed2000

The importance of local data in unintended pregnancy prevention programming.

OBJECTIVE: Lack of local data on pregnancy intendedness poses a serious problem for those responsible for regional program development and evaluation. This article demonstrates how the Boulder County Health Department addressed this problem by conducting its own assessment. The information gathered served as the basis for collaborative population-based programming and policy development aimed at decreasing unintended pregnancy in the county. METHODS: A random-digit-dial telephone survey of 300 men and 300 women was conducted to estimate the prevalence of unintended pregnancy and establish groups at highest risk. Qualitative data regarding the psychosocial and contextual factors associated with unintended pregnancy were gathered in six focus groups conducted with 46 males and females aged 18-28 who had experienced an unintended pregnancy. RESULTS: The prevention strategies identified by the focus group participants lead to the development of locally relevant interventions among specific high-risk populations identified in the telephone survey. Programmatic and policy initiatives included raising awareness among key service providers and the community at large, creative means of bringing information and resources to those at risk, strengthening the delivery of clinical services, and promoting school involvement in unintended pregnancy prevention. CONCLUSION: Maternal and child health authorities should encourage the collection and use of pregnancy intendedness data at the local level.

Adolescent↗
PubMed2005

The relationship between take-away methadone policies and methadone diversion.

The development of policies in relation to unsupervised doses of methadone (take-away doses) should be based upon the best available evidence. There are both risks and benefits associated with take-away doses. This study aimed to explore the relationship between take-away policies and one measure of harm: methadone injection rates. Six different states in Australia were compared in relation to their methadone take-away policy and rates of methadone injection within their population of injecting drug users. At a simplistic level, those states with restrictive and less flexible take-away policies tended to have the lowest reported prevalence of methadone injection. However, this does not fully explain variability in methadone injecting. There were also considerable differences between those states with similar take-away policies. Variables which appear to impact upon methadone injecting rates include: take-away policies, drug preference, drug availability, treatment availability and degree of treatment penetration. Consideration of the benefits, rather than merely the harms, of various take-away policy options may provide an evidence-based platform for take-away policy development.

Australia↗
PubMed1996

Treatment seeking for malaria: a review of recent research.

A review of literature on treatment seeking for malaria was undertaken to identify patterns of care seeking, and to assess what is known about the adequacy of the treatments used. There is considerable variation in treatment seeking patterns, with use of the official sector ranging from 10-99% and self-purchase of drugs ranging from 4-87%. The majority of malaria cases receive some type of treatment, and multiple treatments are common. The response to most episodes begins with self-treatment, and close to half of cases rely exclusively on self-treatment, usually with antimalarials. A little more than half use the official health sector or village health workers at some point, with delays averaging three or more days. Exclusive reliance on traditional methods is extremely rare, although traditional remedies are often combined with modern medicines. Although use of antimalarials is widespread, underdosing is extremely common. Further research is needed to answer the question of what proportion of true malaria cases get appropriate treatment with effective antimalarial drugs, and to identify the best strategies to improve the situation. Interventions for the private and public sector need to be developed and evaluated. More information is needed on the specific drugs used, considering resistance patterns in a particular area. In order to guide future policy development, future studies should define the nature of self-treatment, record multiple treatments and attempt to identify the proportions of all cases who begin treatment with antimalarials at standardized time intervals. Hypothetical questions were found to be of limited usefulness in estimating rates of actual treatments. Whenever possible, studies should focus on actual episodes of illness and consider supplementing retrospective surveys with prospective diary-type methods. In addition, it is important to determine the specificity of local illness terms in identifying true malaria cases and the extent to which local perceptions of severity are consistent with clinical criteria for severity and symptoms of complicated malaria.

Drug Resistance↗
PubMedDate not supplied

Physical activity policy and program development: the experience in Finland.

This article describes the development of sports and physical activity policies and programs in Finland during the past 30 years. The past two decades have been marked by a shift in emphasis from competitive and elite sports to health-enhancing physical activity for all, as seen most clearly in two successive sports acts and a government resolution. The new, increasingly multisectoral policies have led to substantial changes in the public funding of sports organizations, services, and construction of sports sites. Furthermore, three successive five-year national physical activity promotion programs have been launched. As a result, increased and new types of opportunities to participate in physical activity have become available, and the infrastructure and networks for provision of services have been strengthened. Until the mid 1990s, leisure time physical activity increased in Finland, but during the last seven to eight years, both leisure time and commuting physical activity have been stable. This finding may be an indication of the difficulty to increase physical activity in an industrialized country with already relatively high levels of physical activity even when systematic, long-term policies and measures are applied.

Exercise↗
PubMed2006

Current status of regulating biotechnology-derived animals in Canada: animal health and food safety considerations.

Development of an effective regulatory system for genetically engineered animals and their products has been the subject of increasing discussion among researchers, industry and policy developers, as well as the public. Since transgenesis and cloning are relatively new scientific techniques, transgenic animals are 'novel' organisms for which there is limited information. The issues associated with the regulation of transgenic animals pertain to environmental impact, human food safety, animal health and welfare, trade and ethics. It is a challenge for the developers to prove the safety of the products of biotechnology-derived animals and also for regulators to regulate this increasingly powerful technology with limited background information. In principle, an effective regulatory sieve should permit safe products while forming a formidable barrier for those posing an unacceptable risk. Regulatory initiatives for biotechnology-derived animals and their products should be able to ensure high standards for human and animal health, a sound scientific basis for evaluation; transparency and public involvement, and maintenance of genetic diversity. This review proposes a regulatory regime that is based on scientific risk based assessment and approval of products or by-products of biotechnology-derived animals and its application in context to Canadian regulations.

Animal Welfare↗
PubMedDate not supplied

Community food security: background and future directions.

Nutrition educators research, teach, and conduct outreach within the field of community food security (CFS), yet no clear consensus exists concerning what the field encompasses. Nutrition education needs to be integrated into the CFS movement for the fundamental reason that optimal health, well-being, and sustainability are at the core of both nutrition education and CFS. Establishing commonalities at the intersection of academic research, public policy development, and distinctive nongovernmental organizations expands opportunities for professional participation. Entry points for nutrition educators' participation are provided, including efforts dedicated to education, research, policy, programs and projects, and human rights.

Community Health Services↗
PubMed1993

Changes in access to and availability of alcohol in the United States: research and policy implications.

Recent changes in alcohol availability and access in the United States are reviewed and the role public policy research played in such changes are discussed. The paper finds that there are two concurrent trends, i.e. increased alcohol availability through changes in wine and spirits structural availability, lower prices and increased outlet densities, and decreased availability and access through higher minimum drinking ages, server intervention and training, server liability, low- and no-alcohol beverages, and warning labels on alcohol containers. This paper discusses these trends and the implications for policy development to which research is an input.

Alcoholic Beverages↗
PubMed1996

Cholesterol policy and the primary prevention of coronary disease: reflections on clinical and population strategies.

Despite billions of dollars spent on targeted and population-wide strategies aimed at reducing human consumption of saturated fat and cholesterol, aspects of the diet-heart connection remain a source of debate. At least part of the uncertainty arises from a growing appreciation that the relationship between dietary habits, serum lipids, and atherosclerosis is more complex than was previously thought. While we wait for answers from clinical and basic research, what is to be done? This review examines evidence about clinical policies and population strategies for the primary prevention of coronary disease, with specific reference to diet and dyslipidemias. It also summarizes some current policies and offers conclusions about broad directions for further policy development.

Attitude to Health↗
PubMed2000

Transport and health: en route to a healthier Australia?

We have been slow to recognize the impact that decisions about transport, land use and infrastructure have on health. Apart from encouraging a sedentary lifestyle, reliance on motor vehicle transport has a range of adverse health effects (traffic accidents, air and noise pollution, and greenhouse gas emissions). Physical activity equivalent to 30 minutes (in total) of brisk walking on all, or most, days of the week provides preventive and protective benefits for a wide range of health conditions (including cardiovascular disease, diabetes, depression and osteoporosis). "Active transport"--walking, cycling and/or using public transport instead of car travel--could have dual health benefits by providing physical activity and reducing the adverse health effects of motor vehicle transport. Doctors, medical administrators and health advocates can encourage the use of "active transport", and influence community-based programs and policy development about land use planning and travel demand management.

Australia↗
PubMed2000

Turning the tide: tobacco and the 21st century.

Despite efforts by groups as diverse as the federal and state governments, public health agencies, and various advocacy groups, tobacco use continued to increase among youth during the latter part of the 1990s. This article reviews the history of tobacco control in the latter part of the 20th century with special emphasis on policy development aimed at controlling use by children and adolescents. New trends in prevention and cessation are reviewed along with a discussion of tobacco control policies that will extend into this new century.

Adolescent↗