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PubMed2001

The diabetes health care of Aboriginal people in South Australia (Part 2).

Although type 2 diabetes is a recognised health priority in South Australia, Aboriginal people with diabetes do not utilise the mainstream diabetes health services on a regular basis for health care. This means that Aboriginal clients have the potential to develop diabetes-related problems and, furthermore, are not in a position to make informed decisions about health care issues. This lack of client empowerment is contrary to the goals of contemporary diabetes health care and, as a result, Aboriginal clients suffer the consequences of ineffective management with a compromised lifestyle. To identify how this situation might be improved, a qualitative study funded by Diabetes Australia was undertaken in South Australia. The overall goal was, firstly, to identify the reasons why Aboriginal people with diabetes do not attend mainstream health agencies on a regular basis and secondly, if possible, to improve attendance. Thus, Aboriginal health professionals (n = 43) were recruited from the 8 statistical divisions of South Australia and interviewed about Aboriginal diabetes health care issues. In Part 1 of this series, the research findings indicated the beliefs and attitudes held by clients about diabetes, their lack of knowledge about management issues, their responses to diabetes, the effects of diabetes on their lifestyle and the strategies that diabetes health professionals used to help their clients deal with diabetes health issues. In Part 2 the research findings indicated the importance of the Aboriginal health worker to the successful diabetes management of Aboriginal clients, the constraints that affect the delivery of diabetes health care and the recommendations made by health professionals to improve the standard of diabetes health services.

Australia↗
PubMed1997

Mental health care training priorities in general practice.

BACKGROUND: Mental health problems constitute a large part of general practitioners' (GPs') work, for which they may have received little training beyond their undergraduate education. They continue to find themselves criticized in the literature over inadequate recognition and management of these problems. While there is concern about the effectiveness of continuing medical education (CME), educational needs assessment can improve the outcome of CME programmes. AIM: To assess GPs' perceived educational needs regarding mental health problems. METHODS: A questionnaire was developed, piloted and posted to GPs (n = 380) in the Lambeth, Southwark and Lewisham Family Health Services Authority (FHSA) area in south-east Thames. In addition to demographic data, the questionnaire asked practitioners to select from a list of 26 mental health topics those in which they would like further training, their preferred educational formats and timetabling, and willingness to attend for training. Two postal reminders were sent to non-respondents. Data were analysed using SPSS. RESULTS: Altogether, 62% (237/380) of the GPs responded. The range for the number of topics selected was from zero to 26 and the mode was 5. Most frequently selected topics were psychiatric emergencies, somatization, counselling skills, 'heartsink' patients, psychosexual problems and stress management, each of which was chosen by at least 40%. Small group work alone, and allied to a lecture, was rated as the most useful educational format. In all, 74% (175/237) indicated that they would be interested in attending a half-day training course. CONCLUSION: These results suggest that GPs working in the inner city recognize the importance of improving their skills in the care of mental health problems, and indicate which topics are regarded as the most important and suitable for educational interventions. A needs-led approach to continuing medical education of this kind will help to plan CME programmes relevant to GPs' needs.

Adult↗
PubMed1994

Tuberculosis at the end of the twentieth century.

Tuberculosis has once again emerged as a significant public health problem in Western countries. Much of the rise has been fueled by the growing numbers of persons infected with HIV. Co-infection with Mycobacterium tuberculosis and HIV has been shown to result in high rates of active tuberculosis, and possibly in acceleration of progression to AIDS. Primary tuberculosis occurs at high rates among dually infected persons, further emphasizing the need for effective isolation of infectious cases. Recent preliminary studies have demonstrated that the survival of persons with multidrug-resistant tuberculosis can be six months and longer, far in excess of the 4 to 12 weeks reported previously. At least seven health care workers have died of occupationally-acquired multidrug-resistant tuberculosis, making control of the spread of tuberculosis in health care settings an urgent public health priority.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Ends and means in public health policy in developing countries.

International discussions of public health policy strategies in developing countries have been characterized by strong and conflicting positions. Differences regarding the means of health sector improvement can often be traced to differences about the ends, that is, the goals of the health sector. Three types of health sector goals are reviewed: health status improvement, equity and poverty alleviation, and individual welfare (utility) improvement. The paper argues that all three must be considered in developing health sector reform strategies in all countries. Highly normative policy positions often can be attributed a unidimensional affiliation with one health sector goal and denial of the relevance of the others. The current global interest in using cost-effectiveness analysis to set national health priorities is assessed in light of this eclectic approach. Examples are provided of how a health sector strategy based on cost-effectiveness would give sub-optimal solutions. These examples include situations where a private health care sector exists and provides some degree of substitution for publicly provided services; significantly high income elasticities exist for health care such that higher income beneficiaries may differentially capture public subsidies; and market failures exist in insurance. It is argued that these conditions are virtually universal in developing countries. Thus, rational policy development should explicitly consider multiple goals for the health sector.

Developing Countries↗
PubMed2006

Omega-3 fatty acids and perinatal depression: a review of the literature and recommendations for future research.

INTRODUCTION: Perinatal depression refers to major depression in the context of pregnancy and postpartum. In consideration of its prevalence and consequences, the treatment and prevention of perinatal depression should be important public health priorities. Omega-3 fatty acids are attractive for consideration in perinatal women, due to known health benefits for the mother and baby. Antidepressant medications may pose risks in utero and in breastfeeding. METHODS: MEDLINE and manual searches were conducted. RESULTS: Epidemiological and preclinical data support a role of omega-3 fatty acids in perinatal depression. Two studies failed to support a role of omega-3 fatty acids for postpartum depression prophylaxis, although one included a small sample, and the other utilized a low dosage. Two pilot studies suggest good tolerability and potential efficacy in the acute treatment of perinatal depression. CONCLUSIONS: Further research studies are warranted to determine the role of omega-3 fatty acids in the treatment of perinatal depression.

Depression, Postpartum↗
PubMed2000

Primary health care lessons from the northeast of Brazil: the Agentes de Saúde Program.

Market-led economic reforms are usually viewed as being in conflict with government-stimulated socioeconomic development for disadvantaged groups. Nevertheless, Ceará, a poor state in the Northeast of Brazil, has since 1987 pursued both of those strategies simultaneously. One part of that approach has been a program of nurse-directed auxiliary health workers serving about 5 million people--almost all the persons outside the capital city and half of those in the capital. The system requires that the auxiliaries, called agentes de saúde, live in the local communities that they serve. The health agents visit each home once a month to carry out a small number of priority health activities. While health agent positions are in high demand, the minimum-wage salary that the agents receive makes up only a small portion of the state budget. A key aspect of the system is timely and comprehensive information, which is based on agent visits and is managed by trained nurses. Since the health agents system was launched, there has been a rapid decline in infant mortality, a rapid rise in immunization, identification of bottlenecks limiting the utilization of other medical resources, and timely interventions in times of crisis. The health agents system has combined administrative decentralization with financial centralization during a period of electoral democratization. The system has strengthened Ceará's commitment to primary care even as market-oriented changes have reduced the overall role of government. The Ceará program is being copied throughout the Northeast and other regions of Brazil. The key role that nurses play in the Ceará program in organizing and leading a system of basic primary care in poor neighborhoods and rural areas may provide useful lessons for other countries. In addition, Ceará does not have many of the favorable characteristics of other countries that have successfully invested in primary health care. Ceará thus represents a more achievable model for other countries, where, like Brazil, income, educational levels, and land tenure equity are limited.

Brazil↗
PubMedDate not supplied

Intimate partner violence and health: a critique of Canadian prevalence studies.

OBJECTIVE: The Canadian Public Health Association, along with other professional organizations, has identified intimate partner violence (IPV) as a priority health issue to which the health professions must respond. This study synthesizes Canadian studies on the prevalence of IPV against women, focusing in particular on the stated implications for women's health and health care. METHODS: Medical and social science databases were searched for all articles pertaining to IPV in Canada for 1974 through September 2000. Reference lists of these and other related publications were consulted to supplement the literature review. Data on study characteristics, methods, and results were extracted by two independent reviewers. Discrepancies were resolved by consensus. RESULTS: Sixteen studies were identified in this review, 11 population-based and 5 conducted in clinical settings. Age, ethnicity, and socioeconomic status were not consistently documented, making comparisons and evaluations of generalizability difficult. Annual prevalence of IPV in Canada was found to range from 0.4% to 23%, with severe violence occurring from 2% to 10% annually. Less than two fifths (37.5%) of the studies incorporated a health-related measure. INTERPRETATION: This review reveals a paucity of Canadian prevalence data on IPV, marked by design and methodological issues. Poor quality data may pose a challenge to articulating and establishing a coordinated health care response to eliminating IPV in Canada.

Adolescent↗
PubMed1998

CATCH/IT: a data warehouse to support comprehensive assessment for tracking community health.

A systematic methodology, Comprehensive Assessment for Tracking Community Health (CATCH), for analyzing the health status of communities has been under development at the University of South Florida since the early 1990s. CATCH draws 226 health status indicators from multiple data sources and uses an innovative comparative framework and weighted evaluation criteria to produce a rank-ordered list of community health problems. CATCH has been applied successfully in many Florida counties; focusing attention on high priority health issues and measuring the impact of health expenditures on community health status outcomes. Previously performed manually, we are using information technology (IT) to automate the CATCH methodology with a full-scale data warehouse, user-friendly forms and reports, and extended analysis and data mining capabilities. The automated system, CATCH/IT, will reduce the time to prepare community health status reports from months to days. In this paper, we present the current status of the project, along with the principal research and development issues and future directions of the project.

Community Health Planning↗
PubMedDate not supplied

Assessing the readiness and training needs of non-urban physicians in public health emergency and response.

Emergency readiness has become a public health priority for United States communities after the 9/11 attacks. Communities that have a less developed public health infrastructure are challenged to organize preparedness and response efforts and to ensure that health care providers are capable of caring for victims of terrorist acts. A survey was used to assess non-urban physicians' prior experience with and self-confidence in treating, and preferred training needs for responding to chemical, biologic, radiologic, nuclear, and explosive (CBRNE) cases. Data were collected through a mailed and Web-based survey. Although the response rate was calculated at 30%, approximately one third of the surveys were not able to be delivered. Most respondents reported never having seen or treated CBRNE-inflicted cases and were not confident in their ability to diagnose or treat CBRNE cases, but many were willing to participate in a state-led response plan. Almost half of the individuals had not participated in any related training but expressed interest in receiving training in small group workshops or through CD-ROM. These results provide potential direction for strategic preparedness planning for non-urban health care providers.

Attitude of Health Personnel↗
PubMed2004

Prisoners' attitudes toward Hepatitis B vaccination.

BACKGROUND: Hepatitis B continues to be a substantial problem in the United States despite the existence of a safe and effective vaccine. Vaccination programs for inmates could reach many high-risk individuals but little is known about U.S. inmates' willingness to accept hepatitis B virus (HBV) vaccination while incarcerated. The goal of this study was to assess inmates' knowledge about hepatitis B and their willingness to accept hepatitis B vaccination while incarcerated. METHODS: We interviewed 153 male and female inmates at the Rhode Island Department of Corrections (RIDOC) using a voluntary, anonymous survey. RESULTS: Ninety-three percent of inmates said they would agree to receive the hepatitis B vaccine while incarcerated. More than half of the 30% who reported having risk factors for hepatitis B did not consider themselves to be at risk for hepatitis B and almost half (44%) of all inmates were not aware that hepatitis B can be transmitted through unprotected sex. CONCLUSION: Hepatitis B vaccination programs in correctional settings are a public health priority and would be well received by the target population. Such programs would help protect the health of incarcerated persons and the communities to which they return.

Adult↗
PubMed2001

Injury prevention and the promotion of physical activity: what is the nexus?

The promotion of physical activity is a public health priority for Australia. The new "National Physical Activity Guidelines for Australians" include a statement on additional health benefits of vigorous sporting and fitness activities. However, injury associated with sport and physical activity can lead to significant health care costs and consequent disabilities and reduced mobility may result in inactivity, this increasing the risk of cardiovascular disease and other health problems. Consideration of injury prevention principles when promoting physical activity is therefore crucial. There are several areas of research needed in this new field. These include the importance of good quality population monitoring and the use of other data sources to determine the population-wide consequences and health costs of injury sustained during sport and physical activity. The goal is to have evidence based, educational, regulatory and other preventive strategies that can be systematically evaluated by drawing on well organised, representative population-based injury data.

Athletic Injuries↗
PubMed2007

Prevention, control, and elimination of neglected diseases in the Americas: pathways to integrated, inter-programmatic, inter-sectoral action for health and development.

BACKGROUND: In the Latin America and Caribbean region over 210 million people live below the poverty line. These impoverished and marginalized populations are heavily burdened with neglected communicable diseases. These diseases continue to enact a toll, not only on families and communities, but on the economically constrained countries themselves. DISCUSSION: As national public health priorities, neglected communicable diseases typically maintain a low profile and are often left out when public health agendas are formulated. While many of the neglected diseases do not directly cause high rates of mortality, they contribute to an enormous rate of morbidity and a drastic reduction in income for the most poverty-stricken families and communities. The persistence of this "vicious cycle" between poverty and poor health demonstrates the importance of linking the activities of the health sector with those of other sectors such as education, housing, water and sanitation, labor, public works, transportation, agriculture, industry, and economic development. SUMMARY: The purpose of this paper is three fold. First, it focuses on a need for integrated "pro-poor" approaches and policies to be developed in order to more adequately address the multi-faceted nature of neglected diseases. This represents a move away from traditional disease-centered approaches to a holistic approach that looks at the overarching causes and mechanisms that influence the health and well being of communities. The second objective of the paper outlines the need for a specific strategy for addressing these diseases and offers several programmatic entry points in the context of broad public health measures involving multiple sectors. Finally, the paper presents several current Pan American Health Organization and other institutional initiatives that already document the importance of integrated, inter-programmatic, and inter-sectoral approaches. They provide the framework for a renewed effort toward the efficient use of resources and the development of a comprehensive integrated solution to neglected communicable diseases found in the context of poverty, and tailored to the needs of local communities.

Caribbean Region↗
PubMed2001

Changing approaches to asthma management in Australia: effects on asthma morbidity.

Asthma is an important public health issue in Australia and is responsible for significant morbidity and mortality in the community. Recognition of the impact of asthma on the health of Australians, and the apparent failure of new medications to reduce mortality and hospital admission rates resulted in a major review by the stakeholders in asthma care. This led to new approaches to asthma management based on strategic use of asthma medications and the development of the Asthma Management Plan (AMP). The AMP drew together current understanding of asthma to develop a simple stepwise approach to management that could be readily applied in patient management. The National Asthma Campaign (NAC), a coalition of the major stakeholders in asthma care, was launched in 1990 to lead the dissemination of the AMP. In association with other organisations interested in asthma care in Australia, the NAC has developed the AMP, and co-ordinated a decade of education and advocacy about asthma that targeted doctors, health professionals and the general public. These activities have been successful in raising awareness about asthma in the community. However, recent research, while demonstrating the continued uptake of written asthma action plans for asthma and decrease in use of inhaled bronchodilator medications, reported a decrease in use of preventive therapy by people with asthma. These activities have had a sustained impact on asthma-related health outcomes with mortality at the lowest level since 1960 and a decline in hospital readmission rates. This is useful information because there is sound evidence that the prevalence and possibly severity of asthma in children has increased. However, review of management in primary care and among people who present to emergency services with acute asthma suggest that many people continue to manage their asthma poorly. Continued education is needed to build on the progress that has been made. There are opportunities to do this through efforts to integrate general practitioners into the wider health system through the formation of Divisions of General Practice. Recognition of asthma as a health priority area at a national level will help to enhance and maintain awareness of the public health importance of asthma and facilitate the further development of the initiatives begun during the last decade or more.

Asthma↗
PubMedDate not supplied

Strategies for promoting the health of minorities: the school-age population.

An excess burden of disease and disability exists among minority populations in the United States. Health promotion strategies can be designed and implemented in a variety of settings to address the priority health needs of minorities and, in turn, contribute to the reduction of this burden. School-based health promotion presents an excellent opportunity for reaching minority and non-minority children and youth who are at risk for disease and disability due to lifestyle behaviors.

Adolescent↗
PubMed1999

National Tuberculosis Programme in Romania 1997-2000: how it works.

Romania displays one of the highest epidemiological parameters of tuberculosis among European countries: the incidence reached 113.3 per 100,000 in 1998, the prevalence of chronic cases was 18.9 and mortality 11.5 per 100,000 in 1996. A National Tuberculosis Programme aimed at decreasing the present burden of the disease has been elaborated according to the WHO strategy in 1997 and for its implementing. The National Committee on Pneumophtisiology and the Central Unit of the National Institute of Pneumophtisiology were made responsible. Tuberculosis managers and supervisors were nominated in each of the 48 counties and a total of 18,000 family doctors were involved in this programme at the primary health care level. Tuberculosis has been declared the second health priority in Romania and the following budget providers for its effective control were acquired: Ministry of Health, World Bank, Open Society Foundation, Funds of Romania and World Health Organization. The following achievements can be mentioned so far: A technical manual on the National Programme has been published, WHO modules on DOTS strategy were translated into Romanian, a training course on the WHO-DOTS strategy was organized for tuberculosis managers and laboratory chiefs, a pilot project on the WHO-DOTS strategy started in lasi, first control visits in counties and pneumophtisiologists were implemented, training for family doctors was organized and a project for health education with video shots was presented on the national TV channel.

Adolescent↗
PubMed2004

Public health issue brief: physical education: year end report-2004.

In the past 30 years, the prevalence of overweight and obesity among children and adolescents has increased alarmingly. Because overweight and obesity increase the risk for chronic illnesses and associated health care cost, reducing and preventing obesity has become a top health priority among lawmakers. During the past three years, the media, the food and beverage industry, public health advocates and both federal and state policymakers have devoted significant attention to this escalating health problem and its associated risk factors. This issue brief outlines the role of state physical education policy to address childhood obesity. This report will provide information on the issues surrounding childhood obesity and physical education, physical education guidelines, related legislative history, 2004 physical education legislative actions and state physical education statutes.

Adolescent↗
PubMed1991

Ethics and equity in U.S. health care: the data.

Access to and equality in health care has deteriorated in the 1980s, as shown by the data on racial differences in reducing infant mortality rates, in life expectancy, and in the incidence and economic burden of AIDS. Various health status measures indicate significant declines with decreasing income, and the use of medical care services is higher for low-income groups. The growing number of uninsured and underinsured persons has exacerbated the problem. A consensus is emerging among diverse groups that health care should be extended to those who do not have access to it and that providing universal and affordable health care is a major national health priority.

Acquired Immunodeficiency Syndrome↗