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PubMed2000

An assessment of funding to support rural and remote health research in Australia.

A systematic search was undertaken to ascertain the nature, source and extent of funding awarded to research projects that were directed specifically at aspects of rural health over the past decade. Comment is also made on the challenge of obtaining such information directly from databases. The sources investigated were the conventional research funding bodies, hospital trusts and foundations, university funding schemes and government sources. The results of these searches revealed a crude average of 3 million dollars per year from conventional research funding with the remaining sources adding a similar amount in total. Analysis of the data using a framework modified from the Strategic Review of Health and Medical Research in Australia shows that funding is concentrated in the health services and public health areas with a preponderance of funding being directed towards the description of conditions and interventions. Significant levels of funding have been directed towards the National Health Priority Areas.

Australia↗
PubMed2001

Natural history of prostate cancer--epidemiologic considerations.

Multicentricity, heterogeneity, and sampling error complicate the study of the natural history of prostate cancer. Carcinomas previously termed "latent" are probably similar to those detected clinically. The diagnosis of carcinoma is only made following biopsy and histologic confirmation. Estimates of grade and stage made at the time of detection are prone to sampling error and are likely to change following examination of radical prostatectomy specimens. In regions with lower life expectancies, the problem of prostate cancer becomes a lower priority due to its association with aging. Access to care, numbers of medical facilities, and differing public health priorities make international rates difficult to compare. However, in view of the high worldwide prevalence of the disease, further epidemiologic studies of prostate cancer are warranted.

Adenocarcinoma↗
PubMed2000

Implementation and evaluation of church-based health fairs.

From a comprehensive, community health-needs assessment based on the Neuman Systems Model (Neuman, 1995), cardiovascular disease was identified as the priority health concern in one quadrant of a small Midwestern city. The Plan, Do, Check, Act program planning model (Dees & Garcia, 1995) was the basis for the planning, implementation, and evaluation of a mini cardiovascular health fair held at 3 churches. Congruence of the program planning model with the roles of the clinical specialist in community health nursing is discussed, followed by a discussion of the health fair goals and objectives, implementation, and formative and summative evaluations.

Cardiovascular Diseases↗
PubMed2005

Farm noise emissions during common agricultural activities.

Noise injury in agriculture is a significant yet often unrecognized problem. Many farmers, farm workers, and family members are exposed to noise levels above recommended levels and have greater hearing loss than their non-farming contemporaries. The aim of this study was to gather up-to-date information on farm noise levels and to enhance the quality of information available to assist farmers in reducing noise exposure and meeting Occupational Health and Safety (OHS) regulations regarding noise management. Farm visits were conducted on 48 agricultural establishments that produce a range of commodities. Noise levels were measured at the ears of operators and bystanders involved in typical activities on farms. The average and peak noise levels were measured for 56 types of machinery or sites of farming activity, totaling 298 separate items and activities. Common noise hazards identified included firearms, tractors without cabs, workshop tools, small motors (e.g., chainsaws, augers, pumps), manual handling of pigs, shearing sheds, older cabbed tractors, and heavy machinery such as harvesters, bulldozers, and cotton module presses. We found that use of firearms without hearing protection presents a pressing hearing health priority. However, farming activities involving machinery used for prolonged periods also present significant risks to farmers' hearing health. Noise management strategies on the farm are essential in order to prevent noise injury among farmers.

Agricultural Workers' Diseases↗
PubMed1988

The profitization of health promotion.

In this article the author argues that not only is the marketplace an ineffective arena for health development, it is currently generating decision-making paths that obscure more effective perspectives and directions to promote Americans' health. To illustrate this premise, available evidence is presented that suggests that the use of "health promotion" by the proprietary sector, as well as the commercialization of health promotion, is creating decision-making processes that are not accountable to those whom they affect. This emerging infrastructure is characterized by organizations, programs, delivery channels, and evaluative criteria that do not give people's health priority over organizational interests. These developments require critical examination and work on alternatives if the promotion of health is to result in more health than hype.

Behavior Control↗
PubMed1994

The NIPEH network of cooperating countries of central and eastern Europe. National Integrated Programmes on Environment and Health.

The National Integrated Programmes on Environment and Health (NIPEHs) in countries of Central and Eastern Europe (CCEE) are introduced. The NIPEH programme is one of the primary activities of the Bilthoven Division of the World Health Organization's European Centre for Environment and Health (WHO-ECEH). Located in the heart of the Netherlands on the compound of the Dutch National Institute of Public Health and Environmental Protection (RIVM) in Bilthoven, WHO-ECEH's Bilthoven Division has established a small but effective team of highly motivated experts who can draw upon the expertise available both within the Dutch host institution RIVM as well within the ECEH Centre of WHO-EURO. The NIPEHs have striven to lead the way in setting environmental health priorities in cooperation with our partners, taking into account not only what is relevant from the environmental health perspective, but also what is technologically and administratively feasible. The principal goal is to convert the information gathered by cooperating instructions into understandable information for policy and decision-making and for the interested scientific community.

Czech Republic↗
PubMed2003

Priority setting in health authorities: a novel approach to a historical activity.

As resources in health care are scarce, health authorities and other health organizations are charged with determining how best to spend limited resources. While a number of formal approaches to priority setting within health authorities have been used internationally, there has been limited success with such activity, particularly across major service portfolios. This participatory action research project instituted a novel priority setting framework, coined macro-marginal analysis (MMA), in a fully integrated urban health region in Alberta, Canada. The focus of MMA is on identifying areas for service growth and areas for resource release, then determining, based on pre-defined, locally generated criteria, if actual shifts or re-allocation of resources should occur. For fiscal year 2002/03, the Calgary Health Region identified over 40 M dollars in resource releases (approximately 3% of the total budget), which were made available for servicing the deficit, and more importantly for our purposes, re-investing in service growth areas. The MMA framework is pragmatic in nature and has the ability to incorporate relevant evidence directly into the decision-making process. This work constitutes a significant advancement in health economics, and responds where previous priority setting approaches have failed in that it allows decision-makers to achieve genuine re-allocation of resources with the aim of improving population health or better meeting other important criteria.

Alberta↗
PubMed2003

A cross-sectional study of employer and employee occupational health needs and priorities within the Irish Civil Service.

BACKGROUND: This study aimed to establish how important an occupational health unit (OHU) is to its clients, and to identify the perceived needs and priorities for such a service. METHODS: A cross-sectional postal survey of a stratified, randomly selected group of employees (n = 760) and all human resources (HR) managers (n = 34) was conducted in the Irish Civil Service. Each participant was requested to rate the overall importance of the OHU and to prioritize eight proposed functions for the unit: medical surveillance, general health education, pre-employment/promotion medical assessments, ill-health retirement assessments, return-to-work (after sick leave) assessments, occupational health education, research, and general medical screening. The results were analysed according to age group, gender, grade and occupation. RESULTS: There was a response rate of 69% from employees and 74% from personnel managers. Significantly more HR managers than employees (92 versus 81%) thought an occupational health service was either important or very important. There were also differences in prioritization of functions by employees and HR managers. HR managers prioritized those functions concerned with assessing individuals' fitness for work, notably pre-employment/promotional health assessments, whereas employees consider group-directed 'preventative' functions to be more important, i.e. general medical screening, health education and medical surveillance. Both sets of opinions are not mutually exclusive, and considerable overlap exists, notably in the areas of occupational and general health education.

Adult↗
PubMed2006

Health sector reform and sexual and reproductive health services in Mongolia.

Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.

Abortion, Induced↗
PubMed2003

[Children and adolescents in foster care: health problems and guidelines for their health care].

In Spain, between 8,000 and 10,000 children and adolescents enter foster or residential care every year. This article aims to provide a review to increase knowledge of the health problems of minors in foster care.Sixty-five percent of the studies consulted were performed in the USA, 25 % in Spain and 10 % in other developed and industrialized countries. These studies report that a high percentage of these minors present complicated and serious physical, mental, and/or developmental problems. However, no appreciable qualitative differences in the most frequent health problems presented by these minors have been observed and there is general consensus that the high-priority health needs are the provision of preventive and/or therapeutic psychopedagogic, psychiatric, dermatologic, dental, nutritional, ophthalmologic, respiratory and immunization services. Failure to identify and provide early treatment of the health needs of these minors not only adversely affects their quality of life and future physical, emotional and intellectual development, but can also increase their difficulties in adaptation while in foster care and their future social adaptation. Their permanent relationship with the biological or adoptive family when foster care stops could also be jeopardized. Therefore, all children and adolescents in foster care should receive initial health screenings, comprehensive assessments and monitoring of their physical, mental health, and developmental status. We provide guidelines for the healthcare of these minors, which should be of use to healthcare professionals taking care of these children and adolescents while they remain in foster care.

Adolescent↗
PubMed2004

Building a socially accountable health professions school: towards unity for health.

In many countries, health systems suffer from fragmentation as different health activities conducted by different stakeholders are poorly coordinated, resulting in a mitigated performance to improve quality, equity, relevance and cost-effectiveness in health care. The impact on health would be enhanced if main stakeholders such as health professional schools, service organizations, professional associations, health policy bodies and the general public shared a common vision on how to best meet people's priority health needs. An approach initiated by WHO in 1999 and developed by The Network: Towards Unity for Health endeavours to create a unity of purpose and action among these stakeholders. This article comments on challenges and opportunities in implementing this approach whose pillars are integration and partnerships. The conditions for each stakeholder to become more socially accountable and the role of a teacher, researcher, manager or community representative in contributing to this process are discussed.

Humans↗
PubMed1997

Illegal sales of cigarettes to minors--Mexico City, Mexico, 1997.

Because of the increasing prevalence of tobacco use among youth in the United States and Mexico, in 1996 the United States-Mexico Binational Commission (US-MBC) Health Working Group identified prevention of tobacco use, with an emphasis on adolescents, as one of its four priority health concerns. From 1970 to 1990, annual death rates for the leading causes of smoking-related deaths in Mexico nearly tripled and, in 1992, an estimated 10,253 persons in Mexico died as a result of smoking-related diseases, 9% of all deaths that year. In addition, from 1988 to 1993, the prevalence of current smoking among minors aged 12-17 years increased from 6.6% to 9.6%, respectively (in Mexico City, the 1993 prevalence was 12.8%), and in 1993, 72% of adult smokers in Mexico reported becoming regular smokers before age 18 years. Although since 1984 the General Health Law of Mexico has prohibited the sale of tobacco products to minors aged < 18 years, compliance with this law has not been assessed. As part of the Mexican national program to reduce the prevalence of cigarette smoking among children and adolescents and in support of the goals of the US-MBC, during 1997 the General Directorate of Epidemiology (GDE) in the Secretariat of Health (SOH) conducted a survey of tobacco outlets in Mexico City to assess the percentage of retailers willing to sell cigarettes to minors. This report summarizes the results of the survey, which indicate that virtually no surveyed retailers asked minors attempting to purchase cigarettes about their age and that most retailers sold cigarettes to minors.

Adolescent↗
PubMed2005

Cost-effectiveness analysis for priority setting in health: penny-wise but pound-foolish.

Cost-effectiveness analysis has much conceptual attractiveness in priority setting but is not used to its full potential to assist policy-makers on making choices in health in developed or in developing countries. We call for a shift away from present economic evaluation activities-that tend to produce ad hoc and incomparable economic evaluation studies and, therefore, add little to the compendium of knowledge of cost-effectiveness of health interventions in general-toward a more systematic approach. Research efforts in economic evaluation should build on the foundations of cost-effectiveness research of the past decades to arrive at an informative methodology useful for national policy-makers. This strategy means that governments should steer sectoral cost-effectiveness analysis to obtain systematic and comprehensive information on the economic attractiveness of a set of new and current interventions, using a standardized methodology and capturing interactions between interventions. Without redirecting the focus of economic evaluation research, choosing in health care bears the risk to remain penny-wise but pound-foolish.

Biomedical Technology↗
PubMed1998

Undergraduate preparation for primary health care roles in an academic nursing center.

The goal of the Nursing Center at the University of North Dakota is to prepare professional nurses to meet priority health needs of the next century through service to people currently in need. Health needs in the state, educational needs related to preparation for primary health care roles, and an explicit nursing paradigm for primary health care framed the development of the Nursing Center. As an integral part of the College of Nursing, the Nursing Center serves as a primary site for undergraduate clinical experiences. Family-centered, community-based programs were designed to simultaneously meet health needs of underserved rural populations and educational needs of undergraduates for preparation in primary health care roles. Implementation proved feasible from both service and educational perspectives. Initial evaluation data demonstrated a high level of effective clinical activity and role development for students beyond that experienced in more traditional settings.

Community Health Nursing↗
PubMed2004

Dietary patterns, smoking, and subclinical heart disease in women: opportunities for primary prevention from the Framingham Nutrition Studies.

OBJECTIVES: To investigate the relationship between a heart-healthy dietary pattern and subclinical heart disease in women, and to identify potential opportunities for primary prevention. DESIGN: Prospective analysis in which dietary patterns and cardiovascular disease (CVD) risk factors were assessed at baseline. Presence of subclinical heart disease was assessed using carotid atherosclerosis (stenosis >or=25%) measured by ultrasound at 12-year follow-up. SUBJECTS/SETTING: We studied 1,423 women in the population-based Framingham Offspring/Spouse (FOS) Study cohort, Framingham, Massachusetts. Subjects did not have CVD at baseline. STATISTICAL ANALYSES: CVD risk factor differences among the dietary clusters were evaluated using analysis of covariance and logistic regression. The relationship between heart-healthy and less heart-healthy dietary patterns and the presence of subclinical heart disease at follow-up was examined using odds ratios calculated from multivariate logistic regressions; stratification by smoking status (current, former, never) was also explored. RESULTS: Women who ate a heart-healthy diet had more favorable baseline CVD risk factor profiles. The age-adjusted odds of subclinical heart disease at follow-up was 40% lower for heart-healthy women (OR 0.60, P=.02). Multivariate adjustment for BMI, blood lipid levels, and blood pressure only slightly attenuated these odds. The odds remained reduced after adding pack-years of smoking to the multivariate model, but statistical significance was attenuated (OR 0.74, P=.20). In analyses stratified by smoking status, women who consumed a heart-healthy diet and who had never smoked had more than 80% less odds for subclinical heart disease compared with smokers whose diets were less heart-healthy (adjusted OR 0.17; P=.0001). CONCLUSIONS: Women who achieve a heart-healthy eating pattern, in combination with the avoidance of smoking, have a lower odds of subclinical heart disease. Among former smokers, the avoidance of smoking seemed to have somewhat more influence than diet on stenosis risk. A public health priority for women to promote the primary prevention of heart disease is the adoption of positive lifestyle behaviors, especially healthful eating (dietary patterns rich in fruits, vegetables, low-fat dairy foods, leaner protein sources, and lower in fats) and the avoidance of smoking.

Adolescent↗
PubMed2002

The global burden of epilepsy.

We briefly describe the Global Burden of Diseases (GBD) study, its goals, and some of its outcomes as related to neurologic and psychiatric disorders. The summary measure of population health DALYs (Disability Adjusted Life Years) are described, as well as the implications for neuropsychiatric disorders of changing health indicators and the move from mortality toward disability indicators. The pressing need for new measures for health is answered by the new WHO Classification of Functioning Disability and Health, ICF, and a brief summary of its basic principles is provided. Although a better understanding of the physical, social, and economic burden of epilepsy has moved this disorder higher on the world's agenda, epilepsy still has problems to be recognized as a public health priority. The implications of a shift toward considering the disability of epilepsy, as outlined in the the WHO World Health Report 2001, are important. The burden of epilepsy is high and, for the year 2000, accounts for approximately 0.5% of the whole burden of diseases in the world.

Cost of Illness↗
PubMed2003

A portrait of district nursing: its contribution to primary health care.

This paper explores the role and contribution of district nursing within primary health care. Examples of how this service is organised within different health care systems are used to discuss the context-dependent nature and challenges of the work. By drawing on UK policy change, health priorities and recent research into district nursing, the paper concludes that, in attempting to deal with the challenges of health care in the 21st century, the significance and potential of district nursing services are frequently overlooked. It is recommended that a research strategy for district nursing should build on the profession's comprehensive understanding of the needs of families and communities and should aim to provide evidence for practice that will further improve patient and client outcomes.

Community Health Nursing↗
PubMed2006

Our lives were healthier before: focus groups with African American, American Indian, Hispanic/Latino, and Hmong people with diabetes.

Focus groups were conducted to explore health-related beliefs and experiences of African American, Hispanic/Latino, American Indian, and Hmong people with diabetes and engage community members in improving diabetes care and education for these populations. Eighty participants attended 12 focus groups, 3 per population. Major themes were loss of health attributed to modern American lifestyles, lack of confidence in the medical system, and the importance of spirituality. Participants recommended improvements in the areas of health care, diabetes education, social support, and community action. Their recommendations emphasize the importance of respectful, knowledgeable health care providers; culturally responsive diabetes education for people with diabetes and their families; and broad-based community action. These recommendations align with current public health priorities and medical knowledge. It is proposed that healthy traditions from diverse populations can be leveraged to improve the health of all people with diabetes.

Adult↗